HRV / Neurofeedback
Summary:
HRV biofeedback and EEG-based neurofeedback are non-invasive techniques designed to modulate autonomic and cortical activity. They are used in migraine to reduce attack frequency by improving autonomic balance and reducing cortical hyperexcitability.
Biological Plausibility
Both HRV and EEG neurofeedback directly influence physiological systems involved in migraine, such as autonomic tone and thalamo-cortical regulation. Increased vagal activity and decreased sympathetic drive are correlated with reduced migraine frequency. Neurofeedback may also normalize aberrant EEG patterns seen in migraineurs.
Evidence
Several randomized controlled trials support HRV biofeedback for migraine prevention, with meta-analyses showing moderate efficacy. EEG neurofeedback has fewer trials, but early studies suggest potential benefit.
Effect Size
Typical reduction is 1–2 migraine days per month. About 35–45% of patients achieve at least a 50% reduction in frequency after 8–12 sessions, with greater effects when protocols are personalized and delivered by trained providers.
⚠️ Risk
Extremely low risk. Minor discomfort from sensors or frustration due to the learning curve is possible. No systemic side effects.
Cost
$$$
Scores
- Benefit: 4
- Burden: 4
- Ratio: 1.0
Clinical Takeaways
- Good option for stress-sensitive migraine patients.
- Requires consistent practice and guidance from trained providers.
- Most effective when combined with lifestyle changes and long-term use.
Key References
- Nestoriuc Y, et al. *Biofeedback treatment for headache disorders: a comprehensive efficacy review.* Appl Psychophysiol Biofeedback. 2008.
- Stokes D, et al. *Neurofeedback and biofeedback with 37 migraineurs: a clinical outcome study.* Behav Brain Funct. 2010.