Medical policy: Biofeedback as a Treatment of Headache

Policy number: MP 2.400

Effective date: 9/1/2026

Policy

Biofeedback may be considered medically necessary as part of the overall treatment plan for migraine and tension-type headache.

Biofeedback for the treatment of cluster headache is investigational. There is insufficient evidence to support a general conclusion concerning the health outcomes or benefits associated with this procedure for the above indications.

Unsupervised home use of biofeedback for treatment of headache is investigational. There is insufficient evidence to support a general conclusion concerning the health outcomes or benefits associated with this procedure for the above indications.

Cross-Reference:

• MP 1.033 Sacral Nerve Neuromodulation-Stimulation
• MP 2.029 Neurofeedback
• MP 2.062 Temporomandibular Disorder
• MP 2.064 Biofeedback as a Treatment of Chronic Pain
• MP 2.096 Electromyography (EMG) (Needle and Non-Needle) of the Anal or Urethral Sphincter
• MP 2.304 Medical Treatments of Autism Spectrum Disorders
• MP 2.398 Biofeedback as a Treatment of Fecal Incontinence or Constipation
• MP 2.399 Biofeedback as a Treatment of Urinary Incontinence in Adults
• MP 2.401 Biofeedback for Miscellaneous Indications
• MP 4.012 Injectable Bulking Agents for the Treatment of Urinary and Fecal Incontinence
• MP 6.020 Transcutaneous Electrical Nerve Stimulation and Transcutaneous Afferent Patterned Stimulation

Product variations

This policy is only applicable to certain programs and products administered by Capital Blue Cross and subject to benefit variations. Please see additional information below.

FEP PPO - Refer to FEP medical policy manual. The FEP medical policy manual can be found at: fepblue.org/benefit-plans/medical-policies-and-utilization-management-guidelines/medical-policies.

Description/Background

Biofeedback is intended to teach individuals self-regulation of certain physiologic processes not normally considered to be under voluntary control. The various forms of biofeedback mainly differ in the nature of the disease or disorder under treatment, the biologic variable that the subject attempts to control, and the information that is fed back to the subject.

Biofeedback techniques include peripheral skin temperature feedback, blood-volume-pulse feedback (vasoconstriction and dilation), vasoconstriction training (temporalis artery), and electromyographic biofeedback; they may be used alone or in conjunction with other therapies (eg, relaxation, behavioral management, medication). Biofeedback training is done either in individual or group sessions. A typical program consists of 10 to 20 training sessions of 30 minutes each.

Biofeedback has been proposed as a treatment for a variety of diseases and disorders, including anxiety, headaches, hypertension, movement disorders, incontinence, pain, asthma, Raynaud disease, and insomnia.

Headache Overview

Migraine, tension-type, and cluster headache are all primary headaches with distinct presentations. Migraine is characterized by intense, often localized, pain or throbbing usually accompanied by nausea, vomiting, light and/or sound sensitivity. Tension headache pain tends to be less intense and may be bilateral or encircle the head. Both migraine and tension-type headache are relatively common conditions. Cluster headache occurs less frequently. Subjects with cluster headache have brief but intensely painful attacks that occur multiple times per day. Cluster attacks may last days, weeks, or months.

Regulatory Status

A variety of biofeedback devices have been cleared for marketing by the U.S. Food and Drug Administration (FDA) through the 510(k) process. These devices are designated by the FDA as class II with special controls and are exempt from premarket notification requirements. The FDA defines a biofeedback device as “an instrument that provides a visual or auditory signal corresponding to the status of 1 or more of a patient's physiological parameters (eg, brain alpha wave activity, muscle activity, skin temperature, etc.) so that the patient can control voluntarily these physiological parameters.”

Evidence pertaining to the use of biofeedback for urinary incontinence is addressed in evidence review MP 2.399.

Evidence pertaining to the use of biofeedback for chronic pain is addressed in evidence review MP 2.064.

Evidence pertaining to the use of biofeedback for miscellaneous indications (treatment of hypertension, anxiety, asthma, movement disorders [eg, motor function after stroke, injury, or lower-limb surgery], and other applications) is addressed in evidence review MP 2.401.

Evidence pertaining to the use of biofeedback for fecal incontinence or constipation is addressed in evidence review MP 2.398.

