CONTEXT:

Migraine is a common problem in children and adolescents, but few satisfactory prophylactic treatments exist.

OBJECTIVE:

Our goal was to investigate the pooled evidence for the effectiveness of using biofeedback to reduce childhood migraine.

DATA SOURCES:

A systematic search was conducted across the databases Medline, Embase, CENTRAL, CINAHL, and PsychINFO.

STUDY SELECTION:

Prospective, randomized controlled trials of biofeedback for migraine among children and adolescents were located in the search.

DATA EXTRACTION:

Data on reduction of mean attack frequency and a series of secondary outcomes, including adverse events, were extracted. Risk of bias was also assessed.

RESULTS:

Forest plots were created by using a fixed effects model, and mean differences were reported. Five studies with a total of 137 participants met the inclusion criteria. Biofeedback reduced migraine frequency (mean difference, –1.97 [95% confidence interval (CI), –2.72 to –1.21]; P < .00001), attack duration (mean difference, –3.94 [95% CI, –5.57 to –2.31]; P < .00001), and headache intensity (mean difference, –1.77 [95% CI, –2.42 to –1.11]; P < .00001) compared with a waiting-list control. Biofeedback demonstrated no adjuvant effect when combined with other behavioral treatment; neither did it have significant advantages over active treatment. Only 40% of bias judgments were deemed as “low” risk.

LIMITATIONS:

Methodologic issues hampered the meta-analyses. Only a few studies were possible to include, and they suffered from incomplete reporting of data and risk of bias.

CONCLUSIONS:

Biofeedback seems to be an effective intervention for pediatric migraine, but in light of the limitations, further investigation is needed to increase our confidence in the estimate.

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