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Startseite > Forschung > Publikationen / Publications > Niederberger

Dr. Niederberger


Grill, S., Yahiaoui-Doktor, M., Basrai, M., Struck, J., …, Niederberger, U., …, & Kiechle, M. (2021). Precursor fractions of neurotensin and enkephalin might point to molecular mechanisms of cancer risk modulation during a lifestyle-intervention in germline BRCA1/2 gene mutation carriers. Breast cancer research and treatment, 186(3), 741–752. PMID:33543354, doi:10.1007/s10549-020-06070-x.

BACKGROUND Germline BRCA1/2 mutation carriers (gBMC) face increased cancer risks that are modulated via non-genetic lifestyle factors whose underlying molecular mechanisms are unknown. The peptides Neurotensin (NT) and Enkephalin (ENK)-involved in tumorigenesis and obesity-related diseases-are of interest. We wanted to know whether these biomarkers differ between gBMC and women from the general population and what effect a 1-year lifestyle-intervention has in gBMC. METHODS The stable precursor fragments pro-NT and pro-ENK were measured at study entry (SE), after 3 and 12 months for 68 women from LIBRE-1 (a controlled lifestyle-intervention feasibility trial for gBMC involving structured endurance training and the Mediterranean Diet). The SE values were compared with a cohort of the general population including female subjects with and without previous cancer disease, non-suggestive for hereditary breast and ovarian cancer (OMA-reference). For LIBRE-1, we analysed the association between the intervention-related change in the two biomarkers and certain lifestyle factors. RESULTS At SE, gBMC had a higher median pro-NT than OMA-reference (in the subgroups with previous cancer 117 vs. 91 pmol/L, p = 0.002). Non-diseased gBMC had lower median pro-ENK levels when compared to the non-diseased reference group. VO2peak and pro-NT 1-year change in LIBRE-1 were inversely correlated (r = - 0.435; CI - 0.653 to - 0.151; p = 0.004). Pro-ENK correlated positively with VO2peak at SE (r = 0.323; CI 0.061-0.544; p = 0.017). Regression analyses showed an inverse association of 1-year changes for pro-NT and Omega-6/Omega-3 (Estimate: - 37.9, p = 0.097/0.080) in multivariate analysis. CONCLUSION Our results give first indications for lifestyle-related modification particularly of pro-NT in gBMC.

Kropp, P., Niederberger, U., & Dresler, T. (2021). Wirkungsweise und Anwendung des Biofeedbacks am Beispiel von Kopfschmerzen. Psychotherapeut. doi:10.1007/s00278-021-00499-1.
Neirich, L., Yahiaoui-Doktor, M., Lammert, J., Basrai, M., …, Niederberger, U., …, & Grill, S. (2021). Physical activity and Mediterranean diet as potential modulators of osteoprotegerin and soluble RANKL in gBRCA1/2 mutation carriers: results of the lifestyle intervention pilot study LIBRE-1. Breast Cancer Research and Treatment. doi:10.1007/s10549-021-06400-7.

Purpose Emerging evidence suggests that the progesterone-mediated receptor activator of nuclear factor $\kappa$B (RANK)/soluble RANK ligand (sRANKL)/osteoprotegerin (OPG) pathway plays an important role in mammary carcinogenesis and is hyperactivated in germline (g)BRCA1/2 mutation carriers. We analyzed the effects of a 3-month intensive lifestyle intervention within the LIBRE-1 study on the serum levels of OPG and sRANKL and hypothesized that the intervention program provides a beneficial impact on the biomarkers by increasing OPG and reducing sRANKL serum concentrations. Methods Serum levels of OPG and sRANKL of 49 gBRCA1/2 mutation carriers were quantified using enzyme-linked immunosorbent assays. We used previously collected blood samples from participants of the prospective LIBRE-1 study, who were randomized into an intervention group (IG), increasing physical activity and adherence to the Mediterranean diet (MedD) through supervised sessions from study entry to the first study visit after 3 months and a usual-care control group (CG). Differences in biomarker levels before and after the 3-month intervention were tested within and between study groups. Results The lifestyle intervention resulted in a significant increase in OPG for participants in both the IG (q = 0.022) and CG (q = 0.002). sRANKL decreased significantly in the IG (q = 0.0464) and seemed to decrease in the CG (q = 0.5584). An increase in the intake of Omega-3 polyunsaturated fatty acids was significantly associated with an increase in OPG (r = 0.579, q = 0.045). Baseline serum levels of sRANKL were a strong predictor for the change of sRANKL in the course of the intervention ({\ss}-estimate = − 0.70; q = 0.0018). Baseline physical fitness (assessed as VO2peak) might predict the change of OPG in the course of the intervention program ({\ss}-estimate = 0.133 pg/ml/ml/min/kg; p = 0.0319; q = 0.2871). Conclusion Findings from this pilot study seem to confirm our hypothesis by showing an increase in OPG and decrease in sRANKL over a 3-month lifestyle intervention and suggest that increased physical activity and adherence to the MedD are potent modulators of the biomarkers OPG and potentially sRANKL.


Gerber, W.-D., Niederberger, U., & Siniatchkin, M. (2020). Schmerzen. In Petermann, F. (Ed.), Entspannungsverfahren (pp. 253–267). Weinheim: Beltz.
Göbel, C. H., Göbel, A., Niederberger, U., Heinze, A., …, & Göbel, H. (2020). Occipital Nerve Stimulation in Chronic Migraine: The Relationship Between Perceived Sensory Quality, Perceived Sensory Location, and Clinical Efficacy—A Prospective, Observational, Non-Interventional Study. Pain Ther., 9(2), 615–626. PMID:32910427, doi:10.1007/s40122-020-00194-0.

INTRODUCTION: Occipital nerve stimulation (ONS) is used to treat therapy-resistant chronic migraine. Clinical use has resulted in a wide intraindividual and interindividual variation of clinical efficacy. The aim of this study was to analyze a potential relationship between sociodemographic variables, headache parameters, perceived sensory quality, perceived sensory location, as well as clinical efficacy. METHODS: Thirty-two subjects (21.9% male, mean age 45.77 years) suffering from chronic migraine refractory to other treatment and therefore treated with ONS were included in this study. We used a computer-based imaging method for mapping the ONS-induced perceived sensory location, the perceived spatial sensory field size, as well as the perceived sensory quality in a long-term course over 21 months in weekly time intervals. Additionally, the effect of ONS on the migraine headache was documented weekly by the participants using a verbal rating scale. Over the observation period, a total of 808 individual weekly data sets were recorded and a potential relationship between ONS-induced perceptions and headache parameters could be analyzed. RESULTS: We found that 48.9% of stimulation intervals were reported as effective by patients. Women displayed a significantly higher responder rate than men. The reported effectiveness did not differ depending on age, the average number of migraine days per month, the MIDAS score, or the duration of the migraine disorder prior to ONS treatment. Implantation with trial period led to significantly lower responder rates than without the trial period. The most frequently perceived sensory quality of "tingling" was found significantly more frequently in non-responders than in responders. Responders displayed significantly lower pleasantness scores for their reported perceptions than non-responders. Sensations that were spatially perceived above the line connecting the external acoustic meati with the external occipital protuberance (MOP line) led to patients reporting a positive clinical effect significantly more frequently than sensations spatially perceived below the MOP line. Spatially small fields of sensory perception were correlated with a higher responder rate than those covering broader areas. CONCLUSIONS: The ONS-induced sensory location, the size of the spatial sensory field, as well as the sensory quality are significantly correlated with the reported clinical effectiveness. The results suggest that besides surgical technique, the individual and continuous programming of the stimulation parameters is clinically relevant in increasing the therapeutic effectiveness.


Haselbeck, C., Niederberger, U., Gubi-Kelm, S., Jahn, F., …, & Siniatchkin, M. (2019). Secure attachment style appears to compensate for the effect of prenatal maternal distress regarding difficult infant temperament development. Z. Kinder. Jugendpsychiatr. Psychother., 47(3), 239–251. PMID:30080118, doi:10.1024/1422-4917/a000606.

Objective: Secure attachment style is a known protective factor regarding psychopathological development. The infant's attachment style, which is developed during the first two years of life, is therefore considered a moderating factor on the association between prenatal maternal distress and child temperament development which has repeatedly been reported in previous studies. Method: In this longitudinal study on a new sample of 51 mother-child-dyads, reported maternal distress and maternal empathy were assessed during pregnancy. Infant temperament and motor development were assessed at 12 months, while additionally controlling for the infant's attachment style as a postnatal factor. Results: Infants with secure attachment style whose mothers had experienced higher prenatal distress showed slightly better gross motor development at the age of 12 months. No association could be found between prenatal maternal distress and infant temperament. Conclusions: The results support the view that secure attachment style in children is a protective factor and softens the effects of prenatal maternal distress on difficult temperament development.


Kowalski, J. T., Falkenhagen, F., Radtke, Y., Niederberger, U., …, Darabaneanu, S., …, & Siniatchkin, M. (2018). Contingent negative variation in acute trauma patients: A prospective exploratory study. Biol. Psychol., 138, 126–132. PMID:30205130, doi:10.1016/j.biopsycho.2018.09.001.

