Headaches as a Response to Neurofeedback Training

Introduction

Neurofeedback training is a non-invasive brain training technique that uses real-time feedback to help individuals regulate patterns of brain activity. By measuring electrical activity in the brain using electroencephalography (EEG), neurofeedback allows individuals to learn how to modify specific brainwave patterns associated with attention, relaxation, emotional regulation, and cognitive performance.

Neurofeedback is generally considered a safe and well-tolerated intervention, with research demonstrating positive outcomes across a range of populations, including individuals with attention difficulties, anxiety, sleep problems, and neurological conditions (Arns et al., 2009; Sitaram et al., 2017). However, as with any form of brain training, some individuals may experience temporary responses during the adaptation process.

One uncommon response reported by some clients undergoing neurofeedback is headaches. Although headaches are not considered a typical or expected outcome of neurofeedback, clinicians occasionally observe individuals experiencing mild headaches, pressure sensations, fatigue, or temporary discomfort, particularly during the early stages of training.

Understanding why headaches may occur, how long they last, and how they can be managed is important for both practitioners and clients.

Are Headaches a Common Response to Neurofeedback?

Current evidence suggests that headaches following neurofeedback training are uncommon and are not considered a typical adverse effect of intervention. Large clinical trials investigating the safety and effectiveness of neurofeedback generally report that most participants tolerate training well, with few significant adverse effects observed. For example, randomised controlled trials examining neurofeedback for children with ADHD have demonstrated that the intervention is generally safe and feasible, with participants completing multiple training sessions without major complications (Gevensleben et al., 2009; van Dongen-Boomsma et al., 2013).

However, clinical reports indicate that a small proportion of individuals may experience temporary responses during the adjustment period, including headache or head pressure, mental fatigue, drowsiness, changes in sleep patterns, increased emotional sensitivity, or temporary increases in anxiety or restlessness (Hammond and Kirk, 2008; Sherlin et al., 2011).

These experiences are typically mild and often improve as the individual adapts to training or when neurofeedback parameters, such as session duration or training intensity, are adjusted.

It is also important to recognise that headaches occurring during neurofeedback sessions may not always be directly caused by the training itself. Headache experiences are influenced by multiple factors, including pre-existing migraine susceptibility, stress levels, sleep quality, hydration status, prolonged screen exposure, eye strain, and sensitivity to visual or auditory feedback used during sessions. Therefore, practitioners should consider the individual’s overall health, lifestyle factors, and training environment when assessing headaches during neurofeedback rather than assuming that the symptoms are solely related to brain training (Hammond and Kirk, 2008; Sherlin et al., 2011).

Research Evidence on Neurofeedback-Related Headaches and Adverse Responses

Because headaches are uncommon, few studies have investigated them as a primary outcome. Instead, information comes from studies examining neurofeedback safety, adverse events, and clinical practice recommendations.

Types of Headaches Reported During Neurofeedback Training

Although headaches are considered an uncommon response to neurofeedback training, some individuals report experiencing mild head discomfort, pressure sensations, or fatigue-like symptoms during the early stages of training. Clinical discussions of neurofeedback adverse responses suggest that these experiences are usually nonspecific and may reflect differences in arousal regulation, cognitive demand, or sensitivity to training parameters rather than a distinct neurofeedback induced headache condition (Hammond and Kirk, 2008; Thompson and Thompson, 2003).

The experience of headaches during neurofeedback appears to vary considerably between individuals. Some clients may notice symptoms immediately following a session, while others may experience discomfort later in the day. The variability of responses is consistent with evidence showing that neurofeedback outcomes depend on individual characteristics, including baseline EEG patterns, learning ability, and responsiveness to feedback training (Sherlin et al., 2011; Sitaram et al., 2017).

Tension-Type Headaches and Head Pressure

The most described headache like response during neurofeedback resembles a tension type headache, where individuals report sensations of tightness, pressure, or heaviness around the forehead, temples, or back of the head. Although direct research investigating neurofeedback induced tension headaches is limited, these sensations may overlap with symptoms commonly associated with cognitive fatigue, sustained concentration, and increased muscle tension during demanding tasks (Hammond and Kirk, 2008).

During neurofeedback sessions, individuals learn to regulate patterns of brain activity through repeated feedback and reinforcement. This process involves attention, self-monitoring, and gradual adaptation, which may temporarily increase cognitive effort during early sessions (Sherlin et al., 2011; Sitaram et al., 2017).

