In the 1970s, sensors were placed on the forehead to measure muscle tension via a gauge for stress-related headaches; the gauge would drop as the frontal muscles relaxed. Years later, an audio signal was added to the system to provide feedback when the muscle reached the relaxation threshold; this was termed the "therapeutic tone." Additionally, tones of varying pitches could be used to help reduce muscle tension, serving as an added reward. As the muscles relaxed, headaches diminished.

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As biofeedback evolved, it expanded beyond monitoring muscle activity to include brain waves, heart rate, and breathing patterns.

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Neurofeedback is a form of brain exercise that teaches individuals to reduce the specific brain waves associated with tension; it is particularly effective in cases of migraine.

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There are meta-analyses demonstrating the proven efficacy of biofeedback for migraines.

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These analyses incorporate findings from 55 studies—including randomized controlled trials—and cover follow-up periods of up to 17 months, supporting its recognition within evidence-based medicine.[1]

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The American Academy of Neurology, the US Headache Consortium,

the American Academy of Family Physicians,

the American Headache Society,

the American College of Emergency Physicians,

the American College of Physicians-American Society of Internal Medicine,

the American Osteopathic Association, and

the National Headache Foundation

have all recognized biofeedback as a proven treatment method for migraines.

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According to the report by the Quality Standards Subcommittee of the American Academy of Neurology (authored by Prof. Dr. Wall E., Assoc. Prof. Dr. J. Keith Campbell, Dr. Donald B. Penzien, and Dr. Eric M. from the Mayo Medical School/Mayo Clinic Department of Neurology and the University of Mississippi Medical Center Department of Psychiatry and Human Behavior), biofeedback is classified as "Grade A" among cognitive and behavioral treatment recommendations for migraine headaches.

Grade A is defined as evidence of efficacy and quality based on multiple well-designed randomized clinical trials yielding consistent results directly supporting the recommendation. [2]-[3]

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Levels of evidence for efficacy: Levels 4 and 5. A comprehensive review of the gathered and presented evidence leads to the conclusion that biofeedback is a supported, effective treatment option for migraines. This corresponds to Level 4 according to AAPB/ISNR evidence-based medicine criteria.

A meta-analysis conducted in 2008 supports biofeedback as an effective and specific treatment option for tension-type headaches. [4]

According to AAPB/ISNR evidence-based medicine criteria, this represents the highest level of evidence (Level 5).