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Meta-Analysis of Biofeedback for Tension-Type Headache:
The aim of the present meta-analysis were to investigate the short- and
long-term efficacy, multidimensional outcome, and treatment moderators of
biofeedback as a behavioral treatment option for tension-type headache.
A literature search identified 74 outcome studies, of which 53 were selected
according to predefined inclusion criteria. Meta-analytic integration resulted
in a significant medium-to-large effect size that proved stable over an average
follow-up phase of 15 months. Biofeedback was more effective than headache
monitoring, placebo, and relaxation therapies. The strongest improvements
resulted for frequency of headache episodes. Further significant effects were
observed for muscle tension, self-efficacy, symptoms of anxiety, depression,
and analgesic medication. Moderator analyses revealed biofeedback in combination
with relaxation to be the most effective treatment modality; effects were
particularly large in children and adolescents. In intention-to-treat and
publication-bias analyses, the consistency of these findings was demonstrated.
It is concluded that biofeedback constitutes an evidence-based treatment option
for tension-type headache.
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