Biofeedback and progressive muscle relaxation in the treatment of headache in childhood, and the long term regular monitoring of their effect

Primary headache is common in childhood. The painful symptoms interfere with the children’s and adolescents’ performance at school, in games and in their family lives. After an initial diagnosis, taking not only the physical, but also the affective, behavioral and situational factors into account, it is consequently essential to provide treatment as promptly as possible to avoid the condition becoming chronic. In recent years, the literature has increasingly supported the application of non-pharmacological treatments to headache in childhood, but few studies have routinely monitored the clinical and physiological modifications induced by such treatments in the course of a short- and long-term follow-up. The aim of the present study was to analyze the effectiveness of two different non-pharmacological treatments, electromyographic biofeedback (BFB) and progressive muscle relaxation (PMR), by means of a systematic assessment of the clinical and physiological changes observed after the treatment and at various follow-up points for up to 1 year. Twenty children took part in the study, 10 treated with BFB and 10 with PMR. All the children had suffered from recurrent headache for at least 6 months. They were given a headache diary to complete before the treatment, at the end of the treatment and then at 1, 3, 6 and 12 months of follow-up. The variables analyzed were: headache frequency, duration and intensity, headache index, muscle tension (EMG), intake of medication, percentage of improvement. The results showed that both treatments led to a significant improvement in the frequency of the painful attacks and in the headache index. PMR also induced a reduction in the duration of the headache episodes. After treatment, there was a marked reduction in the use of medication and the mean percentage of improvement tended to increase with time, remaining consistently higher than 50% at all the time points considered. On the whole, the improvements tended progressively to be consolidated and even increase, especially from the third month of follow-up onwards. Our findings confirm the effectiveness of non-pharmacological therapies in the treatment of childhood headache and support the likelihood of stable and generalized short- and long-term therapeutic effects