Migraine-Like Symptoms and Sensory Sensitivity

A smaller number of individuals, particularly those with previous migraine history or sensory sensitivity, may report symptoms resembling migraine experiences. These may include sensitivity to light or sound, discomfort from visual stimulation, or headache sensations. Current neurofeedback research does not indicate that training causes migraine disorders; instead, individual susceptibility and environmental factors may influence whether discomfort occurs during sessions (Hammond and Kirk, 2008).

Because neurofeedback commonly involves visual and auditory feedback, individuals with sensory sensitivity may require adjustments to stimulation intensity or training conditions. Personalised protocols are therefore recommended to account for individual differences in neurological and sensory responses (Sherlin et al., 2011; Sitaram et al., 2017).

Mental Fatigue and Cognitive Overload

Some clients describe their experience not as a traditional headache, but as mental tiredness, pressure, or reduced concentration following a session. This may occur because neurofeedback involves active participation in a learning process requiring attention, reinforcement, and repeated attempts to modify brain activity patterns (Sherlin et al., 2011).

The brain adapts to repeated experiences through neuroplastic mechanisms, including changes in synaptic efficiency and functional organisation. Learning-based interventions can temporarily increase neural demand before improved efficiency develops through practice (Kleim and Jones, 2008; Zatorre et al., 2012).

Duration and Impact of Neurofeedback-Related Headaches

One of the most important considerations for clients and practitioners is how long headaches may last following neurofeedback training. When headaches occur following neurofeedback training, available clinical evidence suggests that they are usually temporary and tend to resolve after sessions or following adjustment of training parameters (Hammond and Kirk, 2008; Sherlin et al., 2011).

The duration of symptoms may depend on multiple factors, including individual sensitivity, protocol design, session intensity, baseline stress levels, sleep quality, and previous headache history. Neurofeedback is an individualised intervention, meaning that training parameters can be modified according to each person's response and tolerance (Sitaram et al., 2017).

Are Headaches More Common in Adults or Children?

Current evidence does not demonstrate that headaches occur more frequently in either adults or children undergoing neurofeedback. Most research examining neurofeedback safety has focused on children with ADHD and has generally reported good tolerability and few adverse effects (Gevensleben et al., 2009; van Dongen Boomssma et al., 2013).

Children and Adolescents

Children represent one of the largest populations studied in neurofeedback research, particularly in relation to ADHD. Randomised controlled trials investigating neurofeedback in children have generally reported minimal adverse effects, suggesting that headaches are not a common response among younger populations (Gevensleben et al., 2009; van Dongen-Boomsma et al., 2013).

However, children may experience or communicate discomfort differently from adults. Younger individuals may not always describe sensations such as pressure, fatigue, or discomfort clearly. Therefore, practitioners often rely on behavioural observations and feedback from both the child and caregivers to identify whether adjustments are needed.

Children also tend to demonstrate high neuroplasticity, meaning their brains are naturally undergoing significant developmental changes. This may allow them to adapt efficiently to neurofeedback training, although individual responses can still vary.

Adults

Adults may report headaches more frequently in clinical settings because of additional factors such as occupational stress, sleep disruption, prolonged screen exposure, and previous headache susceptibility. However, current evidence does not demonstrate that adults are biologically more vulnerable to neurofeedback related headaches (Hammond and Kirk, 2008; Sherlin et al., 2011).

Adults may have greater awareness of subtle bodily sensations and may be more likely to report changes following training. As with younger populations, headaches in adults are typically considered an uncommon and manageable response rather than a typical outcome of neurofeedback.

Potential Mechanisms Behind Headaches Following Neurofeedback

The exact mechanisms behind neurofeedback-related headaches remain unclear because research specifically examining this phenomenon is limited. However, several possible explanations have been proposed based on our understanding of brain regulation, learning, and sensory processing (Table 1).

Brain Adaptation and Changes in Neural Regulation

When the brain is repeatedly trained to regulate specific activity patterns, adaptations may occur within neural networks involved in attention, self-regulation, and cognitive control. For some individuals, this period of adaptation may temporarily require increased cognitive effort, potentially contributing to sensations of fatigue, mental strain, or head discomfort. Similar responses can occur during other forms of intensive learning, where initial effort and neural adaptation are followed by improved efficiency with continued practice (Kleim and Jones, 2008; Zatorre, Fields and Johansen-Berg, 2012).

Although headaches following neurofeedback training appear to be uncommon, understanding why they may occur is important for improving client experience and ensuring personalised treatment. At present, limited research has directly investigated the biological mechanisms responsible for neurofeedback-related headaches. However, clinical literature on neurofeedback adverse responses suggests that temporary discomfort may be associated with individual sensitivity, training parameters, changes in arousal regulation, and sensory factors involved in the training environment (Hammond and Kirk, 2008; Sherlin et al., 2011).

