A pilot study of one-session biofeedback training in pediatric headache

Abstract

Relaxation training and thermal biofeedback are promising treatments for pediatric headache. [1][2][3][4][5] This study evaluated the effectiveness of an hour-long, biofeedback-assisted relaxation training (BART) session within the context of a multidisciplinary pediatric headache center. The objectives were to determine whether peripheral body temperature (PBT) changes obtained during the training session (T1) could be maintained when measured at the child's subsequent follow-up clinic visit (T2), and to summarize headache perception and quality of life at T1 and T2.Methods. Twenty children consecutively referred for BART received standard multidisciplinary treatment and BART based on headache presentation and developmental status. The sample consisted of 10 girls and 10 boys, with a mean age of 11.6 years (SD ϭ 2.2 years). The sample was predominantly white (95%). All children were clinically diagnosed with migraine, with 90% meeting International Headache Society criteria. The sample was representative of the general population of the headache center 6 and those children referred for BART.Children were taught age-appropriate skills in deep breathing, progressive muscle relaxation, and guided imagery. PBT was monitored via a computer-based biofeedback system. Children were encouraged to practice with an audio tape at least three times each week (for 2 weeks) and at headache onset. Thereafter, the children were instructed to perform relaxation regularly on their own.PBT was measured at three time points: pretraining (PT), T1, and T2. At PT, PBT was measured before any relaxation training had occurred. At T1, PBT was measured before and after BART. At T2, PBT was assessed at the beginning of the clinic visit (prerelaxation) and 10 minutes after being instructed to "relax as you normally do" (postrelaxation). T2 data were collected at the child's first or second follow-up clinic visit after BART and before examination by members of the headache center team. The time from T1 to T2 averaged 150.7 days (SD ϭ 77.3 days). Changes in PBT (PBT ⌬) were calculated for T1 and T2 by subtracting PBT at pretraining/ relaxation from PBT post-training/relaxation. For 85% of the sample (n ϭ 17), we were also able to calculate PBT ⌬ at PT.Results. Results show that children were not able to significantly increase their PBT before BART (mean PBT ⌬ at PT ϭ 0.27°F; SD ϭ 0.70°F). However, once trained in BART, a positive change in PBT occurred at T1 (mean ϭ 3.3°F; SD ϭ 2.5°F) and T2 (mean ϭ 3.7°F; SD ϭ 4.5°F). Within-subject t-tests showed that changes were significant from PT to T1 (t ϭ Ϫ4.087; p Ͻ 0.01) and from PT to T2 (t ϭ Ϫ2.687; p Ͻ 0.02). PBT changes were maintained from T1 to T2 (t ϭ Ϫ0.427; NS: df ϭ 19). Ninety percent of children at T1 and 95% at T2 were able to obtain a positive change in PBT.Headache severity decreased from a mean of 5.0 (0 to 10 scale; 10 ϭ most pain) at T1 to 4.5 at T2. Average headache frequency decreased from 12.9 to 9.7 days/month, and duration also decreased from 6.9 to 5.2 hours. PBT ⌬ at T2 was s...

Methodological Considerations in Research With Special Populations: Children and Adolescents

“…Treatment.— Interventions should not be merely the application of an approach used with adults to pediatrics. Treatments should be designed for and piloted with pediatric samples 14,15,22,23 . Adjustments for developmental and environmental differences from adults should be explicitly stated (eg, inclusion of parents, peers, or school personnel in treatment approaches; changes in the techniques implemented to make behavioral approaches developmentally appropriate for a young child or adolescent 24 ).…”

Prophylaxis of Migraine in Children and Adolescents

“…Headache severity decreased from a mean of 5.0 (0 to 10 scale; 10 = most pain) to 4.5. Average headache frequency decreased from 12.9 to 9.7 days/month, and duration also decreased from 6.9 to 5.2 h. In general, 85 % of parents reported that their child was functioning ''better'' at the end of the study [54].…”

“…The response rate was 58 % overall; 48 % for chronic headaches and 73 % for episodic headaches [53]. Powers et al [54] looked at 20 children (mean age 11.6 years) consecutively referred for biofeedback and relaxation therapy who received standard multidisciplinary treatment and biofeedback based on headache presentation and developmental status. Children were taught age-appropriate skills in deep breathing, progressive muscle relaxation, and guided imagery.…”

Behavioral and Cognitive-Behavioral Interventions with Pediatric Populations

“…Because anxiety and pain are associated with increased sympathetic activity and arousal, the use of relaxation techniques that induce parasympathetic activity and subsequent reduction in sympathetic activity represents a logical choice for intervention. Indeed, empirical evidence exists supporting the use of such treatment, reporting treatment gains in physiological parameters and control of client-presented problems (Holden et al, 1999;Powers, 1999;Powers et al, 2001). Within the treatment session, patients are taught relaxation through the use of one of a variety of scripts or manuals, many of which are designed especially for use with children.…”