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Relaxation and biofeedback training in paediatric headache

Clinical bottom line:

Relaxation training probably reduces chronic headache and migraine in children and adolescents. Relaxation is probably as effective as other non-pharmacological interventions. There appear to be long-term benefits. Based on one trial, biofeedback with relaxation training reduced migraine. It is not possible to say whether the addition of biofeedback increased the benefits of relaxation or not. Larger, randomised trials are required to provide definitive answers.

Headache is one of the most common types of recurrent pain in children, with estimates of up to 75% of children under 15 experiencing some type of headache. A range of pharmacological and non-pharmacological approaches were tested in the management of paediatric headache, with mixed findings.

Systematic review

Duckro PN, Cantwell-Simmonds E. A review of studies evaluating biofeedback and relaxation training in the management of pediatric headache. Headache. 1989; 29: 428-33.

Inclusion criteria were full journal publication (refereed journals); relaxation training with and without biofeedback in the treatment of childhood and adolescent headache and migraine. Included trials did not have to be randomised.

Reviewers reported on trial findings as in the original reports.


Relaxation training Seven trials looked at relaxation training. Only six are considered here, as one trial had a very small group size (n=5). These six trials were comparable in terms of relaxation intervention which ranged from 3-10 sessions over 5-10 weeks. However, all but one were of very small size (group size approx. 10-15).

Four of six trials had a non-active control condition. In four of four cases relaxation training was effective compared with placebo. This benefit persisted at 4-6 month follow-up, when measured.

Six of six trials had an active control condition. Relaxation training was better than an information-giving intervention, a discussion group, stress reduction and propranolol 3 mg/kg/day post-treatment and at 5-6 months. (No follow-up for propranolol). No differences were found between relaxation training and cognitive coping, self-directed relaxation, or concentration exercises.

Relaxation training with biofeedback Reviewers included five trials. Three of these had no control group, and one had a group size of approximately five. Only the findings of the remaining trial are reported here.

One trial compared biofeedback-assisted relaxation with diary-keeping. The treatment group experienced greater reduction in headache frequency, intensity and duration than the control group, post-treatment and at six month follow-up.

Adverse effects

Not reported in review.

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