The occurrence of headaches is therefore unlikely to result from a single mechanism. Instead, it may reflect an interaction between individual differences in brain responsiveness, changes in neural regulation, protocol-specific factors, and external influences such as stress, sleep, or sensory stimulation. Careful monitoring and personalised adjustment of neurofeedback protocols are recommended to minimise unwanted responses and optimise training outcomes (Hammond and Kirk, 2008; Sitaram et al., 2017).

Table 1: Potential Mechanisms Contributing to Headaches During Neurofeedback Training

Strategies to Reduce and Manage Headaches During Neurofeedback

Although headaches are an uncommon response to neurofeedback training, recognising and managing them appropriately is an important aspect of clinical practice. Current evidence suggests that neurofeedback is generally well tolerated, and when discomfort occurs, it is usually temporary and can often be managed through individualised adjustments to training protocols (Arns et al., 2009; Sherlin et al., 2011).

Individualised Assessment

A personalised approach is essential for reducing unwanted responses during neurofeedback. Before starting training, practitioners should consider factors such as previous headache history, migraine susceptibility, sleep quality, stress levels, medication use, and individual EEG patterns. This allows training parameters to be selected according to the client’s needs rather than applying the same protocol to every individual (Hammond and Kirk, 2008).

Understanding a client’s baseline characteristics is particularly important because headaches may not always be caused by neurofeedback itself. Existing factors such as dehydration, poor sleep, stress, or a history of migraines may increase susceptibility to headaches during any cognitively demanding activity.

Monitoring Client Responses and Adjusting Protocols

Continuous monitoring is an important part of effective neurofeedback practice. Clients should be encouraged to report symptoms such as headaches, fatigue, changes in sleep, or increased emotional sensitivity following sessions.

When headaches occur, practitioners can modify different aspects of training, including the targeted frequency range, feedback thresholds, or session length. Clinical guidance highlights that protocol flexibility is important because individuals can respond differently to the same neurofeedback approach (Hammond and Kirk, 2008; Sherlin et al., 2011).

Optimising the Training Environment

Headaches experienced during neurofeedback sessions may also be influenced by environmental factors rather than changes in brain activity alone. Visual stimulation from computer screens, auditory feedback, prolonged concentration, and poor posture may contribute to discomfort, particularly in individuals who are sensitive to sensory input.

Creating a comfortable training environment, adjusting screen brightness, reducing unnecessary sensory stimulation, and ensuring appropriate positioning can help minimise these factors. This is particularly relevant for individuals with previous migraines or sensory sensitivity.

Supporting Healthy Brain Function Outside Training

Lifestyle factors can influence how individuals respond to neurofeedback. Adequate sleep, hydration, stress management, and regular nutrition support optimal brain function and may reduce susceptibility to headaches.

Sleep is especially important because it contributes to learning, memory consolidation, and neuroplasticity, all processes involved in adapting to neurofeedback training (Kleim and Jones, 2008). Supporting healthy routines alongside neurofeedback may therefore improve both comfort and training outcomes.

When Should Headaches Be Reviewed?

While mild and temporary headaches may occur during the adjustment period, persistent, severe, or worsening symptoms should be reviewed carefully. Practitioners should assess whether symptoms may be related to protocol settings, environmental factors, or unrelated health conditions.

A client-centred approach views headaches as useful feedback about how an individual is responding to training. By adjusting protocols and considering the wider context of the client’s health, practitioners can maintain both safety and effectiveness during neurofeedback training (Sherlin et al., 2011).

Conclusion

Neurofeedback is considered a safe and well-tolerated method of brain training, with research supporting its use across a range of clinical and cognitive applications. Although headaches may occasionally be reported by some individuals, they appear to represent an uncommon and usually temporary response rather than a typical consequence of training.

Current evidence suggests that headaches may arise from a combination of factors, including brain adaptation, changes in arousal regulation, sensory sensitivity, or the need for protocol adjustment. Importantly, research from clinical trials demonstrates that most individuals complete neurofeedback programmes without significant adverse effects.

By carefully monitoring client responses and tailoring training approaches, practitioners can minimise discomfort while supporting the brain’s ability to develop healthier patterns of regulation. Understanding uncommon responses such as headaches contributes to improving neurofeedback practice and ensuring that training remains safe, personalised, and effective.

This article was written by Hitashi Sharma

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References

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