It is still unclear why some individuals completely recover after an acute trauma and others develop a long-lasting post-traumatic stress disorder (PTSD). This study investigates whether the contingent negative variation (CNV) - a slow negative event-related potential - may be associated with the occurrence of PTSD after acute trauma. CNV (auditory 2-stimulus reaction time paradigm) was recorded within one month as well as 6 months after an acute trauma (dangerous or grave physical injuries, witnessing of attempted suicide or murder, robbery, extortion, accidents, heavy illness, death or loss of an important person, hostage-taking) in 39 otherwise healthy adults and compared with CNV recordings in 38 healthy control subjects without potentially traumatizing experience in their history. According to their subsequent clinical course, these subjects were divided into two groups: participants who recovered completely 1 month after the trauma (PTSD- group, n = 31), and those who began to experience PTSD (PTSD+ group, n = 8). Patients from both trauma groups were characterized by a significantly longer reaction time immediately after the trauma. The PTSD+ group demonstrated lower amplitudes of the late CNV component immediately and six months after the trauma compared with the PTSD- and the control group. Whether the lower CNV amplitudes in patients who develop PTSD after the acute trauma, which is already present in the first days after the trauma, may be related to a higher risk for development of PTSD in these subjects, this has to be clarified in further prospective studies.


Haselbeck, C., Niederberger, U., Kulle, A., Wache, K., …, & Siniatchkin, M. (2017). Prenatal maternal distress seems to be associated with the infant's temperament and motor development: an explorative study. J. Neural Transm., 124(7), 881–890. PMID:28361282, doi:10.1007/s00702-017-1712-0.

According to the concept of fetal programming, prenatal distress has long-lasting consequences on the offspring's health later in life. The hypothalamic-pituitary-adrenal axis is considered a mediating system by which maternal distress is transferred to the fetus in intrauterine environment. In this longitudinal explorative study on 30 mother-child-dyads, reported maternal distress and salivary cortisol were collected during pregnancy. Infant temperament, motor and cognitive development were assessed at 16 months. Additionally, infant cortisol levels throughout the day and in reaction to a psycho-social stressor where measured. As expected, infants whose mothers had experienced higher prenatal distress expressed a more difficult temperament and lower fine motor development at 16 months. No association could be shown between prenatal maternal distress and infant salivary cortisol.

Kiechle, M., Dukatz, R., Yahiaoui-Doktor, M., Berling, A., …, Niederberger, U., …, Siniatchkin, M., …, & Engel, C. (2017). Feasibility of structured endurance training and Mediterranean diet in BRCA1 and BRCA2 mutation carriers – an interventional randomized controlled multicenter trial (LIBRE-1). BMC Cancer, 17(1), 752. PMID:29126396, doi:10.1186/s12885-017-3732-4.

BACKGROUND: Women with pathogenic BRCA germline mutations have an increased risk for breast and ovarian cancer that seems to be modified by life-style factors. Though, randomized trials investigating the impact of lifestyle interventions on cancer prevention and prognosis in BRCA carriers are still missing. METHODS: We implemented a multicenter, prospective randomized controlled trial in BRCA1/2 patients, comparing a lifestyle intervention group (IG) with a control group (CG) with the primary aim to prove feasibility. Intervention comprised a structured, individualized endurance training alongside nutrition education based on the Mediterranean diet (MD) for 3 months, plus monthly group training and regular telephone contact during the subsequent 9 months. The CG attended one session on healthy nutrition and the benefits of physical activity. Primary endpoints were feasibility, acceptance and satisfaction over 12 months. Furthermore, effects on physical fitness, diet profile, body mass index (BMI), quality of life and perceived stress were investigated. RESULTS: Sixty-eight participants (mean age 41, mean BMI 23.2 kg/m(2)) were enrolled, of whom 55 (81%, 26 IG, 29 CG) completed 12 months. 73% (n = 26) participated in at least 70% of all intervention sessions. Predictors for drop-outs (19%; n = 13) or non-adherence (27%; n = 7) were not found. 73% rated the program highly and 80% would participate again. Severe adverse events did not occur. Positive effects in the IG compared to the CG were observed for secondary endpoints: BMI, MD eating pattern and stress levels. CONCLUSIONS: This lifestyle intervention was feasible, safe and well accepted. Positive results on eating habits, physical fitness and stress levels warrant a larger randomized trial. TRIAL REGISTRATION: The study has been retrospectively registered at (reference: NCT02087592 ) on March 12, 2014. The first patient was included on February 24, 2014.

Kropp, P., Meyer, B. M., Dresler, T., Fritsche, G., …, Niederberger, U., …, & Straube, A. (2017). Entspannungsverfahren und verhaltenstherapeutische Interventionen zur Behandlung der Migräne. Der Schmerz, 31(5), 433–447. PMID:28364171, doi:10.1007/s00482-017-0214-1.

Besides pharmacological and interventional possibilities nonpharmacological options, deriving from behavioural approaches may be helpful in the treatment of migraine. Already consulting a patient reduces frequency of attacks. Relaxation (especially progressive muscle relaxation), endurance sports, and biofeedback as well as cognitive behavioural therapy are effective in treatment of migraine. The combination of these treatment options also with pharmacological treatment increase the positive effects.

Kropp, P., Niederberger, U., & Dresler, T. (2017) Eichenberg, C., Brähler, E., & Hoefert, H.-W. (Eds.). Selbstbehandlung und Selbstmedikation. Göttingen: Hogrefe.Meyer, B. M., Niederberger, U., Sorgenfrei, V., & Kropp, P. (2017). Kopfschmerz unter (Selbst-)kontrolle. MMW - Fortschritte der Medizin, 159(2), 62–65. PMID:28168463, doi:10.1007/s15006-017-9221-5.


Kiechle, M., Engel, C., Berling, A., Hebestreit, K., …, Siniatchkin, M., …, Niederberger, U., …, & Halle, M. (2016). Lifestyle intervention in BRCA1/2 mutation carriers: study protocol for a prospective, randomized, controlled clinical feasibility trial (LIBRE-1 study). Pilot Feasibility Stud., 2(1), 74. PMID:25465289, doi:10.1186/s40814-016-0114-7.

BACKGROUND: Migraine is a disorder of central information processing which is characterized by a reduced habituation of event-related potentials. There might be positive effects of aerobic exercise on brain function and pain. The aim of this study was to investigate the influence of exercise on information processing and clinical course of migraine. METHODS: 33 patients completed a ten-week aerobic exercise programme. To examine the influence of the treatment on information processing and attention, Trail Making Test (TMT) A and B, d2-Letter Cancellation Test (LCT) and recordings of the Contingent Negative Variation (CNV) were performed before and after the training. RESULTS: Patients showed a significant reduction of the migraine attack frequency, the iCNV-amplitude and the processing time for TMT-A and TMT-B after treatment. Moreover, there was a significant increase of the habituation and positive changes in parameters of attention (d2-LCT) after the training. CONCLUSIONS: This study demonstrates that aerobic exercise programme influences central information processing and leads to clinical effects on the migraine symptomatology. The results can be interpreted in terms of an improvement of a dysfunctional information processing and a stimulus selection under aerobic exercise.

Gassling, V., Receveur, K., Niederberger, U., Koos, B., …, & Siniatchkin, M. (2016). No deficit in neurocortical information processing in patients with cleft lip and palate. Clin. Oral Investig., 20(1), 23–30. PMID:25832360, doi:10.1007/s00784-015-1465-9.

BACKGROUND: Cleft lip and palate (CLP) represents the most common malformation of the midfacial region worldwide. It can be suggested that the facial stigmatization, the speech impediment, and the long-standing pressure of treatment cause a range of life stressors. Neurocortical information is influenced by physiological and psychological factors and varies significantly in patients suffering from chronic stress, anxiety, depression, or other psychopathological conditions following maladaptation. The aims of the present study were to investigate the neurocortical information processing of patients with CLP using the contingent negative variation (CNV) paradigm and to evaluate secondary psychopathology, anxiety, and depression. MATERIALS AND METHODS: Twenty-five adults with CLP and 25 healthy volunteers, matched in age and gender, were investigated using recordings of the CNV. Initial CNV (iCNV), late CNV (lCNV), and total CNV (tCNV) as well as habituation slope of the iCNV were determined in each subject. Additionally, each participant had to complete the hospital anxiety and depression questionnaire (HADS) and the Symptom Checklist-90-R (SCL-90-R). RESULTS: Individuals with CLP did not differ significantly from healthy subjects according to any of the CNV parameters investigated. No correlations could be revealed between the measured items and the confounding factors age and gender. Additionally, there were no differences between the groups regarding depression and SCL-90-R; however, anxiety showed significant group differences on a subclinical level. CONCLUSIONS: These data suggest that subjects with CLP show normal neurocortical information processing. It seems likely that CLP and its treatment have no impact on psychosocial functioning and neurophysiological mechanisms of attention. CLINICAL RELEVANCE: The specific living conditions of patients with CLP do not result in disease-specific neurophysiological changes.

Kiechle, M., Engel, C., Berling, A., Hebestreit, K., …, Siniatchkin, M., …, Niederberger, U., …, & Halle, M. (2016). Effects of lifestyle intervention in BRCA1/2 mutation carriers on nutrition, BMI, and physical fitness (LIBRE study): study protocol for a randomized controlled trial. Trials, 17(1), 368. PMID:27473440, doi:10.1186/s13063-016-1504-0.

