In biofeedback therapy, patients monitor their body functions through various instruments and attempt to control them at will. A meta-analysis of 53 outcome studies found biofeedback to be superior to relaxation therapy and placebo in reducing headache frequency and analgesic consumption. A 2007 meta-analysis concluded that biofeedback could be recommended as a nonmedical treatment for and prevention of chronic migraine.
Cognitive and behavioral therapies, also known as stress management techniques, can reduce tension-type headaches by more than 50%, said Dr. Cowan. Combining cognitive and behavioral therapies with drugs such as amitriptyline may be more beneficial than either treatment alone, he added.
Treating Migraine by Manipulating the Body
Some patients with migraine use practices that manipulate the body, but the science that supports these techniques’ efficacy is not strong, said Dr. Cowan. The US Headache Consortium has not endorsed acupuncture, cervical manipulation, or occlusal therapy as treatments for migraine because of insufficient evidence.
Evidence indicates that other manipulative practices may be beneficial, however. Some data support spinal manipulation as a treatment for cervicogenic headache, and preliminary findings suggest that massage therapy can reduce migraine frequency and improve sleep quality.
Integrating Alternative Techniques Into Medical Practice
“I think that it’s important for all of us as headache specialists to develop some integrative medicine skills,” said Dr. Cowan. Physicians should choose a technique that interests them and learn enough about it to be comfortable using it, he added. “In the same way that we don’t all have the same armamentarium of drugs, we’re not all going to have the same armamentarium of complementary and alternative approaches. But I think it’s something we need to be aware of if we’re going to be of full service to our patients. And I think it’s something that should be discussed openly and up front with your patients, rather than when everything else has failed.”
Physicians also must determine how to be reimbursed for alternative medical practices, said Dr. Cowan. Techniques such as biofeedback and hypnosis are usually billable as psychotherapy when they are performed by PhDs. “There actually are ways of incorporating these into your practice,” he concluded.
—Erik Greb
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