Kolbe Lisa, Eberhardt Tanya, Leinberger Beate, Hinterberger Thilo
Psychosomatische Medizin, Universitätsklinikum Regensburg.
Psychother Psychosom Med Psychol. 2020 Jul;70(7):300-307. doi: 10.1055/a-1059-9356. Epub 2020 Jan 21.
Biofeedback-treatment for primary headache is highly recommended. Its expenses are mostly not or not completely covered by health funds, hindering the implementation in the care system. This randomized controlled study aimed at evaluating the efficacy of a biofeedback-treatment for primary headache in the outpatient care system all over Germany.
The participants were divided into a direct treatment-group (n=41) and a waiting control-group (n=29). The treatment was carried out for 8-11 sessions with vasoconstriction-/vasodilation training for migraine, with electromyography training for headache of the tension type (diagnosis according to the criteria of the International Headache Association). Headache characteristics (frequency, duration, intensity) were collected via headache-diary before, during and after the treatment and headache specific disability using the Pain Disability Index before and after the treatment. The waiting group stated additional information of the questionnaires about 3 months before and again ultimately before the start of the treatment. Measurement of the headache specific self-efficacy (Headache Management Self-efficacy Scale) took place every second session. For the collected parameters the effect sizes f or r were computed before in comparison to after the treatment and comparing the treatment-group to the waiting-group.
Headache characteristics decreased during the time of the study significantly linearly with medium to strong effects (frequency f=0.302, p<0.001, duration f=0.186, p<0.001, mean intensity f=0.502, p<0.001, maximal intensity f=0.546, p<0.001). Using biofeedback the self-efficacy rose significantly (p<0.001, r=0.782), even compared to the waiting time (p<0.001, r=0.604). Additionally the handling of pain, the psychological disability and the disability in everyday life improved significantly.
Overall the effects were comparable to already existing studies. Therefore biofeedback turned out to be efficient against migraine and tension-type headache in the out-patient care setting. By that a better integration in the care system seems to be qualified.
原发性头痛的生物反馈治疗备受推荐。其费用大多未被或未完全被健康基金覆盖，这阻碍了其在医疗体系中的实施。这项随机对照研究旨在评估在德国全国门诊医疗体系中，原发性头痛生物反馈治疗的疗效。
参与者被分为直接治疗组（n = 41）和等待对照组（n = 29）。治疗进行8 - 11次，针对偏头痛进行血管收缩/舒张训练，针对紧张型头痛进行肌电图训练（根据国际头痛协会标准诊断）。在治疗前、治疗期间和治疗后通过头痛日记收集头痛特征（频率、持续时间、强度），并在治疗前后使用疼痛残疾指数收集头痛特异性残疾情况。等待组在治疗开始前约3个月及最终再次填写问卷补充信息。每两节课测量一次头痛特异性自我效能（头痛管理自我效能量表）。对于收集到的参数，计算治疗前与治疗后的效应量f或r，并比较治疗组与等待组。
在研究期间，头痛特征显著线性下降，具有中度至重度效应（频率f = 0.302，p < 0.001；持续时间f = 0.186，p < 0.001；平均强度f = 0.502，p < 0.001；最大强度f = 0.546，p < 0.001）。使用生物反馈后，自我效能显著提高（p < 0.001，r = 0.782），甚至与等待期相比也有提高（p < 0.001，r = 0.604）。此外，疼痛处理、心理残疾和日常生活中的残疾情况也有显著改善。
总体而言，这些效果与现有研究相当。因此，生物反馈在门诊护理环境中对偏头痛和紧张型头痛有效。由此看来，它似乎更适合更好地融入医疗体系。
