Meta-analysis of biofeedback for tension-type headache: efficacy, specificity, and treatment moderators

J Consult Clin Psychol. 2008 Jun;76(3):379-96. doi: 10.1037/0022-006X.76.3.379.


The aims of the present meta-analysis were to investigate the short- and long-term efficacy, multidimensional outcome, and treatment moderators of biofeedback as a behavioral treatment option for tension-type headache. A literature search identified 74 outcome studies, of which 53 were selected according to predefined inclusion criteria. Meta-analytic integration resulted in a significant medium-to-large effect size (d = 0.73; 95% confidence interval = 0.61, 0.84) that proved stable over an average follow-up phase of 15 months. Biofeedback was more effective than headache monitoring, placebo, and relaxation therapies. The strongest improvements resulted for frequency of headache episodes. Further significant effects were observed for muscle tension, self-efficacy, symptoms of anxiety, depression, and analgesic medication. Moderator analyses revealed biofeedback in combination with relaxation to be the most effective treatment modality; effects were particularly large in children and adolescents. In intention-to-treat and publication-bias analyses, the consistency of these findings was demonstrated. It is concluded that biofeedback constitutes an evidence-based treatment option for tension-type headache.

Publication types

  • Meta-Analysis
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Behavior Therapy / methods*
  • Biofeedback, Psychology*
  • Chronic Disease
  • Electromyography
  • Humans
  • Sensitivity and Specificity
  • Tension-Type Headache / diagnosis*
  • Tension-Type Headache / therapy*