BACKGROUND: Women with highly penetrant BRCA mutations have a 55-60 % lifetime risk for breast cancer and a 16-59 % lifetime risk of developing ovarian cancer. However, penetrance differs interindividually, indicating that environmental and behavioral factors may modify this risk. It is well documented that the risk for sporadic breast cancer disease can be modified by changing lifestyle factors that primarily include physical activity, dietary habits, and body weight. It can thus be hypothesized that the modification of these lifestyle factors may also influence the incidence and progression of cancer in BRCA mutation carriers. METHODS/DESIGN: This multicenter, interdisciplinary, prospective, two-armed, randomized (1:1) controlled trial aims to enroll a minimum of 600 BRCA1 and BRCA2 mutation carriers to partake in either a lifestyle intervention or usual care. The study primarily aims to demonstrate an improvement of nutritional behavior (adherence to the Mediterranean diet), body mass index, and physical fitness. Furthermore, the effects on quality of life, stress coping capacity, breast cancer incidence, and mortality will be investigated. The intervention group (IG) will receive a structured lifestyle intervention over 12 months, whereas the control group (CG) will only receive information regarding a healthy lifestyle. During the first 3 months, women in the IG will receive structured, individualized, and mainly supervised endurance training with a minimum of 18 MET-h physical activity per week and nutrition education based on the Mediterranean diet. Over the following 9 months, IG monthly group training sessions and regular telephone contacts will motivate study participants. The CG will receive one general training session about healthy nutrition in accordance with the recommendations of the German Society of Nutrition (standard of care in Germany) and the benefits of regular physical activity on health status. At randomization and subsequent time points (3 and 12 months), cardiopulmonary fitness will be assessed by spiroergometry, and nutritional and psychological status will be assessed by validated questionnaires, interviews, and clinical examinations. DISCUSSION: As data on the role of lifestyle intervention in women with a hereditary risk for breast and ovarian cancer are currently lacking, this study will be of major importance from a scientific, as well as a practical advice viewpoint. It will investigate the optimal strategy to improve physical fitness, nutritional status, and psychological factors such as quality of life, perceived stress, optimism, as well as incidence and outcome of cancer in this selected group of women at high risk. If the study indicates a positive long-term outcome, a structured lifestyle intervention program could be added to health care prevention strategies for BRCA1 and BRCA2 mutation carriers. TRIAL REGISTRATION: NCT02516540 . Registered on 22 July 2015.

Meyer, B., Niederberger, U., & Kropp, P. (2016). Entspannungsverfahren. In Gaul, C., & Diener, H. C. (Eds.), Kopfschmerzen (pp. 242–244). Stuttgart: Georg Thieme Verlag.Meyer, B., Niederberger, U., & Kropp, P. (2016). 28 Biofeedback. In Gaul, C., & Diener, H. C. (Eds.), Kopfschmerzen (pp. 242–243). Stuttgart: Georg Thieme Verlag.


Göbel, A., Göbel, C. H., Heinze, A., Heinze-Kuhn, K., …, Niederberger, U., …, & Göbel, H. (2015). No TitleRelationship between induced cognitive and affective qualities of sensation and clinical effects of occipital nerve stimulation in the treatment of chronic migraine. Cephalalgia, 35.Göbel, A., Göbel, C. H., Heinze, A., Heinze-Kuhn, K., …, Niederberger, U., …, & Göbel, H. (2015). Optimizing treatment effects of occipital nerve stimulation by adjusting stimulation parameters in the treatment of chronic migraine. Cephalalgia, pp. 58–59.
Göbel, A., Göbel, C. H., Heinze, A., Heinze-Kuhn, K., …, Niederberger, U., …, & Göbel, H. (2015). Imaging Sensory Effects of Occipital Nerve Stimulation: A New Computer-based Method in Neuromodulation. Brain Stimul., 8(2), 295–298. PMID:25465289, doi:10.1016/j.brs.2014.09.019.

BACKGROUND: Within the last years, occipital nerve stimulation (ONS) has proven to be an important method in the treatment of severe therapy-resistant neurological pain disorders. The correspondence between lead placement as well as possible stimulation parameters and the resulting stimulation effects remains unclear. OBJECTIVE: The method aims to directly relate the neuromodulatory mechanisms with the clinical treatment results, to achieve insight in the mode of action of neuromodulation, to identify the most effective stimulation sets and to optimize individual treatment effects. METHODS: We describe a new computer-based imaging method for mapping the spatial, cognitive and affective sensory effects of ONS. The procedure allows a quantitative and qualitative analysis of the relationship between lead positioning, the stimulation settings as well as the sensory and clinical stimulation effects. CONCLUSION: A regular mapping of stimulation and sensory parameters allows a coordinated monitoring. The stimulation results can be reviewed and compared with regards to clinical effectiveness.

Göbel, C. H., Clasen, S., Göbel, A., Heinze, A., …, Niederberger, U., …, & Göbel, H. (2015). Effect of occipital nerve stimulation on central pain processing in patients with chronic migraine. Cephalalgia, 35(13).


Göbel, A., Göbel, C., Heinze, A., Niederberger, U., …, & Göbel, H. (2014). EHMTI-0378. Imaging sensory effects of occipital nerve stimulation: a new computer-based method in neuromodulation. J. Headache Pain, 15(S1), K4. doi:10.1186/1129-2377-15-S1-K4.Kropp, P., Dresler, T., & Niederberger, U. (2014). Psychosomatik der Kopfschmerzen. Psychotherapeut, 59(1), 57–71. doi:10.1007/s00278-013-1028-y.
Overath, C. H., Darabaneanu, S., Evers, M. C., Gerber, W.-D., …, Niederberger, U., …, Siniatchkin, M., & Weisser, B. (2014). Does an aerobic endurance programme have an influence on information processing in migraineurs? J. Headache Pain, 15(1), 11. PMID:24528557, doi:10.1186/1129-2377-15-11.

BACKGROUND: Migraine is a disorder of central information processing which is characterized by a reduced habituation of event-related potentials. There might be positive effects of aerobic exercise on brain function and pain. The aim of this study was to investigate the influence of exercise on information processing and clinical course of migraine. METHODS: 33 patients completed a ten-week aerobic exercise programme. To examine the influence of the treatment on information processing and attention, Trail Making Test (TMT) A and B, d2-Letter Cancellation Test (LCT) and recordings of the Contingent Negative Variation (CNV) were performed before and after the training. RESULTS: Patients showed a significant reduction of the migraine attack frequency, the iCNV-amplitude and the processing time for TMT-A and TMT-B after treatment. Moreover, there was a significant increase of the habituation and positive changes in parameters of attention (d2-LCT) after the training. CONCLUSIONS: This study demonstrates that aerobic exercise programme influences central information processing and leads to clinical effects on the migraine symptomatology. The results can be interpreted in terms of an improvement of a dysfunctional information processing and a stimulus selection under aerobic exercise.


Fritsche, G., Kröner-Herwig, B., Kropp, P., Niederberger, U., & Haag, G. (2013). Psychologische Therapie der Migräne. Der Schmerz, 27(3), 263–274. PMID:23685993, doi:10.1007/s00482-013-1319-9.

This review summarizes the various forms of behavioral treatment of migraine which could demonstrate empirical efficacy. The main unimodal kinds of treatment are thermal and electromyography (EMG) biofeedback training and progressive muscle relaxation. The various relaxation techniques do not differ in their efficacy in treating migraine. On average a reduction in migraine frequency of 35-45 % is achieved. The mean effect sizes (ES) of various biofeedback techniques are between 0.4 and 0.6. Cognitive-behavioral treatment is applied as a multimodal treatment and on average achieves an improvement in migraine activity by 39 % and an ES of 0.54. All behavioral procedures can be used in combination or as an alternative to drug prophylaxis with comparable success. A combination of pharmacological and behavioral treatment can achieve additional success. There is strong evidence for the clinically significant efficacy of all forms of behavioral treatment in childhood and adolescence. There are no signs of differential indications.

Haselbeck, C., Kulle, A., Niederberger, U., Bergmann, T. O., …, & Gerber, W.-D. (2013). Fötale Programmierung. Kindheit und Entwicklung, 22(4), 224–231. doi:10.1026/0942-5403/a000121.

Entsprechend dem Konzept der F{\"{o}}talen Programmierung wirkt sich pr{\"{a}}nataler Stress nachhaltig auf die Gesundheit des Nachk{\"{o}}mmlings aus. Die Hypothalamus-Hypophysen-Nebennierenrinden-Achse wird als eine mediierende Struktur angenommen, {\"{u}}ber welche sich m{\"{u}}tterlicher Stress in der intrauterinen Umwelt auf den F{\"{o}}tus auswirkt. In der vorliegenden Studie wurde an 46 Mutter-Kind-Paaren die berichtete m{\"{u}}tterliche Stressbelastung und Kortisolaussch{\"{u}}ttung w{\"{a}}hrend der Schwangerschaft erfasst. Im Alter von f{\"{u}}nf Monaten wurden das fr{\"{u}}hkindliche Temperament sowie die motorische und kognitive Entwicklung der S{\"{a}}uglinge untersucht. S{\"{a}}uglinge von M{\"{u}}ttern mit h{\"{o}}herer pr{\"{a}}nataler Stressbelastung zeigten erwartungsgem{\"{a}}{\ss}ein schwierigeres Temperament, jedoch erwartungskontr{\"{a}}r eine bessere motorische Entwicklung. Ein schwieriges Temperament des S{\"{a}}uglings stellt einen Risikofaktor f{\"{u}}r eine fr{\"{u}}he St{\"{o}}rung der Mutter-Kind-Interaktion dar. Fr{\"{u}}he Pr{\"{a}}ventionsma{\ss}nahmen k{\"{o}}nnten helfen, dieses Risiko zu minimieren und Schutzfaktoren zu etablieren.

Kowalski, J. T., Gerber, W.-D., Niederberger, U., & Petermann, F. (2013). Inanspruchnahmeverhalten von Psychotherapie bei Jugendlichen aus Palästina mit und ohne Posttraumatische Belastungsstörung. Kindheit und Entwicklung, 22(2), 80–86. doi:10.1026/0942-5403/a000103.

