A systematic review 1 including 53 studies (24 RCTs, 8 controlled, 21 pre-post studies) with a total of 1532 subjects with tension-type headache was abstracted in DARE. Most included studies evaluated electromyography feedback (EMG-FB) with or without relaxation. Follow-up ranged from one to 60 months. Biofeedback had a moderate to large effect for headache in pre- and post-treatment comparison (effect size d = 0.73, 95% CI 0.61 to 0.84). Biofeedback also had a large effect compared with no treatment (d = 0.81, 95% CI 0.46 to 1.16) and smaller benefits compared with placebo (d = 0.5, 95% CI 0.27 to 0.73) and relaxation (d = 0.2, 95% CI 0.09 to 0.32). Comparisons with pharmacotherapy, physical therapy and cognitive therapy did not show difference between treatments. EMG-FB with relaxation was the most effective type of biofeedback. Biofeedback was more effective in children and adolescents than in adults, and in adults biofeedback was more effective in patients with a longer duration of tension-type headache.
Comment: The quality of evidence is downgraded by inconsistency (heterogeneity in interventions and outcomes) and by study quality (inadequate allocation concealment).
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