Galvanic skin resistance (GSR) biofeedback in tension-type headache – Auditory, visual or combined feedback: Which is beneficial? A randomized controlled trial

Abstract Background: The efficacy of electromyograph (EMG) biofeedback (BF) in the treatment of tension-type headaches (TTH) has been extensively studied, but very few studies have been done comparatively to study efficacy of galvanic skin resistance (GSR) BF. Moreover, no studies have reported the efficacy of isolated audio, visual and combined GSR BF in TTH. Objectives: The present study aimed at studying the efficacy of GSR BF using auditory, visual and combined feedback in patients with TTH. Design: Randomized, controlled study. Participants, settings: 143 subjects were recruited. Of these, 121 subjects (76 females and 45 males) were randomly assigned using the lottery method to four groups receiving auditory (n = 30), visual (n = 30), combined GSR BF (n = 30) and control group (n = 31), respectively. Intervention: Each subject (except control group) received 15 sessions of BF for 30 min each in an isolated room in the physiotherapy outpatient department. The control group received only medication prescribed by their physician. No blinding was followed. Outcome measures: Pain variables, consumption of analgesics and 36-item Short Form health survey (SF-36) quality-of-life scores were recorded at baseline and 6 months after therapy. Results: Repeated-measures analysis of variance at baseline and 6 months showed significant differences in frequency (p = 0.01), duration (p < 0.001) and intensity (p < 0.001) in the GSRav group with insignificant differences in the control group except intensity (p < 0.001). All four groups showed significant improvement in total, physical and mental SF-36 scores after 6 months except mental score in the control group (p = 0.06). An insignificant drop in analgesic usage was seen in all groups after 6 months. Conclusion: All three forms of GSR were effective in treatment of TTH and improving the quality of life of TTH patients. Combined GSR BF seems to have slightly more effectiveness compared with isolated auditory or visual feedback.