Headaches treatment with EMG biofeedback: a focused systematic review and meta-analysis.
Alex Martino Cinnera, Giovanni Morone, Alessio Bisirri and 7 others
PMID 37823248WHAT IT FOUND
Pooling four trials, EMG biofeedback did not reduce headache frequency, intensity or attack duration more than control treatments.
The review's 29 studies are mostly pre-2000 with quality problems, so the evidence that it eases headache pain remains unproven.
Key findings
01When the four trials with usable data were pooled, EMG biofeedback did not significantly change headache frequency compared with control: effect size 0.17 (95% CI -0.06 to 0.39, P=0.14) in 309 patients.
02Pain intensity (effect size 0.21, 95% CI -0.02 to 0.44, P=0.07, 293 patients) and attack duration (0.15, 95% CI -0.08 to 0.37, P=0.21, 293 patients) also did not differ significantly from control.
03The systematic review included 29 studies with 1342 people with primary headaches, but only four reported the data needed for the pooled analysis.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
Only four of the 29 included studies could be pooled, and those four covered at most 309 people, so the meta-analysis rests on a small slice of a much larger literature. Most included studies were published before 2000 and were not run to current trial standards; overall risk of bias was moderate to high, and in most studies the control group did not receive a sham, so participants and assessors knew which treatment was given. Children and adults were pooled together, and protocols varied widely in electrode site, device, session length and total treatment duration (from two to 36 weeks), so these differences cannot be untangled. Frequency and duration of attacks were recorded in different ways across studies, using different scales and headache diaries of uncertain reliability, which the authors themselves suggest may explain why those two outcomes showed nothing. The 126 people who dropped out were excluded from the analysis in all but one study, and the review therefore says nothing about how well the treatment works for people who do not complete it. The review found no evidence on headache-related disability, quality of life, or limitation of work and social activities.
Declared interests
The authors state that they have no conflict of interest with any financial organisation regarding the material discussed in the manuscript. No funding source is named in the text provided, and no company involvement in the design or writing is reported. The authors note that most of the trials they reviewed were old, and that this made their requests to the original authors for additional data fail.
The easy way to misread this
Do not read the paper's conclusion as evidence that EMG biofeedback reduces headache pain. The pooled result for intensity was P=0.07, which falls short of statistical significance, and the authors themselves write that their meta-analysis only approached that threshold without achieving it. None of the three pooled outcomes, frequency, intensity or duration, was statistically significant.
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