In mehreren Studien konnten in den letzten Jahren die Auswirkungen der politischen und milit{\"{a}}rischen Gewalt auf die Entstehung und Aufrechterhaltung psychischer St{\"{o}}rungen wie z. B. der Posttraumatischen Belastungsst{\"{o}}rung (PTBS) bei Kindern und Jugendlichen aus dem Nahen Osten gezeigt werden. In Pal{\"{a}}stina bleibt ein gro{\ss}er Teil dieser Betroffenen u. a. aufgrund der schwierigen Versorgungslage psychotherapeutisch unversorgt. Bisher wurde allerdings nicht betrachtet, was dar{\"{u}}ber hinaus die Inanspruchnahme professioneller psychotherapeutischer Hilfe nach Traumatisierung beeinflusst. Anhand einer Stichprobe von 110 Jugendlichen (Patienten und Gesunde) wird insbesondere untersucht, welche psychologischen Faktoren sich, neben den in dem etablierten Verhaltensmodell von Andersen beschriebenen Faktoren, auf die Inanspruchnahme auswirken.


Gassling, V., Holterhus, P.-M., Herbers, D., Kulle, A., Niederberger, U., …, & Gerber, W.-D. (2012). Stress-Coping and Cortisol Analysis in Patients with Non-Syndromic Cleft Lip and Palate: An Explorative Study. PLoS One, 7(7), e41015. PMID:22911731, doi:10.1371/journal.pone.0041015.

BACKGROUND: Non-syndromic clefts of the orofacial region occur in approximately 1 per 500 to 2,500 live births, depending on geographical area and ethnicity. It can be supposed that the disruption of the normal facial structure and the long-standing pressure of treatment from birth to adulthood bring about a range of life stressors which may lead to a long-lasting impact on affected subjects throughout their lives. Therefore, the present study aimed to assess different aspects of psychosocial stress in affected individuals. METHODS: The study was divided into two parts: first, the Trier Social Stress Test which involves uncontrollability and high levels of social-evaluative stress under real conditions and second, the query of various aspects of coping with psychosocial stress. The test group consisted of 30 affected adult subjects, and an equally sized control group of unaffected volunteers. Cortisol dysregulation was determined by saliva samples before and after stress induction. Meanwhile, participants were asked to complete the SVF 120 stress-coping questionnaire. RESULTS: The analysis of saliva samples showed a similar baseline concentration as well as a similar increase in cortisol levels after stress induction for both groups. Subsequently, the decline in cortisol concentrations was significantly faster in the CLP group (course: p<0.001; groups: p = 0.102; interaction: p = 0.167). The evaluation of the stress-coping questionnaire revealed a significantly shorter rumination about a stressful event in individuals with CLP-related malformations (p = 0.03). CONCLUSION: We conclude that adults with CLP have significantly better stress-coping strategies than their healthy peers. TRIAL REGISTRATION: German Clinical Trials Organization DRKS00003466.

Gerber, W.-D., Gerber-von Müller, G., Andrasik, F., Niederberger, U., Siniatchkin, M., Kowalski, J. T., …, & Petermann, F. (2012). The impact of a multimodal Summer Camp Training on neuropsychological functioning in children and adolescents with ADHD: An exploratory study. Child Neuropsychol., 18(3), 242–255. PMID:21824010, doi:10.1080/09297049.2011.599115.

This study examined the combined effects of methylphenidate (MPD) and response cost and token strategy (RCT), administered in an intensive ADHD Summer Camp Training (ASCT) format, on neuropsychological functions. Forty children with ADHD were randomly assigned to either the ASCT treatment (MPD plus RCT) or a control group (MPD plus a 1-hour session of standardized parental education/counselling [SPC]). This latter group was structured to be similar to the more typical current treatment. The ASCT treatment was administered for 2½ weeks and included RCT, consisting of elements of social skill training, attention training, and sports participation. RCT was systematically applied in all daily situations and activities. Executive functions and state of regulation using the Test for Attention Performance (TAP) and the Trail-Making Test (TMT) were assessed before training and at a 6-month follow-up. Participants receiving the ASCT improved specific neuropsychological functions in attention regulation and inhibitory control tasks at the 6-month follow-up. No changes occurred for participants assigned to the control condition. The data suggest that an intensive multimodal summer camp treatment program including strategies of instrumental learning can lead to substantial and enduring improvements in neuropsychological functioning of children and adolescents with ADHD.

Jenuwein, M., Zimmermann, P., Ungerer, J., Fuchs, S., …, Niederberger, U., …, & Kowalski, J. T. (2012). Zum Schweregrad der Posttraumatischen Belastungsstörung im militärischen Kontext. Zeitschrift für Psychiatr. Psychol. und Psychother., 60(4), 309–314. doi:10.1024/1661-4747/a000131.

Zusammenfassung: Die Krankheitsauspr{\"{a}}gung berufsbedingter posttraumatischer Belastungsst{\"{o}}rungen (PTBS) h{\"{a}}ngt im zivilen wie auch im milit{\"{a}}rischen Kontext von vielf{\"{a}}ltigen Einflussfaktoren ab. 74 Soldaten mit PTBS, die sich in der Abteilung f{\"{u}}r Psychiatrie und Psychotherapie des Bundeswehrkrankenhauses Berlin ambulant oder station{\"{a}}r vorstellten, wurden im Hinblick auf Zusammenh{\"{a}}nge zwischen Gesamtschwere der PTBS zu Therapiebeginn sowie der Symptomcluster {\"{U}}bererregung, Vermeidungsverhalten und intrusiver Symptomatik und psychosozialen und milit{\"{a}}rspezifischen Merkmalen untersucht. Soldaten mit einsatzbedingter PTBS litten signifikant st{\"{a}}rker unter {\"{U}}bererregbarkeit als Soldaten mit nicht-einsatzbedingter PTBS. Bei Soldaten in F{\"{u}}hrungsfunktionen (Stabsoffizieren) waren Intrusionen signifikant schw{\"{a}}cher ausgepr{\"{a}}gt als bei anderen Dienstgradgruppen. Bei Soldaten mit verz{\"{o}}gertem Beginn der PTBS waren Gesamtschwere und Intrusionssymptomatik schw{\"{a}}cher ausgepr{\"{a}}gt. Diese Studie gibt erste Hinweise auf Faktoren, die eine spezifische Symptomausgestaltung der PTBS bei Soldaten beeinflussen und die in der Gestaltung therapeutischer Konzeptionen Ber{\"{u}}cksichtigung finden sollten.

Kowalski, J. T., Kobs, S., Zimmermann, P., Petermann, F., …, & Niederberger, U. (2012). Influence of acute psychological trauma on time estimation behaviour: a prospective pilot study. J. Neural Transm., 119(10), 1205–1211. PMID:22688672, doi:10.1007/s00702-012-0835-6.

In addition to the symptom triad of intrusions, avoidance behaviour and hyperarousal, typical and frequent characteristics of acute and chronic posttraumatic disorders are neuropsychological disturbances of working memory and executive functions. So far, however, only a very limited number of studies have dealt with their effects on the capability to assess time-related information. The purpose of this prospective study therefore was to compare persons after an acute traumatic experience with healthy controls in the course of 12 months, focusing on their ability to estimate time as a measure of their readiness of attention. 39 participants aged 17-59 years (mean age = 35.1 years, who had experienced a traumatic event and exhibited symptoms of acute stress disorder) were compared with 38 healthy controls (mean age = 36.1 years) at eight times of measurement within a period of 12 months. Performance was determined by means of a prospective time estimation task. The participants had to estimate a time interval of 5 s, once with and once without feedback about the quality of the estimates. The time estimates by the traumatised persons were significantly less precise than those by the control group. Progress analyses have shown that trauma patients exhibit larger deviations from the defined time interval, both under feedback conditions and without feedback. Psychological traumatisation leads to both an acute and long-term, demonstrable impairment of time estimation ability. The recognizable disturbance of information processing may both be a cause and a result of clinical trauma symptoms.

Kowalski, J. T., Radtke, Y., Falkenhagen, F., Kropp, P., …, & Niederberger, U. (2012). Verlaufsuntersuchung depressiver Symptomatik nach akuter Traumatisierung. Z. Klin. Psychol. Psychother., 41(3), 211–218. doi:10.1026/1616-3443/a000151.

Hintergrund: Der Zusammenhang zwischen Akuter Belastungsst{\"{o}}rung (ASD) und der Posttraumatischen Belastungsst{\"{o}}rung (PTSD) ist vielfach untersucht. Wenige Erkenntnisse liegen {\"{u}}ber den klinischen Verlauf depressiver Symptome nach ASD vor. Fragestellung: Unterscheiden sich Patienten nach akuter Traumatisierung hinsichtlich der Entwicklung depressiver Symptome von Nicht-Traumatisierten? Methode: 39 akut Traumatisierte wurden mit einer gesunden Kontrollgruppe (KG, N=38) verglichen. Die ASD und die depressiven Symptome wurden mit standardisierten Verfahren (SKID, ASDS, DS) zu verschiedenen Messzeitpunkten untersucht. Ergebnisse: ASD-Patienten waren initial signifikant depressiver als die KG. Nach anf{\"{a}}nglicher Beschwerderemission nahmen die depressiven Symptome bei der Gruppe der sp{\"{a}}teren PTSD-Patienten wieder zu. Schlussfolgerung: Depressive Symptome nach ASD sind sowohl bei Patienten mit als auch ohne nachfolgende PTSD h{\"{a}}ufig. Nach anf{\"{a}}nglicher Remission der depressiven Beschwerden kann es zu einer Reexazerbation kommen.

Kowalski, J. T., Kreußel, C., Gerber, W.-D., Niederberger, U., & Petermann, F. (2012). Inanspruchnahme von Psychotherapie durch Jugendliche mit und ohne eine Posttraumatische Belastungsstörung. Kindheit und Entwicklung, 21(4), 238–244. doi:10.1026/0942-5403/a000090.

