To determine if frequent use of a combined biofeedback-virtual reality (VR) device improves outcomes in chronic migraine, including headache days, frequency of acute medication use, migraine-related disability, anxiety, depression, sleep disturbance, and catastrophizing.

Chronic migraine (CM) is a prevalent, disabling condition. Behavioral treatments, such as biofeedback, reduce headache-related outcomes in episodic migraine by 35–55%. We hypothesized that use of biofeedback, a mind-body breathing technique that modulates the autonomic nervous system, combined with VR, could be an effective treatment for CM, particularly in patients refractory to pharmacotherapy.

In this randomized controlled 12-week pilot study, 50 patients aged 18-85 years with ICHD-3 diagnosis of CM were recruited from University of Washington’s Headache Clinic. Patients were randomized to the intervention group (frequent use of biofeedback-VR plus standard medical care; n=25) or to the wait-list control group (standard medical care alone; n=25). Headache days, frequency of acute medication use, depression (PHQ-8), anxiety (PSS), insomnia (PROMIS), and catastrophizing (CAP) were measured at weeks 0, 2, 4, 8, and 12. Medically refractory patients (by American Headache Society or European Headache Federation criteria) were identified.

A statistically significant decrease (55% vs 32%; p = 0.028) in frequency of acute medication use was demonstrated in the experimental group (n=14) compared with the control group (n=22). The remaining other variables also showed improvement, though these values were non-significant. The majority (69%) of patients met criteria for medically refractory migraine.

Frequent use of add-on biofeedback-VR therapy significantly decreased frequency of acute medication use in CM. Though the other variables did not meet statistical significance, they trended toward improvement, suggesting that patients with CM may benefit from biofeedback-VR treatment. Biofeedback-VR is a safe, non-invasive therapy that holds promise for many patients, including those with medically refractory CM, those interested in non-medication approaches, and/or those inclined toward an integrative treatment strategy.