Cognitive Behavioral Therapy and Biofeedback for Chronic Headache: Effects on Pain Catastrophizing, Sleep Quality, and Disability.

To compare the effectiveness of Cognitive Behavioral Therapy (CBT), Biofeedback and their combination on pain catastrophizing, sleep quality, and headache-related disability among patients with chronic daily headache (CDH).In a randomized controlled trial conducted at a tertiary care hospital in North India, 100 patients diagnosed with CDH were randomly assigned to four groups: CBT (n = 25), Biofeedback (n = 25), Combined CBT + Biofeedback (n = 25) and Treatment-as-Usual (TAU; n = 25). Assessments were conducted at baseline, post-intervention, and at a 2-month follow-up using the Pain Catastrophizing Scale (PCS), Pittsburgh Sleep Quality Index (PSQI) and Migraine Disability Assessment Scale (MIDAS). Significant time effects were observed for all outcomes-pain catastrophizing (F = 147.39, p < .001, η 2 ₚ = 0.67), sleep quality (F = 92.68, p < .001, η 2 ₚ = 0.56), and headache-related disability (χ 2 = 99.10, p < .001). Time × group interactions were also significant for PCS (p = .026) and PSQI (p = .048), indicating differential patterns of improvement across interventions. Post-hoc analyses revealed that the combined CBT + BFB group showed the greatest and most sustained improvements in pain catastrophizing and sleep quality. Headache-related disability decreased significantly in all intervention groups. CBT and Biofeedback are effective psychological interventions for managing chronic headache, with their integration producing superior and sustained outcomes. The findings highlight the utility of multimodal interventions that target both cognitive-emotional and physiological processes in chronic headache management.