Obwohl die Forschung zum Thema Posttraumatische Belastungsst{\"{o}}rung (PTBS) bei Kindern und Jugendlichen in Deutschland in den vergangenen Jahren deutlich intensiviert wurde, liegen bisher kaum Befunde zum Inanspruchnahmeverhalten professioneller Hilfe nach Traumatisierung vor. Trotz deutlich verbesserter psychotherapeutischer M{\"{o}}glichkeiten bleibt aber offenbar ein gro{\ss}er Teil der Betroffenen {\"{u}}ber Jahre unbehandelt. Anhand einer Stichprobe von 104 Jugendlichen (Patienten und Gesunde) wird untersucht, welche Faktoren sich auf das Inanspruchnahmeverhalten auswirken. Neben den Faktoren des Modells zum Inanspruchnahmeverhalten von Andersen werden auch psychologische Faktoren wie Angst vor Stigmatisierung ber{\"{u}}cksichtigt.

Kropp, P., Brecht, I.-B., Niederberger, U., Kowalski, J. T., …, & Gerber, W.-D. (2012). Time-dependent post-imperative negative variation indicates adaptation and problem solving in migraine patients. J. Neural Transm., 119(10), 1213–1221. PMID:22688673, doi:10.1007/s00702-012-0843-6.

According to the Seligman theory of learned helplessness, depression is caused by a repetitive experience of loss of control resulting in internal, stable and global attributional styles for negative events. In depressed patients and healthy controls experiencing such events, an increased amplitude of the post-imperative negative variation (PINV) has been described. The aim of the study was to investigate a possible correlation between migraine, depression, learned helplessness and PINV. 24 patients suffering from migraine without aura and 24 healthy controls were exposed to a situation of loss of control whilst the contingent negative variation (CNV) from C3, C4 and Cz were recorded. Before conducting the experiment, the subjects were asked to answer the Beck Depression Inventory (BDI) and the German attributional style questionnaire (GASQ). Amplitudes of total CNV, early and late component and PINV were calculated in eight blocks of four recordings each. The results confirm findings of a pronounced PINV in situations of loss of control, though high amplitudes were not correlated with low values in the GASQ and therefore with learned helplessness. High PINV in migraine patients correlated with high scores in the BDI and the list of the complaints questionnaire. However, this was not the case in healthy controls. In this experimental situation, PINV in migraine patients can be interpreted as an expectancy potential in order to avoid failure and helplessness.

Springer, I. N., Schulze, M., Wiltfang, J., Niederberger, U., …, & Wolfart, S. (2012). Facial Self-Perception, Well-Being, and Aesthetic Surgery. Ann. Plast. Surg., 69(5), 503–509. PMID:21712698, doi:10.1097/SAP.0b013e3182223d42.

BACKGROUND: It is controversial whether impaired well-being is associated with (a) an increased likelihood of having a negative body/facial image; or (b) dissatisfaction with the postoperative result following aesthetic surgery. We set out to improve current knowledge in this matter. METHODS: A total of 324 subjects (n = 162 females, n = 162 males, 18-30 years) were photographed, asked to complete the adjective mood scale and to rate 46 statements regarding their own appearance, and its impact on social functioning as well as their willingness to undergo aesthetic surgery on a visual analog scale. The photographs of these subjects were also assessed by 50 independent judges. RESULTS: Average self-awarded ratings of appearance were significantly more positive in subjects with normal as compared to those with impaired well-being (P = 0.014). Items regarding the impact of appearance on social functioning were answered significantly more negatively by subjects with impaired well-being as compared with those with the normal well-being (P = 0.001). Subjects with impaired well-being did not declare an increased willingness to undergo aesthetic surgery (P > 0.197). Assessment by the independent judges did not reveal differences in the average level of attractiveness of subjects with impaired well-being and those with normal well-being (P = 0.666). CONCLUSIONS: Impaired well-being is associated with impaired facial selfperception, independent of attractiveness. Willingness to undergo aesthetic surgery seems not to be affected by one's sense of well-being. In the subjects with impaired well-being who undergo aesthetic surgery, facial self-perception seems unlikely to be improved.


Darabaneanu, S., Overath, C. H., Rubin, D., Lüthje, S., …, Niederberger, U., …, & Weisser, B. (2011). Aerobic Exercise as a Therapy Option for Migraine: A Pilot Study. Int. J. Sports Med., 32(06), 455–460. PMID:21472632, doi:10.1055/s-0030-1269928.

Exercise is assumed to have a positive effect on migraine. However, none of the few studies on this topic can prove the expected positive influence of exercise. Therefore, the aim of this pilot study was to develop a training program suitable for migraine patients and to examine its effect on migraine. 16 patients were examined. 8 migraine patients completed a 10-week aerobic running exercise program consisting of 3 workouts per week. The program was developed by sports scientists especially to increase the fitness level. Physical fitness, i. e., physical working capacity, was assessed using a PWC 150 test. There was also a control group of 8 patients without any special physical training. Migraine patients of the exercise group showed both a reduction in the number of migraine days per month (p=0.048) and the intensity of the attacks (p=0.028). An increase in fitness level resulted in a lowered stress level. Stress strategies like "displacement activity" (r=-0.715; p=0.046), "looking for self-affirmation" (r=-0.742; p=0.035) and "feelings of aggression" (r=-0.802; p=0.017) were reduced. Increasing the level of fitness (PWC 150) is one predictor for migraine improvement (r=0.409, p=0.031). Aerobic exercise which leads to a better fitness level is an alternative therapy method for migraine.

Gerber, W.-D., Darabaneanu, S., Dumpert, H.-D., Müller, G. G.-v., Kowalski, J. T., …, Niederberger, U., Siniatchkin, M., & Petermann, F. (2011). Kortikale Informationsverarbeitungsprozesse bei Vätern von Kindern mit Aufmerksamkeitsdefizit-/Hyperaktivitätsstörung (ADHS): eine Pilotstudie mit langsamen Hirnpotenzialen. Zeitschrift für Neuropsychol., 22(2), 87–95. doi:10.1024/1016-264X/a000041.

Hintergrund/Fragestellung: ADHS wird als eine wom{\"{o}}glich genetisch bedingte St{\"{o}}rung der kortikalen Informationsverarbeitung im Kindes- und Jugendalter, die bei mehr als zwei Drittel der Betroffenen auch im Erwachsenenalter andauert, beschrieben. Wenig bekannt ist {\"{u}}ber die kortikale Informationsverarbeitung und Aufmerksamkeitsbereitschaft von V{\"{a}}tern von Kindern mit ADHS. In der vorliegenden Studie sollten daher V{\"{a}}ter von ADHS-Kindern mit gesunden Kontrollen hinsichtlich ihrer kortikalen Aufmerksamkeitsbereitschaft verglichen werden. Patienten und Methoden: 14 V{\"{a}}ter von ADHS-Kindern im Alter von 24 bis 62 Jahren (M = 39,4 Jahre) wurden mit 14 V{\"{a}}tern von gesunden Kindern (M = 36,7 Jahre) verglichen. Die kortikale Aufmerksamkeitsbereitschaft wurde mittels Contingente Negative Variation (CNV) in einem zwei Stimulusparadigma (Go/NoGo; Cz, Fz) mit einem Intervall von 3 Sekunden gemessen. Die ADHS-Kernsymptome wurden mittels spezifischer Frageb{\"{o}}gen erfasst. Ergebnisse: Die CNV-Reaktionszeiten der ADHS-V{\"{a}}ter waren signifikant langsamer als die der gesunden Kontrollgruppe. Zudem ergab sich eine deutlich beschleunigte Habituation, w{\"{a}}hrend sich die CNV-Amplituden im Cervix-Potenzial statistisch nicht von den Gesunden unterschieden. Dagegen zeigte sich frontal eine signifikant st{\"{a}}rkere Negativierung der ADHS-V{\"{a}}ter. Schlussfolgerung: V{\"{a}}ter von ADHS-Kindern zeigen in den langsamen Hirnpotenzialen {\"{a}}hnliche Auff{\"{a}}lligkeiten, wie sie auch bei Kindern nachweisbar sind. Die erkennbare gest{\"{o}}rte kortikale Informationsverarbeitung k{\"{o}}nnte sowohl als Hinweis einer genetischen Disposition, als auch epigenetischer Determination denkbar sein.

Kowalski, J. T., Niederberger, U., Koch, A., & Gerber, W.-D. (2011). Crisis intervention: Attitude towards post crisis prevention in emergency service personnel. Nervenheilkunde, 30, 264–268.


Gerber, W.-D., Petermann, F., Gerber-von Müller, G., Dollwet, M., Darabaneanu, S., Niederberger, U., …, & Andrasik, F. (2010). MIPAS-Family—evaluation of a new multi-modal behavioral training program for pediatric headaches: clinical effects and the impact on quality of life. J. Headache Pain, 11(3), 215–225. PMID:20376520, doi:10.1007/s10194-010-0192-5.

Several meta-analyses have demonstrated that the combination of electrical muscle activity and Temperature Biofeedback could be regarded as gold standard in chronic pediatric headaches. However, these techniques seem to be uneconomical and furthermore they are not directed to improve the social competence as well as resolve possible impairments in daily activities of the child. Therefore, multi-modal behavioral techniques have been proposed, but no studies comparing these with the gold standard were conducted. The present study compared the impact of a new multi-modal behavioral education and training program--MIPAS-Family--with a combined Biofeedback treatment, evaluating clinical efficacy as well as the effect on the quality of life (QoL) of children with chronic headaches. Thirty-four children and adolescents with recurrent headache, ranging from 7 to 16 years, were randomly assigned to the MIPAS-Family (N = 19) or the Biofeedback (N = 15) condition. All patients were diagnosed by the criteria of the International Headache Society. The children and their parents completed headache diaries, diaries of daily living activities and a QoL questionnaire (KINDL). Both groups showed significant improvements concerning the headache intensity and headache duration. We found no significant differences in the main headache parameters between both treatments. After the treatments, the children were less disturbed by their headaches in the domains school, homework, and leisure time. In conclusion, MIPAS-Family is as effective as Biofeedback but it is more cost-effective and addresses the whole family and the daily activities.

