Factors Associated with Patient Adherence to Biofeedback Therapy Referral for Migraine: An Observational Study

Abstract

Abstract Background Biofeedback has Grade A evidence for the treatment of migraine, yet few studies have examined the factors associated with patients' decisions to pursue biofeedback treatment recommendations. Objective To examine reasons for adherence or non-adherence to referral to biofeedback therapy. Methods Patients with migraine who had been referred for biofeedback by a headache specialist/behavioral neurologist were interviewed in person or via Webex. Patients completed a questionnaire addressing demographics and questions related to their headache histories. At one month, patients were asked if they had pursued the recommendation for biofeedback therapy, their reasons for their decision, and their impressions about biofeedback for those who pursued it. Results Of the nearly two-thirds (65%; 33/51) of patients who responded at one month, less than half (45%, 15/33) had contacted biofeedback providers, and only 18% (6/33) were able to participate in biofeedback. Common themes emerged in patients who did not pursue biofeedback, including feeling that they did not have time, endorsing financial obstacles, including treatment cost and/or insurance coverage, and finding it too difficult to schedule an appointment due to limited provider availability. When asked about their preference between a physical therapist or psychologist as a biofeedback provider, responses were mixed; many patients indicated no preference so long as they took insurance and/or were experienced, while others indicated a specific preference for a physical therapist or psychologist due to familiarity, or prior experiences with that kind of provider. Conclusion Patients with migraine referred for biofeedback therapy face numerous obstacles to pursuing treatment.