The treatment of tension headache—I. Muscular abnormality and biofeedback

The specificity and efficacy of a short EMG biofeedback treatment were assessed in a selected group of chronic tension-headache cases—those having significantly elevated levels of muscle tension. The effects of training patients to raise/maintain EMG levels were compared to those obtained from patients who were trained to lower tension levels. The results showed little evidence of increased self-control of the muscle despite successful EMG control during six bio-feedback sessions. A progressive and significant reduction in resting level was found only in the groups trained to reduce EMG levels. The treatment proved ineffectual in reducing headache. The implications of the dissociation of muscle tension and headache are discussed both with respect to current views of tension headaches and the role of biofeedback in their treatment.     

Effect of EMG-biofeedback training in reduction of muscle tension for individuals displaying type A behavior patterns

This study investigated the effect of EMG biofeedback training in reducing muscle tension among subjects who displayed Type A behavior. 22 Type A college students (19 to 22 yr. old) were randomly assigned to either a biofeedback group or a control group. After 6 wk. of training, Type A subjects showed a significant reduction in muscle tension for both resting and aroused states; however, the reduction of muscle tension did not result in reduction of Type A behavior patterns.     

BIOFEEDBACK AND RATIONAL-EMOTIVE THERAPY IN THE MANAGEMENT OF MIGRAINE HEADACHE

Twenty-four migraine patients were randomly assigned to one of four conditions: (a) self-monitoring of headache activity (waiting list), (b) frontalis EMG biofeedback, (c) digit temperature biofeedback, and (d) digit temperature biofeedback plus Rational-Emotive Therapy (RET). Bidirectional control over the target physiological response was assessed through a reversal design in each session. Following at least a four-week baseline, the three biofeedback groups received 8 to 10, 30-minute sessions of bidirectional biofeedback training, scheduled twice a week. Subjects in the combined digit temperature biofeedback plus RET group received three 40-minute sessions of RET as an addition to the third, fifth, and seventh biofeedback sessions. Records of daily home practice were kept throughout treatment and three-month followup. Subjects on the waiting list monitored headaches for at least five months, corresponding to “baseline”, “treatment”, and three-month followup. Digit temperature biofeedback alone and in conjunction with RET did not prove to be more effective than the control conditions. All the EMG subjects reduced headache activity to two-thirds or less of the baseline level by the third month of followup. Bidirectional digit temperature performance did not improve with training, was demonstrated in only 33% of the biofeedback sessions, was not maintained over time, and was unrelated to improvement in headache activity. EMG subjects reported biofeedback performance to be an easier task and met the performance criterion on 85% of the sessions. The frequency of home practice contributed over 55% of the variance in retrospective estimates of headache improvement but was not related to changes in daily records of headache activity.     

A system for providing tactile EMG biofeedback

This report describes a flexible and inexpensive biofeedback system for providing discrete pulses against the skin surface at a frequency proportional to the level of activity from selected muscle groups. The primary components consist of a voltage controlled pulse generator and a tactile transducer. Other system capabilities include the production of digital information for recording devices and the providing of pulsed auditory EMG biofeedback. The system may be particularly applicable for the experimental reduction of psychological and muscle tension.     

Initial relaxation response: contrasts between clinical patients and normal volunteers

The effectiveness of EMG biofeedback, progressive muscle relaxation, autogenic training, and self-relaxation were compared using a within-subjects design. Thirteen clinical subjects and 48 normal volunteers participated in 4 counterbalanced relaxation sessions using one of the techniques. Frontalis EMG and surface skin temperature were monitored throughout the sessions. For reducing EMG, biofeedback was more effective than the other three techniques. A significant interaction of treatment X subjects was found for changes in skin temperature. Clinical subjects had the greatest increase in skin temperature with EMG biofeedback and analog subjects responded best to self-relaxation. There were no significant differences in initial measures of EMG or skin temperature for the two samples.     