Kropp, P., & Niederberger, U. (2010). Biofeedback bei Kopfschmerzen. Der Schmerz, 24(3), 279–289. PMID:20563685, doi:10.1007/s00482-010-0892-4.

Biofeedback is a direct feedback of a physiological function. The aim of biofeedback is to change the physiological function into a required direction. To manage this, the physiological function has to be fed back visually or acoustically and it has to be perceived consciously. Biofeedback as a therapeutic practice derives from behavioural therapy and can be used in the context of behavioural interventions. Biofeedback has proved to be successful in non-medical treatment of pain. According to more recent meta-analyses biofeedback reveals high evidence in the treatment of migraine or tension-type headache. In these headaches biofeedback procedures are considered highly effective.

Siniatchkin, M., Darabaneanu, S., Gerber-von Müller, G., Niederberger, U., …, & Gerber, W.-D. (2010). Kinder mit Migräne und Asthma: Zur Rolle der Eltern-Kind-Interaktion. Kindheit und Entwicklung, 19(1), 27–35. doi:10.1026/0942-5403/a000005.

Die Studie besch{\"{a}}ftigt sich mit der Frage, ob f{\"{u}}r Familien, in denen ein Kind an Migr{\"{a}}ne oder Asthma leidet, ein spezifisches Eltern-Kind-Interaktionsmuster vorliegt. An der Studie nahmen 20 Familien mit Migr{\"{a}}ne-Kindern, 17 Familien mit asthmakranken Kindern und 20 Familien mit gesunden Kindern teil. Die Eltern-Kind-Interaktionen wurden standardisiert in Form einer gemeinsamen Bearbeitung eines Puzzles unter Zeitdruck, jeweils getrennt f{\"{u}}r die Paarungen Mutter/Kind sowie Vater/Kind auf Video aufgezeichnet und von neutralen Ratern nach vorgegebenen Kriterien ausgewertet. Bei allen Kindern wurden zudem langsame Hirnpotentiale (Contingente Negative Variation, CNV) abgeleitet. Es wurden asymmetrische, krankheitsspezifische Familieninteraktionen gefunden. Im Vergleich zu dem gesunden Geschwisterkind war die Kommunikation zwischen den Eltern und dem an Migr{\"{a}}ne leidenden Kind durch vermehrt direktive Aufforderungen und einem geringeren Hilfeangebot der Eltern sowie durch submissives kindliches Verhalten gepr{\"{a}}gt. In Familien mit Asthma zeigte sich eine konflikthafte Familieninteraktion und eine geringe Kooperation bei den betroffenen Kindern. Die auff{\"{a}}llige famili{\"{a}}re Interaktion korrelierte mit dem Ausma{\ss}der kortikalen Informationsverarbeitung (Dishabituation). Die Befunde verdeutlichen die besondere Bedeutung von systematischen Elterntrainings bei der Behandlung von Migr{\"{a}}ne und Asthma im Kindes- und Jugendalter.


Gerber, W.-D., Gerber-von Müller, G., Petermann, U., Niederberger, U., & Petermann, F. (2009). Verbessern verhaltensmedizinische Behandlungsstrategien die Lebensqualität bei Kindern mit chronischen Kopfschmerzen? Z. Klin. Psychol. Psychother., 38(4), 231–239. doi:10.1026/1616-3443.38.4.231.
Petermann, U., Petermann, F., Niederberger, U., Stephani, U., Siniatchkin, M., & Gerber, W.-D. (2009). Das ADHS-Summercamp – Entwicklung und Evaluation eines multimodalen Programms. Kindheit und Entwicklung, 18(3), 162–172. doi:10.1026/0942-5403.18.3.162.

Die Studie besch{\"{a}}ftigt sich mit der Frage, ob und inwieweit ein multimodales, massiertes, stringent lernpsychologisch orientiertes Gruppenprogramm (ADHS-Summercamp, ASCT; 12 Tage; 100 Stunden) die klinische ADHS-Kernsymptomatik g{\"{u}}nstig beeinflussen kann. Dabei sollte der besondere Einfluss von Response-Cost-Token (RCT) untersucht werden. Das ASCT wurde in einem Pr{\"{a}}-Post1-Post2-Design mit einer standardisierten Elternberatungsgruppe (SEB) verglichen. An der Studie nahmen insgesamt 27 Kinder im Alter zwischen 6 und 17 Jahren teil, die nach Alter, Geschlecht und Kernsymptomatik per Zufall entweder der ASCT-Gruppe (N = 18) oder der SEB-Gruppe (N = 19) zugeordnet wurden. W{\"{a}}hrend des Summercamps wurden neben einem sozialen Kompetenztraining schulbezogene Tests und Sport durchgef{\"{u}}hrt, wobei {\"{u}}ber alle Alltagssituationen hinweg das RCT systematisch angewendet wurde. Zudem erhielten die Kinder doppelblind, randomisiert und cross-over die drei folgenden Medikationen: Methylphenidat unretardiert, Methylphenidat retardiert und Placebo jeweils vier Tage lang. Das Verhalten der Kinder der ASCT-Gruppe wurde w{\"{a}}hrend des Summercamps zu festgelegten Zeitpunkten und in standardisierten Situationen durch geschulte Beobachter mithilfe von validierten Beobachtungsb{\"{o}}gen (SKAMP; FBB-HKS) bewertet. Beide Gruppen erhielten zudem vor der Intervention, sechs Monate und zwei Jahre danach Eltern- und Lehrerbeobachtungsb{\"{o}}gen, die sich u. a. auf die ADHS-Kernsymptomatik bezogen. Die varianzanalytische Auswertung zeigte eine signifikante Verbesserung der ADHS-Kernsymptomatik der ASCT-Gruppe, die auch nach zwei Jahren relativ stabil blieb. Dabei konnten diese Verbesserungen vorwiegend die Lehrer beobachten. Dagegen zeigte sich bei der SEB-Gruppe in der Lehrerbeobachtung eine Zunahme der Symptomatik nach der Beratung. Die Effekte der ASCT-Gruppe konnten vorwiegend auf die Wirkung des RCT zur{\"{u}}ckgef{\"{u}}hrt werden. Das Gruppentraining f{\"{u}}hrt zu positiven, langfristigen klinischen Effekten, wenn es mit einem RCT verkn{\"{u}}pft ist. Die Einf{\"{u}}hrung von ADHS-Summercamps in Tageskliniken f{\"{u}}r Kinder und Jugendliche, aber auch in verhaltenstherapeutischen Ambulanzen und Praxen, bietet sich besonders aus {\"{o}}konomischen Gr{\"{u}}nden an.


Darabaneanu, S., Kropp, P., Niederberger, U., Strenge, H., & Gerber, W.-D. (2008). Effects of Pregnancy on Slow Cortical Potentials in Migraine Patients and Healthy Controls. Cephalalgia, 28(10), 1053–1060. PMID:18624798, doi:10.1111/j.1468-2982.2008.01653.x.

Increased negative amplitudes and lack of habituation of contingent negative variation (CNV) in migraine are well established and are supposed to reflect an altered cortical excitability level. Migraine attacks occur less during pregnancy but often relapse after delivery. We investigated the effect of pregnancy on slow cortical potentials and reaction time in migraine patients and healthy controls. Four groups were examined: 14 pregnant migraine patients, 12 non-pregnant migraine patients, 15 pregnant healthy women and 16 non-pregnant healthy women aged 19-38 years. Two recordings were performed in the pregnant subjects: in the 36th week of gestation and 4 weeks after delivery. The nonpregnant subjects were recorded at the same time interval of 8 weeks. Pregnant migraine patients showed significantly fewer migraine days during the third trimester of pregnancy and returned to nearly the former level 4 weeks post delivery. Non-pregnant migraine patients demonstrated a significant reduction of migraine days at the second measurement. There was no effect of pregnancy on CNV amplitudes, but there was an effect of pregnancy on the habituation coefficient and reaction time of migraine patients. Faster habituation from a higher preactivation level was found. As an explanation for the changed habituation level we favour the model of correlation between preactivation level and habituation level, the so-called law of initial value. We found a correlation between preactivation level and habituation. Our study confirms a specific effect of pregnancy on slow cortical potentials in migraine patients.

Darabaneanu, S., Darabaneanu, H.-A., Niederberger, U., Russo, P. A. J., …, & Hauschild, A. (2008). Long-Term Efficacy of Subcutaneous Sweat Gland Suction Curettage for Axillary Hyperhidrosis: A Prospective Gravimetrically Controlled Study. Dermatologic Surg., 34(9), 1170–1177. PMID:18518888, doi:10.1111/j.1524-4725.2008.34255.x.

