Enhanced performance feedback to strengthen biofeedback treatment outcome with childhood migraine.

Recent research has indicated that both the magnitude and frequency of performance feedback may be important variables in the biofeedback treatment of headaches. The purpose of this research was to determine whether the qualitative and/or quantitative enhancement of performance feedback could improve the efficacy of thermal biofeedback as a treatment for childhood migraine. In a time-lagged control design, six children with migraine headaches were exposed to thermal biofeedback training and then provided performance feedback reflecting moderate and high success, and, if needed, increased feedback frequency. In four of six subjects, clinically significant reductions in headache activity corresponded directly with the addition of feedback suggesting marked improvement in handwarming relative to peers, even when no improvement in handwarming had actually occurred. In two other subjects, clinically significant changes in headache activity were reported only after performance feedback frequency was increased. The results support the importance of attending to both qualitative and quantitative parameters of feedback as well as skill acquisition during thermal biofeedback treatment of children with migraine.