Biofeedback as Prophylaxis for Pediatric Migraine: A Meta-analysis.

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.