BACKGROUND Subcutaneous sweat gland suction curettage (SSGSC) is gaining acceptance as a therapy for axillary hyperhidrosis. Despite its acceptance, there remains a lack of prospective data describing the efficacy and long-term outcome of SSGSC. OBJECTIVE We examined the sweat rates and patients' satisfaction of 12 months following SGSC in 28 patients with axillary hyperhidrosis. METHODS Axillary sweat rates were determined by semiquantitative gravimetry. A questionnaire was used to determine patients' satisfaction. RESULTS A 58% reduction in sweat rate under resting conditions and an 85% reduction during aerobic exercise in sweat rates was observed. A subdivision of patients into three groups based on their baseline preoperative sweat rates (<25, 25-50, and >50 mg/min) showed that patients with resting sweat rates over 25 mg/min benefited particularly from this procedure, whereas patients with less than 25 mg/min did not. CONCLUSION SSGSC produces a significant reduction in the preoperative sweat rates. A low complication rate and a high degree of patient satisfaction were observed. Long-term follow-up evaluations demonstrate a low number of relapses, making SSGSC a convenient and satisfactory method of treating axillary hyperhidrosis. It should be considered in patients refractory to conventional therapies with baseline sweat rates greater than 25 mg/min. The authors have indicated no significant interest with commercial supporters.

Gerber, W.-D., Petermann, F., Gerber-von Müller, G., Niederberger, U., …, Siniatchkin, M., & Stephani, U. (2008). MIPAS-Family – Entwicklung und Evaluation eines verhaltensmedizinischen Programms zur Behandlung kindlicher Kopfschmerzen. Verhaltenstherapie, 18(4), 247–255. doi:10.1159/000170912.
Strenge, H., & Niederberger, U. (2008). Unidirectional Interference in Use of Nondominant Hand during Concurrent Grooved Pegboard and Random Number Generation Tasks. Percept. Mot. Skills, 106(3), 763–774. PMID:18712198, doi:10.2466/pms.106.3.763-774.

The interference effect between Grooved Pegboard task with either hand and the executive task of cued verbal random number generation was investigated. 24 normal right-handed subjects performed each task under separate (single-task) and concurrent (dual-task) conditions. Articulatory suppression was required as an additional secondary task during pegboard performance. Analysis indicated an unambiguous distinction between the two hands. Comparisons of single-task and dual-task conditions showed an asymmetrical pattern of unidirectional interference with no practice effects during pegboard performance. Concurrent performance with nondominant hand but not the dominant hand of random number generation performance became continuously slower. There was no effect of divided attention on pegboard performance. Findings support the idea that the nondominant hand on the pegboard and random number tasks draw from the same processing resources but that for the executive aspect random number generation is more sensitive to changes in allocation of attentional resources.


Darabaneanu, S., Gerber, W.-D., Kropp, P., & Niederberger, U. (2007). Course of migraine during pregnancy: an ERP study. Cephalalgia, 27, 599.Kropp, P., & Niederberger, U. (2007). New behavioraly oriented methods in head pain therapy. Nervenheilkunde, 26(1-2), 43–48.
Siniatchkin, M., Andrasik, F., Kropp, P., Niederberger, U., …, & Gerber, W.-D. (2007). Central Mechanisms of Controlled-Release Metoprolol in Migraine: A Double-Blind, Placebo-Controlled Study. Cephalalgia, 27(9), 1024–1032. PMID:17680819, doi:10.1111/j.1468-2982.2007.01377.x.

$\beta$-Blockers are widely used in the prophylaxis of migraine and have been described as very effective drugs in many studies. Some investigators have demonstrated that the clinical improvement of migraine corresponds to the normalization of the contingent negative variation (CNV), a slow cortical potential measuring cortical information processing. However, most of these studies have contained a variety of methodological pitfalls, which we attempted to address in the current study. Twenty patients suffering from migraine without aura were randomly divided into two groups. The groups were treated either with controlled-release metoprolol or placebo for 3 months, using a double-blind design. Twice before and once after each month of the treatment the CNV was recorded. After 3 months, a significant reduction of migraine frequency, duration and intensity was demonstrated for the metoprolol compared with the placebo group. The CNV was characterized by a marked reduction of the amplitude of the total CNV and postimperative negative variation and normalization of the eartly CNV habituation following treatment. Therefore, metoprolol may exert its prophylactic effect in migraine through the influence on cortical information processing and excitability represented by the CNV.


Göbel, H., Heinze, A., Niederberger, U., Witt, T., & Zumbroich, V. (2004). Efficacy of Phenazone in the Treatment of Acute Migraine Attacks: A Double-Blind, Placebo-Controlled, Randomized Study. Cephalalgia, 24(10), 888–893. PMID:15377321, doi:10.1111/j.1468-2982.2004.00764.x.

In this study we compared the efficacy of 1000 mg phenazone with that of placebo in the treatment of acute migraine attacks in a randomized double-blind, placebo-controlled study of 208 patients. The main target criterion was the number of patients with a pain reduction from severe or moderate to slight or no pain 2 h after taking the pain medication. The percentage of patients satisfying the main target criterion was 48.6% for phenazone and 27.2% ( P < 0.05) for placebo. Freedom from pain after 2 h was reported by 27.6% with phenazone treatment and 13.6% ( P < 0.05) with placebo. Compared with placebo, the phenazone treatment also resulted in a significant improvement in the associated migraine symptoms of nausea, phonophobia and photophobia. Of patients treated with phenazone 11.4%, and 5.8% of those treated with placebo reported adverse events. There was no significant difference between the groups with regard to numbers of patients with adverse events. No serious adverse events occurred. The results show that phenazone at a dosage of 1000 mg is effective and well tolerated in the treatment of acute migraine attacks.

Niederberger, U., & Kropp, P. (2004). Die nichtmedikamentöse Behandlung der Migräne. Der Schmerz, 18(5), 415–420. PMID:15300473, doi:10.1007/s00482-004-0358-7.

Actual recommendations for treatment of migraine consist both of pharmacological and non-pharmacological treatment. The latter enables the patient higher responsibility and self-efficacy in coping with migraine. Therefore, the active involvement in the treatment of the patients is obligatory in all psychological pain therapy methods. Focus of therapy are emotional, cognitive, behavioural and social factors of migraine illness, with the aim to modify unfavourable habits and migraine attack-inducing factors. As non-pharmacological methods counselling, relaxation training, biofeedback and cognitive-behavioural treatments are employed. The long-term effects are comparable with those of pharmacological treatment, combination of pharmacological and non-pharmacological treatment lead to even higher efficacy and is often indicated. In case of headache in children, behavioural therapy should be the method of first choice. In the text, empirically proven methods of psychological pain therapy in migraine will be explained.


Strenge, H., Niederberger, U., & Seelhorst, U. (2002). Correlation between Tests of Attention and Performance on Grooved and Purdue Pegboards in Normal Subjects. Percept. Mot. Skills, 95(2), 507–514. PMID:12434843, doi:10.2466/pms.2002.95.2.507.

This study investigated the relation between tests of manual dexterity and attentional functions with 49 normal, right-handed medical students (26 women, 23 men, ages 19–30 years) who were assessed with a Purdue Pegboard Test, Grooved Pegboard Test, and a Test for Attentional Performance, comprising measures of tonic and phasic alertness and divided attention. Weak to moderately high partial correlations controlling for finger size were obtained between pegboard test performance of the left hand and phasic alertness ( r = .31–.5O). Purdue Pegboard Assembly subtest scores were weakly correlated with divided attention ( r = −.39). These findings suggest that attention is an important determinant of performance for manual dexterity tests of the nondominant hand.


Göbel, H., Heinze, A., Ingwersen, M., Niederberger, U., & Gerber, W.-D. (2001). Harpagophytum-Extrakt LI 174 (Teufelskralle) bei der Behandlung unspezifischer Rückenschmerzen. Der Schmerz, 15(1), 10–18. PMID:11810324, doi:10.1007/s004820170043.

PROBLEM: This randomised, double-blind, placebo controlled study was intended to investigate the effects of Harpagophytum procumbens (Devil's Claw) on sensory, motor and vascular mechanisms of muscle pain. In addition to clinical efficacy and tolerability, possible action mechanisms were analysed by means of experimental algesimetric methods. METHODOLOGY: The study was performed on patients with slight to moderate muscular tension or slight muscular pain of the back, shoulder and neck. On a double-blind randomised basis the verum group received 2x1 film tablets per day, i. e. 2x480 mg/day, of Harpagophytum extract LI 174 (Rivoltan(R)) at 8.00 a.m. and 8.00 p.m. over a certain period. The duration of the therapy was 4 weeks. Data recording at 14-day intervals was made using a visual analogue scale, pressure algometer test, recording of antinociceptive muscular reflexes, muscle stiffness test, EMG surface activity, muscular ischaemia test, clinical global score and subjective patient and physician ratings. RESULTS: A total of 31 patients in the verum group and 32 in the placebo group were treated. After four weeks of treatment there was found to be a clear clinical efficacy of the verum on the clinical global score and in the patient and physician ratings. Highly significant effects were found in the visual analogue scale, the pressure algometer test, the muscle stiffness test and the muscular ischaemia test. No difference from placebo was found in the recording of antinociceptive muscular reflexes or in the EMG surface activity. Tolerability was good; no serious adverse effects occurred. CONCLUSIONS: A highly significant clinical efficacy was achieved with a monotherapy of Harpagophytum dry extract LI 174 after four weeks' treatment at a dosage of 2x480 mg/day in cases of slight to moderate muscular pain. With regard to the action mechanisms investigated, it may be concluded that treatment with Harpagophytum extract LI 174 may be expected to have a significant influence on sensory and vascular muscular response and bring about a reduction in muscle stiffness. No central nervous effects were discovered.

Göder, R., Fritzer, G., Kapsokalyvas, A., Kropp, P., Niederberger, U., …, Gerber, W.-D., & Aldenhoff, J. B. (2001). Polysomnographic Findings in Nights Preceding a Migraine Attack. Cephalalgia, 21(1), 31–37. PMID:11298661, doi:10.1046/j.1468-2982.2001.00141.x.

