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Summary
Reduced habituation of the nociceptive blink reflex (NBR) is considered a trait marker for genetic predisposition to migraine. In this open-label randomized controlled study, we aimed to test the efficacy of a biofeedback training based on learning of habituation of the NBR (NBR biofeedback) compared with pharmacological (topiramate) treatment and NBR biofeedback plus topiramate treatment in a cohort of migraine without aura patients eligible for prophylaxis. Thirty-three migraine patients were randomly assigned to three months of treatment with: 1) NBR biofeedback, 2) NBR biofeedback plus topiramate 50 mg (b.i.d.), or 3) topiramate 50 mg (b.i.d.). Frequency of headache and disability changes were the main study outcomes. Anxiety, depression, sleep, fatigue, quality of life, allodynia and pericranial tenderness were also evaluated.
NBR biofeedback reduced the R2 area, without improving R2 habituation. However, it reduced the frequency of headache and disability, similarly to the combined treatment and topiramate alone.
Reduced habituation of the NBR is a stable neurophysiological pattern, scarcely modifiable by learning procedures. Training methods able to act on stress-related responses may modulate cortical mechanisms inducing migraine onset and trigeminal activation under stressful trigger factors.
KEY WORDS: biofeedback, migraine, nociceptive blink reflex, topiramate.
Introduction
Biofeedback-related approaches to headache therapy fan into two broad categories: general biofeedback techniques and methods linked more directly to the pathophysiology underlying headache. General biofeedbackassisted relaxation techniques for headache have been evaluated extensively by expert panels and in metaanalyses, and found to be potentially useful for enhancing patient outcomes, albeit with the limit of a lack of significant relief in a sizeable number of patients (Andrassik, 2010). The biofeedback methods most frequently used for migraine treatment have been peripheral skin temperature biofeedback, blood volume pulse (BVP) and electromyography feedback (Nestoriuc et al., 2008). Neurofeedback sessions combined with thermal biofeedback were effective in reducing the frequency of migraine (Stokes and Lappin, 2010). Biofeedback methods that more directly target headache pathophysiology have focused chiefly on migraine, and especially on BVP biofeedback (Friar and Beatty, 1976) and EEG feedback with training involving habituation of contingent negative variation (CNV) (Siniatchkin et al., 2000), or pain experience through EEG rhythms control (Jensen et al., 2008).
Habituation, "a response decrement as a result of repeated stimulation" (Harris, 1943), is a multifactorial event whose underlying plastic neural...