MARK S. SCHWARTZ
Applied psychophysiological treatments, including relaxation and biofeedback,1 are commonly accepted treatments for tension-type and migraine headaches. We estimate that over the past 30 years, relaxation and biofeedback therapies have been used in the treatment of hundreds of thousands of people with these types of headaches. Hundreds of studies over the past 30 years have used relaxation and biofeedback for treating people with headaches termed "muscle tension," "psychogenic," "vascular," "migraine," and "combination" or "mixed" headaches. Furthermore, these biofeedback studies have stimulated research about the causes of headaches, treatment effectiveness, and mechanisms of treatment.
Investigations of treatment effectiveness are now too numerous to review case by case. Reviewers have resorted to meta-analytic and evidence-based approaches, which have consistently supported the value of these therapies (see Andrasik & Walch, 2002, and Penzien, Rains, & Andrasik, 2002, for more complete discussions). Tables 14.1 and 14.2 summarize results from the meta-analyses conducted to date for tension-type and migraine headaches, respectively. In addition, various groups have completed evidence-based reviews, wherein rigorous methodological criteria have been used to evaluate every study under consideration. These types of analyses—which have been performed by the Society of Clinical Psychology (Division 12 of the American Psychological Association; http://www.apa.org/divisions/div12/ rev_est/health.shtml), the U.S. Headache Consortium (composed of the American Academy of Family Physicians, American Academy of Neurology, American Headache Society, American College of Emergency Physicians, American College of Physicians, American Society of Internal Medicine, American Osteopathic Association, and National Headache Foundation) (Campbell, Penzien, & Wall, 2000), and the National Institutes of Health—are similarly supportive. There is also a fair amount of evidence demonstrating that treatment effects endure over time (see Andrasik & Walch, 2002).
The reader is referred to other chapters within this text that bear on topics addressed here (M. S. Schwartz, Chapter 6, for more on intake and cognitive preparation of patients; M. S. Schwartz, Chapter 8, for compliance; N. M. Schwartz & Schwartz, Chapter 3, for definitions; M. S. Schwartz, Chapter 13, for use of audiotapes; and Block, Schwartz, & Gyllenhaal, Chapter 9, for dietary considerations).
Some providers rely primarily on biofeedback and relaxation therapies, and others incorporate these approaches with other behavioral and stress management therapies. Research has helped provide useful information and answers to many questions and issues. Prudent