Tension Headache:
Current Research with EMG Biofeedback
Causes of Tension Headache
Tension headache is usually separated from migraine and mixed headaches in research and treatment, since the causes are believed to be different as well as the symptoms. Signs of tension headache vary depending on the definition, but usually include a band-like tightening around the head and variable duration (Nigl, 1984). Traditionally, the cause of tension headache was believed to be excessive contraction of muscles in the forehead, neck, and shoulders, brought on by stress (Nigl, 1984). However, research has not found any consistent difference in muscle contraction between tension headache sufferers and healthy controls, which leads researchers to look for other etiologies such as the abandoned vasomotor theory. In this theory, headaches are believed to be caused by the expansion of veins in the head, and may be helped by consciously changing blood flow with the help of biofeedback.
Current Research
An important study showing strong evidence against the muscle contraction theory of tension headache was carried out by Holroyd et al. in 1984. The experimenters randomly assigned 43 student tension headache sufferers to four different conditions of biofeedback success. All participants were led to believe they decreased their forehead EMG, but for half of them the feedback actually taught them to raise EMG levels. Participants were also divided into high- and moderate-success groups, with a falsified video relating they supposed performance in relation to the rest of the group. The results of this study showed that regardless of whether they learned to decrease or increase their forehead EMG levels, participants who had been told they were highly successful in relation to the rest of the group had significantly greater improvements in their headache symptoms as compared to the moderate-success group. This finding illustrates that factors other than physiology are important in this type of chronic pain; it appears that cognitive elements such as perceived success and self-efficacy are the most powerful factors in patient improvement.
In further support of this data, Arena and Blanchard (1996) report that review articles have found EMG biofeedback and relaxation therapy to be equally effective in reducing tension headache; participants in either treatment report about a 50% reduction in headache activity. In a review by Bogaards and ter Kuile (1994), it was found that generally, EMG biofeedback alone or combined with relaxation therapy was more successful then no treatment or placebo treatment, and cognitive therapy led to substantial improvements in the few studies that examined it on its own. Therefore, tension headache cannot be caused by pure muscle contraction in most cases; this erroneous etiology is the driving theory behind biofeedback.
It seems to be important to emphasize the importance of a positive attitude by the therapist. Patients should be given very positive feedback, placing emphasis on any successes in order to help give rise to feelings of self-efficacy (Arena & Blanchard, 1996). In treatment of tension headache, more research is needed on the use of cognitive therapy to determine its potential worth. If cognitive factors are the operating causes behind biofeedback's success in treating tension headache, cognitive therapy appears to be a promising treatment.
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