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Effectiveness of LORETA Z-score Neurofeedback in the treatment of headaches

J. Lucas Koberda,  Andrew Moses, Paula Koberda,Andrew Bienkiewicz,Laura Koberda,Jessica Winslow, Jeffrey Plante

TallahasseeNeuro-BalanceCenter,FL, USA. E-mail

ABSTRACT  Click HERE to see entire slide as PDF

Introduction: Z-score LORETA Neurofeedback (NFB) is a new form of EEG-biofeedback which has been a promising tool in the treatment of several neuropsychiatric symptoms. Prior published papers with quantitative electroencephalography (QEEG) reports indicated elevated beta power in patients suffering from chronic headaches. Previously 1-2 electrodes NFB was shown to be an effective treatment of patients suffering from chronic pharmaco-resistant migraines  EEG-biofeedback uses scalp recordings and delivers biofeedback based on feedback from the brain as well as surrounding tissue including scalp muscles. The aim of this study was to evaluate effectiveness of this form of therapy in the treatment of chronic headaches.

Materials and methods: Patients enrolled in this study included those with frequent migraines, chronic tension headaches and other head pains. The design of this study was to complete a QEEG before beginning NFB in order to conduct QEEG-guided biofeedback treatment. A QEEG was also completed after 10 sessions of NFB therapy to see if any objective improvement in reduction of over expressed beta power was noted. Most of the patients completed at least 10 sessions of NFB and the degree of subjective improvement (if any) was recorded. 

Results: 22 patients began this therapy, 2 dropped out before the study was completed. Eighty percent (80%) of patients (16 patients)  reported subjective improvement and 70% of subjects (14 patients) had both subjective and objective improvement (reduction of beta activity on QEEG). One patient diagnosed with chronic trigeminal neuralgia on chronic pregabalin (Lyrica) therapy was able to discontinue medication completely after just a few sessions due to pain resolution. Improvements in headaches lasting longer than 3 months were usually observed. An additional “refresher” NFB therapy was completed for those patients who subsequently experienced reoccurrence of headaches.

Conclusions: This study indicates  the effectiveness of Z-score LORETA NFB in pain reduction of chronic headaches sufferers. Further, a randomized double blinded study may be beneficial for further investigation of effectiveness of this type of therapy.


Quantitative electroencephalography (QEEG) and LORETA has been underutilized in general neurology practice.
-Most neurologist are not familiar with QEEG therefore, QEEG has had very limited application in general neurology practice.
-Recent advances in computer technology have made QEEG testing relatively inexpensive and likely cost-effective (approximate USA insurance payment - $ 300).
-QEEG is based on mathematical processing of 2-5 minutes of selected fragments of standard EEG recording which is able to condense the EEG data to one page color-coded summary. LORETA (Low Resolution Electromagnetic Tomography Analysis)-is a 3D mathematical transformation of QEEG data enabling relatively precise 7-10 mm localization of dysfunction (developed in the Key Institute-Zurich).This gives a neurologist unprecedented ability to look at summarized EEG information which was not previously possible with regular EEG. 

This is the analysis of chronic headache cases who underwent Z-Score LORETA Neurofeedback in our practice. A commercially available QEEG software (Neuroguide, Inc.) was used for EEG and LORETA analysis.TruScan (Deymed, Inc.) EEG amplifier, software and caps were used for a EEG acquisition.