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Biofeedback
is a well-established treatment for migraines, with confirmed efficacy
across numerous studies. Studies have found an effect of biofeedback on
autonomic activity. This pilot study aims to determine if biofeedback for
migraines is associated with psychological and physiological changes in
terms of subjective reports of stress and autonomic stress reactivity.
Additionally, by looking at the time course of these changes and correlations
with treatment response, we aim to determine in exploratory analyses whether
changes in perceived stress and stress reactivity mediate the beneficial
effect of biofeedback for migraines.
40 subjects will be randomized
to receive immediate biofeedback or biofeedback after a 1-month wait-list
period. Subjects will complete questionnaires and undergo physiologic testing
at baseline, midway through treatment, and after treatment. Additionally,
the wait-list group will undergo a 2nd session of baseline testing prior
to starting biofeedback. Outcome measures will include self-report of perceived
stress and mood, headache related functioning, and headache severity. Additionally,
our primary physiologic outcomes will be parasympathetic cardiac control—as
measured by recovery of high frequency power of heart rate variability
following a psychological lab stressor; and sympathetic cardiac contractility—as
evidenced by change in pre-ejection period from baseline, in response to
this stressor. If this study supports our hypothesis that a significant
component of the therapeutic benefit of biofeedback for migraines may be
mediated by changes in perceived stress and stress reactivity, further
studies will be designed to confirm this finding and determine how biofeedback
treatment can be optimized.
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