Biofeedback-Virtual Reality Tool Shows Promise for Patients With Chronic Migraine

Girl wearing immersive Virtual Reality mask.
Researchers sought to establish whether frequent use of a combined biofeedback-virtual reality device is associated with improvements in chronic migraine, especially in patients refractory to pharmacotherapy.

The following article is part of conference coverage from the 2022 American Academy of Neurology (AAN) Annual Meeting. Neurology Advisor’s staff will be reporting breaking news associated with research conducted by leading experts in neurology. Check back for the latest news from the 2022 AAN Annual Meeting.


The regular use of add-on biofeedback-virtual reality therapy in patients with chronic migraine significantly decreased the usage of acute medication, according to a randomized, controlled, 12-week pilot study presented at the 2022 American Academy of Neurology (AAN) Annual Meeting, held from April 2 to April 7 in Seattle, Washington, and virtually from April 24-26, 2022.

Recognizing that chronic migraine is a prevalent, disabling disorder, the researchers sought to establish whether frequent use of a combined biofeedback-virtual reality device is associated with improvements in chronic migraine, including number of headache days, frequency of acute medication use, migraine-related disability, depression (Patient Health Questionnaire-8 [PHQ-8]), anxiety (Perceived Stress Scale [PSS]), sleep disturbance (Patient-Reported Outcomes Measurement Information System [PROMIS]), and catastrophizing (Concerns About Pain [CAP]) — all of which were measured at weeks 0, 2, 4, 8, and 12.

They hypothesized that the utilization of biofeedback combined with virtual reality might be an efficacious treatment for patients with chronic migraine — particularly those who are refractory to pharmacotherapy. Medically refractory patients, per criteria of the American Headache Society or the European Headache Federation, were identified.

Biofeedback is a mind-body breathing technique that modulates the autonomic nervous system. Behavioral treatments such as biofeedback have been shown to decrease headache-associated outcomes in patients with episodic migraine by 35% to 55%.

A total of 50 patients aged 18 to 85 years with an ICHD-3 diagnosis of chronic migraine were recruited from the Headache Clinic at the University of Washington in Seattle. Participants were randomized to the intervention group (i.e., frequent use of biofeedback-virtual reality plus standard medical care) or to the wait-list control group (i.e., standard medical care alone), with 25 patients enrolled in each group of the study.

A statistically significant decrease in the frequency of acute medication use was reported in the intervention group vs control group individuals (55% vs 32%, respectively; P =.028). Although improvements were also observed in the other variables, those values were not statistically significant. The majority of patients (i.e., 69%) fulfilled the criteria for medically refractory migraine.

The researchers concluded that “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.”

Disclosure: None of the study authors has declared affiliations with biotech, pharmaceutical, and/or device companies.  


Cuneo A, Yang R, Wang K, et al. Utility of a novel, combined biofeedback-virtual reality tool as add-on treatment for chronic migraine. Presented at: the 2022 AAN Annual Meeting; April 2-7, 2022; Seattle, Washington; April 24-26, 2022; Virtual Meeting. Abstract S31.009.