MODIFICATION OF COMBINED MIGRAINE-MUSCLE CONTRACTION HEADACHES USING BVP AND EMG FEEDBACK

The effect of blood volume pulse (BVP) and frontalis muscle action potential (EMG) feedback on control of vasoconstriction of the temporal artery and frontalis muscle activity in combined migraine-muscle tension subjects was investigated in a multiple baseline design (across subjects and responses). The data indicated: (a) both subjects obtained an ability to control BVP during BVP feedback and EMG during EMG feedback; (b) there were decreases in frequency of migraine headaches during BVP feedback and decreases in muscle contraction headaches during EMG feedback. The results of this study supported the theoretical explanation of two pain mechanisms involved in combined muscle contraction-migraine headaches as well as the effectiveness of biofeedback procedures that target directly the specific pain mechanism in the elimination of the two types of head pain.     

Relationship between self-reported intensity of headache and magnitude of surface EMG

The study was designed to examine the relationship between self-reported intensity of headache and surface EMG. 98 patients, diagnosed by their neurologists with "muscle-contraction headaches" (tension-type headaches) were referred to evaluate their suitability for biofeedback therapy. At the time of examination, they were asked to rate their average headache intensity on a 10-point scale. Surface EMG data were collected to assess actual muscle contraction. Analysis indicated that among patients diagnosed with muscle contraction headache, there is a positive significant correlation between self-reported intensity of headache and actual muscle-contraction. The current data lend support to the hypothesis that the tension in the headaches currently described as "tension-type" may in fact refer to actual muscular tension or contraction.     

The relationship between frontalis muscle activity and self-reports of headache pain

The relationship between levels of frontalis muscle activity and self-reports of pain was evaluated in two studies. In Study I frontalis muscle activity and self-reports of pain collected during biofeedback treatment of muscular contraction headache clients were correlated. In Study II frontalis EMG activity was increased and decreased using biofeedback techniques while concurrent reports of headache pain were recorded. The results of Study I indicated a significant relationship between EMG activity and reported headache pain for only two of the five subjects studied. The biofeedback procedures in Study II were associated with reliable increases and decreases in EMG activity. Concordance between EMG and pain reports occurred only during the EMG increase condition. Overall correlations were significant for one of the 2 subjects. The results suggest that EMG activity may not be sufficient to account for pain reports in all chronic headache clients, and variables other than EMG activity may be influencing reports of pain in some patients.     

An examination of methods for producing relaxation during short-term laboratory sessions

Reductions in psychological and physiological correlates of tension produced by various muscle relaxation training techniques were examined during a short-term laboratory session. Two studies are described involving a combined total of one hundred subjects receiving either abbreviated progressive relaxation, visual, auditory, or tactile electromyographic (EMG) biofeedback procedures. The Anxiety Differential was administered before and after the laboratory session. Heart rate, respiratory rate, skin conductance, systolic blood pressure, and frontalis and dominant forearm extensor EMG measures were obtained before, during, and after administration of relaxation training. Results indicated feedback in the tactile modality to produce overall reductions in tension comparable to those produced by progressive relaxation. Overall reductions in tension displayed by both progressive relaxation and tactile feedback were generally greater than reductions shown by visual or auditory feedback procedures. Interpretations suggest that certain forms of EMG feedback may offer an alternative to progressive relaxation techniques for producing short-term reductions in tension. Feedback modality is further indicated as a potentially important variable during relaxation training using the EMG feedback technique.     

Sequential comparisons of relaxation training and biofeedback in the treatment of three kinds of chronic headache or,the machines may be necessary some time of the time

Two studies are reported in which patients with chronic headache, who did not improve significantly as a result of a 10-session, 8-week relaxation training program, were subsequently treated with biofeedback. For the tension headache sufferers, 36% of the relaxation non-responders showed significant improvement with frontal EMG biofeedback training. For those with vascular headaches, 44% of the relaxation non-responders showed significant improvement with thermal biofeedback. Vascular headache patients with combined migraine and tension symptoms did better than those with only migraine. Psychological test scores significantly differentiated successful vs non-successful biofeedback responders.     

The modification of tension headache pain using EMG biofeedback

In a controlled trial of the effects of biofeedbaek on patients with tension and mixed tension-migraine headaches, biofeedback proved superior in producing decrements in resting muscle tension levels, headache intensity, medication frequency, and a slight decrement in headache frequency. The time course of the changes in these systems was discussed. Pseudo-biofeedback produced little change. Tension and mixed tension-migraine cases responded differently. The latter learned muscle tension reduction less easily, although their onset levels were high, and they gained less benefit with respect to pain reduction from their training.     

