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Study supports use of ILF neurofeedback in integrative treatment of primary headaches

05. September 2022

Eight patients with tension headache received 10 sessions of ILF neurofeedback and 10 sessions of sham neurofeedback in random order. The intervention was in addition to a baseline psychotherapeutic intervention. Results of the study titled "Infra-Low Frequency Neurofeedback in Tension-Type Headache: A Cross-Over Sham-Controlled Study" from Arina et al. showed that compared to sham treatment, the frequency of headaches after treatment with ILF neurofeedback, was significantly lower.


Neurofeedback and headache

Although neurofeedback is increasingly used for chronic pain, its effectiveness for headaches has been little studied. Yet headaches are among the most common conditions; 38% of the adult population actively suffers from tension headaches (Jensen and Stovner, 2008). In treatment, non-drug treatments, including biofeedback and neuromodulation, are promising alternatives to medication (Nestoriuc et al., 2008; Bendtsen et al., 2010; Ailani et al., 2021).

Neurofeedback uses brain signals and aims to therapeutically modulate a dysfunctional brain state, such as an imbalance in electroencephalographic (EEG) activity or altered intrinsic connectivity patterns (Ros et al., 2013; Marzbani et al., 2016; Nicholson et al., 2016; Dobrushina et al., 2020). In the present study, infra-low frequency (ILF) neurofeedback was applied, which targets the slow brain fluctuations. In practice, neurofeedback is already widely used in the treatment of headache (Othmer, 2017). However, a sham-controlled study in patients with tension headache has not yet been conducted.


Study and methods

The aim of the present study was therefore to evaluate the effects of low-frequency EEG neurofeedback in patients with tension headache using a sham-controlled cross-over study. 8 patients, aged between 18 and 45 years, diagnosed with tension headache, received 10 sessions of neurofeedback treatment and 10 sessions of sham neurofeedback treatment in two intervention phases. The order (neurofeedback first or sham neurofeedback first) was randomized. In addition, the mechanisms of tension headache, including the benign nature of the headache and the risk of medication overdose, and progressive muscle relaxation training were explained to all participating subjects. Patients received an audio recording of the relaxation technique and were asked to use it three times per week. During the study period, participating subjects were required to keep a headache diary that included information on the duration and intensity of headaches and medication use. 
Neurofeedback sessions were conducted according to the Othmer protocol. Furthermore, the NeuroAmp as well as the Cygnet software of the BEE Medic company were used.

Results and implications


Results of the study showed a significant effect of neurofeedback and no effect of sham sessions. Treatment with neurofeedback reduced the frequency of tension headaches. Sham sessions, on the other hand, resulted in a placebo effect in one participant and a nocebo effect in two others. Furthermore, it was found that beliefs about neurofeedback and behavior during the sessions did not influence the effectiveness of neurofeedback.

In conclusion, the results of the study support the use of low-frequency neurofeedback in the integrative treatment of patients with tension headaches.

Read the entire study here.


Ailani, J., Burch, R. C., and Robbins, M. S. (2021). The American Headache Society Consensus Statement: update on integrating new migraine treatments into clinical practice. Headache J. Head Face Pain 61, 1021–1039. doi: 10.1111/head.14153

Bendtsen, L., Evers, S., Linde, M., Mitsikostas, D. D., Sandrini, G., and Schoenen, J. (2010). EFNS guideline on the treatment of tension-type headache - Report of an EFNS task force. Eur. J. Neurol. 17, 1318–1325. doi: 10.1111/j.1468-1331.2010.03070.x

Dobrushina, O. R., Vlasova, R. M., Rumshiskaya, A. D., Litvinova, L. D., Mershina, E. A., Sinitsyn, V. E., et al. (2020). Modulation of intrinsic brain connectivity by implicit electroencephalographic neurofeedback. Front. Hum. Neurosci. 14:192. doi: 10.3389/fnhum.2020.00192

Jensen, R., and Stovner, L. J. (2008). Epidemiology and comorbidity of headache. Lancet Neurol. 7, 354–361. doi: 10.1016/S1474-4422(08)70062-0

Marzbani, H., Marateb, H. R., and Mansourian, M. (2016). Neurofeedback: a comprehensive review on system design, methodology and clinical applications. Basic Clin. Neurosci. 7, 143–158. doi: 10.15412/J.BCN.03070208

Nestoriuc, Y., Rief, W., and Martin, A. (2008). Meta-analysis of biofeedback for tension-type headache: efficacy, specificity, and treatment moderators. J. Consult. Clin. Psychol. 76, 379–396. doi: 10.1037/0022-006X.76.3.379