In a retrospective study, Dr Heidi K. Blume of the University of Washington, Seattle Children's Hospital and colleagues found that 73% of their paediatric patients with episodic headaches had a positive response to biofeedback therapy, as did 48% of those with chronic headaches.
"In the world of chronic headache, 48% is actually pretty good," Dr Blume said. In their report in Headache, Dr Blume and her coauthors cite a 2009 paper by Lateef et al that put the rate of frequent or severe headaches in US children and adolescents at 17%.
"Recurrent childhood headaches are associated with mental health disorders, functional limitations, and poor quality of life similar to the quality of life of children with rheumatic disease and cancer," they add.
Biofeedback therapy is reportedly effective in paediatric migraine (in adult migraine, too) - but as Dr Blume's paper points out, most studies in children excluded those with chronic headaches (i.e., occurring 15 or more days each month for more than three months).
Treatment options are being looked at
And for paediatric headache in general, she added in an interview, there are few randomised controlled trials looking at various treatment options. "We've been kind of interpreting adult trials to look at kids," she said.
To investigate which factors might be associated with response to biofeedback therapy in children and adolescents with headache, including chronic headache, the researchers looked at data on 132 patients, ages eight to 18, who attended at least two biofeedback sessions at their academic paediatric biofeedback clinic between 2004 and 2008. Altogether during that period, 201 patients were referred to the authors, but 63 of those did not come back for a second session, and the remaining six were lost to follow-up.
In biofeedback therapy, patients are taught relaxation and visualisation exercises, which are intended to help them to reduce muscle tension and begin to control autonomic functions, including heart rate and skin temperature. Headache patients, Dr Blume explained, are taught to use these techniques when they begin to get headaches so that they can reduce the pain or even prevent the headache from developing.
Patients in the study had a median 3.5 headache days per week at baseline, and their median headache severity was 6.5 on a scale of one to 10. One in five was taking a selective serotonin reuptake inhibitor (SSRI).
Patients attended biofeedback sessions
Patients attended a median of seven biofeedback sessions; the median duration of therapy was 10.8 weeks. By the last biofeedback session, the median overall headache frequency among study participants was two days per week, while median headache severity was five out of 10. Patients also showed, on average, an improvement in their ability to raise the temperature of the skin on their hands.
Fifty-eight percent of the children had a positive response, defined as a drop by more than 50% in the number of headache days per week or hours per week, or a more than three-point drop in headache severity.
Among patients with episodic headaches, the median number of headache days per week dropped from one to 0.6, while it dropped from seven to four days a week for chronic headache patients. On multivariate analysis, the 55% of patients who were able to raise their hand temperature by more than three degrees Fahrenheit at their last biofeedback session were nearly three times as likely to respond to treatment than those who could not.
The researchers also found that while patients on SSRIs were five times as likely to respond to biofeedback as those not taking the drugs, those who were taking preventive headache medications were 65% less likely to respond.
The link between SSRI use and biofeedback response should be investigated further, Dr Blume said. "So far the studies of SSRIs in adults have not shown any conclusive benefit for headache," she added. "It's interesting that those kids seemed to have a better chance of responding to biofeedback."
(Reuters Health, Anne Harding, July 2012)
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