Biofeedback and gifted children: an initial investigation

37 intellectually gifted students were given a 15-min. training session in EMG frontalis biofeedback to determine its effectiveness for reduction of stress. While differences across sex in biofeedback training were not found, these highly able students significantly reduced their levels of tension.     

Physiological changes after biofeedback and relaxation training for multiple-pain tension-headache patients

This paper is concerned with the psychophysiology of "muscle-contraction" headaches in a group of Compensation patients suffering from multiple pain problems in addition to headaches. A total of 55 of these patients were divided into 4 groups which received frontalis EMG biofeedback, relaxation training, combined biofeedback-relaxation training, or no treatment. Differences were observed among the 3 experimental treatments and the control group with respect to headache changes, but there were no differences among groups with respect to the changes observed in four underlying physiological responses as a function of time or practice. While the subjects who showed the largest changes in headache characteristics were those who exhibited the largest decreases in frontalis EMG, these were also the subjects whose initial frontalis EMG levels were the highest. It is concluded that, in keeping with a growing literature, the link between frontalis EMG and "muscle-contraction" headaches is a tenuous one and that the changes brought about in headache symptomatology through biofeedback or relaxation training are most likely attributable to a generalization of feelings of mastery over the environment or of self-efficacy brought about in the subjects through apparent success at the task.     

A comparison of stress-reduction behavioral counseling and contingent nocturnal EMG feedback for the treatment of bruxism

This study compared the efficacy of two treatment modalities (stress-reduction behavioral counseling and contingent nocturnal EMG biofeedback) on night-time bruxism. The 16 subjects (Ss) were assigned sequentially to one of four treatment groups: (1) stress-reduction behavioral counseling: (2) nocturnal biofeedback; (3) stress-reduction behavioral counseling and nocturnal biofeedback; and (4) waiting-list control group. A portable EMG unit was used to record the nightly total of electrical activity (?20 μV) from the masseter muscle 10 days before and after treatment. The three treatment procedures were found to be significantly superior to no-treatment control group. The outcome of the two treatments which made use of stress-reduction behavioral counseling, although better than the treatment which solely used nocturnal biofeedback, was not significantly better. This study demonstrates that stress-reduction skills learned while awake can have a generalized effect on stress-induced muscle activity during sleep. Implications for further research are discussed.     

Effectiveness of biofeedback and relaxation training in reducing the side effects of cancer chemotherapy.

Assessed the effectiveness of electromyographic (EMG) and skin-temperature (ST) biofeedback and relaxation training (RT) in reducing the aversiveness of cancer chemotherapy. Eighty-one cancer patients, equated on several individual-difference variables, were randomized to one of six groups formed by a 3 (EMG Biofeedback, ST Biofeedback, No Biofeedback) x 2 (RT, No RT) factorial design. Outcome was assessed with physiological, patient-reported, and nurse-reported indices taken over five consecutive chemotherapy treatments. RT patients showed decreases in nausea and anxiety during chemotherapy and physiological arousal after chemotherapy. EMG and ST biofeedback reduced some indices of physiological arousal but had no other effects on chemotherapy side effects. These findings suggest that RT can be effective in reducing the adverse consequences of chemotherapy and that the positive effects found for biofeedback in prior research were due to the RT that was given with the biofeedback, not to the biofeedback alone.     

Emotional responding following experimental manipulation of facial electromyographic activity

Increases in zygomatic electromyographic (EMG) responding have been reported during the imagination of positive affective scenes, and increases in corrugator EMG have been reported during negative affective scenes. Thirty female subjects were instructed to imagine three positive affective scenes and three negative affective scenes. During the initial imagination of each scene, the subject was told simply to imagine the situation. The subject then imagined the situation again and was instructed to enhance the muscle tension in one of two muscle groups (the zygomatic muscles for positive scenes and the corrugator muscle for negative scenes). The subject then imagined the scence a third time and was instructed to suppress the muscle tension in the same muscle group. The order of administration of enhancement and suppression trials was randomized for each scene. Subjects were given several trials to practice controlling both zygomatic and corrugator EMG. Feedback was available during the practice trials and during the enhancement and suppression trials of the experiment. Continuous monitoring of both zygomatic and corrugator EMG during the study indicated that subjects were successful in altering muscle tension in accord with the experimental instructions, and videotapes of subjects' faces indicated no overt changes in facial responding during imagination of the scenes. Subjects' ratings of emotional responding during each scene indicated that subjects experienced less enjoyment and more distress during positive affective trials in which they suppressed zygomatic EMG activity. The results are discussed in terms of the facial feedback hypothesis.     