Rationale

For individuals who have migraines or tension-type headaches who receive biofeedback, the evidence includes systematic reviews. Relevant outcomes are symptoms, functional outcomes, and quality of life. The literature, which includes meta-analyses of a large number of controlled and uncontrolled studies, has suggested that this treatment can reduce the frequency and/or severity of migraines and tension-type headaches. Biofeedback, along with other psychologic and behavioral techniques (eg, relaxation training) may be particularly useful for children, pregnant women, and other adults who are unable to take certain medications. The evidence is sufficient to determine that the technology results in an improvement in the net health outcome.

For individuals who have cluster headache who receive biofeedback, the evidence includes small case series and case reports. Relevant outcomes are symptoms, functional outcomes, and quality of life. No controlled trials were identified on biofeedback for cluster headache. The evidence is insufficient to determine that the technology results in an improvement in the net health outcome.

Definitions

Electromyogram (EMG): is the graphic record of resting and voluntary muscle activities as a result of electrical stimulation.

Physiologic: pertains to normal functions of the human body as opposed to pathological.

Disclaimer

Capital Blue Cross’ medical policies are used to determine coverage for specific medical technologies, procedures, equipment, and services. These medical policies do not constitute medical advice and are subject to change as required by law or applicable clinical evidence from independent treatment guidelines. Treating providers are solely responsible for medical advice and treatment of members. These policies are not a guarantee of coverage or payment. Payment of claims is subject to a determination regarding the member’s benefit program and eligibility on the date of service, and a determination that the services are medically necessary and appropriate. Final processing of a claim is based upon the terms of contract that applies to the members’ benefit program, including benefit limitations and exclusions. If a provider or a member has a question concerning this medical policy, please contact Capital Blue Cross’ Provider Services or Member Services.

Coding information

Note: This list of codes may not be all-inclusive, and codes are subject to change at any time. The identification of a code in this section does not denote coverage as coverage is determined by the terms of member benefit information. In addition, not all covered services are eligible for separate reimbursement.

Covered when medically necessary

*covered when BOTH psychotherapy & biofeedback are provided

Investigational; therefore, not covered:

References

1. Baraness L, Baker AM. Acute Headache. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; Updated July 26, 2023. Accessed September 24, 2025.
2. Food and Drug Administration. Biofeedback device. 21 CFR - 882.5050 (1998). Accessed September 22, 2025.
3. Ailani J, Burch RC, Robbins MS. The American Headache Society Consensus Statement: Update on integrating new migraine treatments into clinical practice. Headache. Jul 2021; 61(7): 1021-1039. PMID 34160823
4. Paudel P, Sah A. Efficacy of biofeedback for migraine: A systematic review and meta-analysis. Complement Ther Med. Jun 2025; 90: 103153. PMID 40064357
5. Nestoriuc Y, Martin A. Efficacy of biofeedback for migraine: a meta-analysis. Pain. Mar 2007; 128(1-2): 111-27. PMID 17084028
6. Nestoriuc Y, Rief W, Martin A. Meta-analysis of biofeedback for tension-type headache: efficacy, specificity, and treatment moderators. J Consult Clin Psychol. Jun 2008; 76(3): 379-96. PMID 18540732
7. Verhagen AP, Damen L, Berger MY, et al. Behavioral treatments of chronic tension-type headache in adults: are they beneficial?. CNS Neurosci Ther. 2009; 15(2): 183-205. PMID 19499626
8. Martino Cinnera A, Morone G, Bisirri A, et al. Headaches treatment with EMG biofeedback: a focused systematic review and meta-analysis. Eur J Phys Rehabil Med. Dec 2023; 59(6): 697-705. PMID 37823248
9. Arce Seaz D, Berring-Uldum AA, Deles NMM. Nonpharmacologic Treatment Options in Pediatric Tension-Type Headache Patients: A Systematic Review. J Child Neurol. Nov 2024; 39(13-14): 510-520. PMID 39252526
10. Stubberud A, Varkey E, McCrory DC, et al. Biofeedback as Prophylaxis for Pediatric Migraine: A Meta-analysis. Pediatrics. Aug 2016; 138(2). PMID 27462067
11. Association for Applied Psychophysiology and Biofeedback. Standards for Performing Biofeedback. 2013; Accessed September 24, 2025.
12. VA/DoD Clinical Practice Guideline. (2023). Management of Headache Work Group. Washington, DC: U.S. Government Printing Office. Accessed September 24, 2025.
13. Centers for Medicare & Medicaid Services. National Coverage Determination (NCD) for Biofeedback Therapy (30.1). n.d; Accessed September 24, 2025.