The Effects of Self-Monitoring, EMG Biofeedback, and Relaxation Tapes in the Treatment of Tension Headaches

Tension headache is an important medical-behavioral disorder because of its high incidence and the personal discomfort and disruption of normal activities that frequently accompany it. Several behavioral strategies have been applied in the treatment of this disorder. Two of the most prominent treatments are EMG biofeedback and Progressive muscle relaxation exercises. Research has shown both of these strategies to be effective treatments of tension headache but much debate still ensues as to which is the more effective treatment. The effects of different self-monitoring procedures have never been compared during EMG biofeedback or Progressive muscle relaxation treatments of tension headache. In the present study, 9 people with tension headaches were used to compare EMG biofeedback and Progressive muscle relaxation tapes in the treatment of tension headache. This study also assessed the contribution of different modes of self-monitoring (daily recording sheets and daily recording sheets plus timers) in the reduction of headache activity. The participants were university students ranging in age from 19 to 25 years. Volunteers included 2 males and 7 females who reported having tension headaches for an average of 41.2 months. Participants were instructed to self-record daily frequency and intensity of headaches plus medication intake, chemical intake and sleeping behavior. After a two week baseline, they were assigned to one of three conditions: EMG, Relaxation tapes, or EMG plus timers. Treatment for each group lasted one week while they continued to fill out their daily self-monitoring sheets and to record their headache activity. Results indicated that each of the nine participants reduced EMG levels with and without feedback given at the conclusion of the treatment phase and that eight of the nine persons also experienced significant reductions in headache frequency. Of these eight, over one-half of them reported decreases in sleep onset and total sleep time with an increase in the amount of restful sleep. While two persons from each group reported decreases in total sleep time and increases in the amount of restful sleep, it was only in the EMG plus timers condition that all three participants reported a decrease in sleep onset. The results of this study indicated that both EMG biofeedback and Relaxation tapes are effective procedures for treating tension headache. Results also suggested that neither home practice nor prior forearm extensor muscle training appeared to be necessary components of success in either treatment modality. Furthermore, although the introduction of timers into the self-monitoring phase of one EMG group did not produce a headache-free condition for those individuals, such an addition may provide a distinct form of cueing which better prepares the headache subject to effectively utilize the biofeedback signal in EMG biofeedback. Additional research was recommended, and limitations of the present data were discussed