Heterogeneity of biofeedback training effects in spasmodic torticollis: a single-case approach

Data from 184 biofeedback sessions are presented, in which 10 subjects with spasmodic torticollis had been trained to reduce pathologic activity in the hypertrophied sternocleidomastoid muscle. Each session was conducted as a single case experiment with nine successive trials. Attempts were made to distinguish motor learning processes which can be elicited independently from the biofeedback-condition from the effects of specific biofeedback information. Results showed dramatic decreases of muscle activity under biofeedback. Contrary to expectation, action potentials did not decrease across a course of 14 training sessions. Instead, effects were exhibited in an all-or-none fashion early in the training. Single-case ARIMA intervention analysis has shown that in 59% of the sessions EMG decreases demonstrated under biofeedback could be elicited prior to biofeedback in a condition of instructed control. Case studies revealed complex interactions of instructed control, specific biofeedback effects, unspecific effects of the biofeedback setting, and cognitive processes. Effects obtained within experimental sessions varied highly between subjects. Results are discussed in terms of newer concepts of basal ganglia dysfunction, and conclusions for the use of biofeedback paradigms in torticollis subjects are outlined.     

Stimulus control of EMG burst duration in human locomotion

To better understand constraints on EMG activity, burst duration was restricted for the rectus femoris (RF) muscle as subjects walked on a motor-driven treadmill. Once in each step cycle (touchdown to touchdown of the left foot) a computer-activated light discriminated a short burst (if green) and silence (if red). All four subjects rapidly met the criterion of 90% success in 50 cycles for a burst 100–300 msec long within a performance duration, PDUR, of 700 msec. In contrast, two of the four failed to reduce the burst to conform to a 100–200 msec requirement. Several variables were ruled out as bearing on these between-subject performance differences: (1) complete failure to produce a short burst within the PDUR, since many were successful; (2) a differential effect upon subjects of two “reinforcer” types (a high tone after success and a low tone after failure, or else audible EMG biofeedback before the high or low tone); (3) appreciable differences in cycle duration or swing/stance ratios; (4) the presence or absence of concomitant activity in other leg muscles whose EMG was recorded. The frequent failure to accurately terminate the burst was suggested to be due to a greater susceptibility, whether reflexive or conditioned, to simulation arising in the contracting RF muscle itself.     

Obsessive-compulsive tendencies may be associated with attenuated access to internal states: Evidence from a biofeedback-aided muscle tensing task

The present study was motivated by the hypothesis that inputs from internal states in obsessive-compulsive (OC) individuals are attenuated, which could be one source of the pervasive doubting and checking in OCD. Participants who were high or low in OC tendencies were asked to produce specific levels of muscle tension with and without biofeedback, and their accuracy in producing the required muscle tension levels was assessed. As predicted, high OC participants performed more poorly than low OC participants on this task when biofeedback was not available. When biofeedback was provided, the difference between the groups was eliminated, and withdrawing the monitor again reversed this effect. Finally, when given the opportunity, high OC participants were more likely than low OC participants to request biofeedback. These results suggest that doubt in OCD may be grounded in a real and general deficiency in accessing internal states.     

Effects of active and passive EMG biofeedback training on performance of motor and cognitive tasks.

The goal of this study was to compare the effects of general relaxation (passive group) and neuromuscular tension control (active group), both using EMG biofeedback techniques, on the performance of memorization, simple reaction time, and rotary pursuit. 18 subjects were given five consecutive daily sessions of training or were placed under control conditions, after which their performance on these various tasks was evaluated. Results indicate that control of neuromuscular tension seemed to facilitate performance on all tasks over that of the control group. Except for simple reaction time, there was no difference between the "active" and "passive" groups. The results are interpreted in terms of factors in selection of subjects and experimental conditions.