Sleep recordings were performed in eight patients to analyse sleep alterations preceding migraine attacks. Polysomnographic recordings from nights before an attack were compared with nights without following migraine. We analysed standard sleep parameters and electroencephalogram (EEG) power spectra. The main findings preceding migraine attacks were a significant decrease in the number of arousals, a decrease in rapid eye movement (REM) density, a significant decrease of beta power in the slow wave sleep, and a decrease of alpha power during the first REM period. The results suggest a decrease in cortical activation during sleep preceding migraine attacks. According to the models of sleep regulation, alterations in the function of aminergic or cholinergic brainstem nuclei have to be discussed.

Kropp, P., Linstedt, U., Niederberger, U., & Gerber, W.-D. (2001). Contingent negative variation and attentional performance in humans. Neurol. Res., 23(6), 647–650. PMID:11547936, doi:10.1179/016164101101198956.

The relation between a paper-pencil test of sustained attention (d2-letter cancellation test, d2-LCT) and the contingent negative variation (CNV) as a cortical slow potential was calculated in 23 healthy undergraduate students. Both d2-LCT and CNV reflect selective, focussed attention. There was a Pearson correlation coefficient of r = -0.670 between the early component of the CNV and the number of checked letters in d2-LCT, indicating significant differences in early CNV between low and high performance in d2-LCT. The results showed a linear relationship between paper-pencil registered attentional properties and the cortically recorded early component of CNV.

Strenge, H., Fritzer, G., Göder, R., Niederberger, U., Gerber, W.-D., & Aldenhoff, J. (2001). Non-linear electroencephalogram dynamics in patients with spontaneous nocturnal migraine attacks. Neurosci. Lett., 309(2), 105–108. PMID:8936454, doi:10.1016/S0304-3940(01)02047-X.

Exteroceptive silent periods (ESPs) of masseter muscle activity evoked by electrical stimulation of the mental nerve were studied over a large range of prepain intensities and at pain threshold in 44 normal subjects. Seven levels of stimulus intensity, based on individual sensory and pain thresholds, were applied and the relationship between ESPs, stimulus intensity and perception, as manifested by the subjective verbal response, was investigated. The analysis revealed that the occurrence of ESPs was not related to the stimulus intensity at the pain threshold. There were individually different patterns of progressive response to increasing current intensities within the pre-pain range in many cases. On the other hand, almost half of all the subjects investigated showed no or only occasional ESPs. In view of this variability the concept of ESPs being a nociceptive behavioural response has to be questioned.


Kropp, P., Niederberger, U., & Gerber, W.-D. (2000). Zur Vorhersage von Sprach- und Zahlenverständnis bei Patienten mit Cochlear-Implantat. Laryngo-Rhino-Otologie, 79(07), 388–391. PMID:11005089, doi:10.1055/s-2000-4631.

BACKGROUND: Cognitive abilities determine the outcome of cochlear implantation. Neuropsychological tests of intellectual, memory, attentional and emotional functions were applied pre-operatively in 33 deaf patients receiving a cochlear implant. The outcome of verbal and numerical comprehension was measured in a subgroup of 14 patients post-operatively and correlated with pre-operative neuropsychological performance. METHODS: Neuropsychological performance was recorded using standardized tests for intellectual abilities (abbreviated Wechsler Adult Intelligence Scale [WAIS], crystallized intelligence scale), memory performance (Benton Visual Retention Test), attentional functions (d2 letter-cancellation-test), reaction time (Vienna Reaction Test) and emotional state (personality inventories). Verbal and numerical comprehension was measured post-operatively following adaptation of the speech processor. Performance and comprehension data were correlated. RESULTS: Cognitive performance parameters did not differ significantly from those of a healthy group. There was a correlation of r = +0.65 between numerical comprehension and the "mosaic-test", a subtest of the WAIS and of r = +0.78 between numerical comprehension and the crystallized intelligence scale. CONCLUSIONS: Pre-operative cognitive parameters may predict the outcome of cochlear implants.


Niederberger, U., Kropp, P., Nurnberger, I., Bouman, D., & Gerber, W.-D. (1999). Treatment monitoring and degree of decision and behavioral planning in patients with migraine. Verhaltenstherapie, 9, 55.Niederberger, U., & Gerber, W.-D. (1999). Human Cerebral Potentials During Motor Training Under Different Forms of Sensory Feedback. J. Psychophysiol. - J PSYCHOPHYSIOL, 13, 234–244. doi:10.1027//0269-8803.13.4.234.


Niederberger, U., Gerber, W.-D., & Schiffer, N. (1998). Sleeping behavior and migraine. An evaluation by daily self-reports. Schmerz, 12(6), 389–395. PMID:12799952, doi:10.1007/s004829800038.

PROBLEM Regarding the coherence of sleeping behavior and the occurrence of migraine attacks, we conducted a study based on migraine and sleeping diaries. METHODS Besides the daily recording of times of falling asleep and waking up, duration of sleep, sleep disruption and quality of sleep, clinical migraine parameters like occurrence of migraine attacks, headache intensity and duration and the daily mood rating were registered over periods of at least 6 weeks. In the analyses, we defined two classes of events: (1) nights not followed by a migraine attack; (2) nights followed by migraine. We examined a retrospective sample (23 patients with altogether 580 attacks) and a prospective sample (16 patients with altogether 96 attacks). RESULTS In both samples, we found that the duration of sleep was significantly reduced in nights followed by migraine (6.8 vs. 8.1 h and 6.4 vs. 7.2 h respectively) due to earlier awakening, with unchanged time of falling asleep. Up to two thirds of the observed migraine attacks were reported to be present directly after awakening. Quality of sleep was markedly reduced in nights followed by a migraine attack (i.e. sleep disruptions, feeling exhausted/no feeling of restedness when wakening up). We found only weak and insignificant correlations between the foregoing daily mood rating and the quantitative parameters of sleeping behavior on nights followed by migraine; somewhat more pronounced correlations were observable between the mood rating and the qualitative sleep parameters. CONCLUSIONS Overall, we conclude that the observed changes in sleeping behavior are largely part of the migraine attack, with the possibility that REM sleep functions as a migraine trigger. In clinical application, we strongly recommend the use of daily self-observations of patients' sleep-related behaviors in the migraine diary, identifying migraine-prone sleeping habits and evaluating their potency for triggering migraine attacks.

Niederberger, U., Gerber, W.-D., & Schiffer, N. (1998). Migräne und Schlaf. Der Schmerz, 12(6), 389–395. doi:10.1007/s004820050169.


Kropp, P., Gerber, W. D., Keinath-Specht, A., Kopal, T., & Niederberger, U. (1997). Behavioral treatment in migraine. Cognitive-behavioral therapy and blood-volume-pulse biofeedback: a cross-over study with a two-year follow-up. Funct. Neurol., 12(1), 17–24. PMID:9127120.

The aim of the present study was to ascertain the effects of two behavioral medicine approaches to the treatment of migraine. We also evaluated the specific effect of the sequence of the two treatments. Thirty-eight patients, suffering from migraine without aura, either obtained treatment in the following sequence: blood-volume-pulse biofeedback followed by cognitive behavioral therapy (Group I) or were given the treatment in reverse order (Group II). The effects of treatment in Group I were significantly better than those in Group II. We conclude that the application of biofeedback helps the patient to recognize the influence of thoughts and emotions on bodily reactions and therefore prepares the way for successful cognitive treatment.

Schellenberg, R., Schwarz, A., Niederberger, U., Böłsche, F., …, Gerber, W.-D., …, & Soyka, D. (1997). Long-time efficacy of cyclandelate and propranolol in prophylaxis of migraine following four months of treatment. Nervenheilkunde, 16(3), 183–187.

After a 4 months randomized double-blind study with cyclandelate versus propranolol all patients kept a miniaturized headache diary for one more year. Both duration of migraine attacks in hours and the number of additional analgetic medication were recorded monthly. Reduction of the duration of migraine attacks in the clinical responders of the cyclandelate treated patients remained nearly unchanged. In the propranolol responders the duration of migraine attacks in hours increased from the third month after finishing the medication and reached values comparable to those at the beginning of the active treatment. Intake of additional analgetic medication during the 1-year-follow-up was lower in the cyclandelate responders than in the propranolol-responders. Cyclandelate can be described as an effective long-lasting drug in migraine prophylaxis.


Strenge, H., Schmidt, G., Niederberger, U., Porschke, H., & Schütz, H. W. (1996). Effects of nicotine gum on F waves in non-smokers. Funct. Neurol., 11(4), 179–185. PMID:8934149.

The effects of chewing gum, containing 0 and 4 mg nicotine, on F waves were studied in healthy volunteers in a repeated measure design. F responses were recorded from the abductor pollicis brevis muscle following stimulation of the median nerve at the wrist. The persistence and various amplitude measures were analysed. Chewing a 4 mg nicotine gum, with a considerable rise in systemic nicotine (6.4-37.4 ng/ml), failed to produce significant effects on F wave parameters in relation to the placebo baseline. The analysis of different F wave amplitude ranges, however, revealed significant nicotine-induced changes: a dose-related decrease of F responses > or = 500 microV and an increase of F waves between 200-290 microV. This may be due to an activation of Renshaw cells in the spinal cord.

Strenge, H., Zichner, V., & Niederberger, U. (1996). Exteroceptive silent period of masseter muscle activity evoked by electrical mental nerve stimulation: relation to non-pain and pain sensations. Funct. Neurol., 11(1), 17–27. PMID:8936454.

Exteroceptive silent periods (ESPs) of masseter muscle activity evoked by electrical stimulation of the mental nerve were studied over a large range of prepain intensities and at pain threshold in 44 normal subjects. Seven levels of stimulus intensity, based on individual sensory and pain thresholds, were applied and the relationship between ESPs, stimulus intensity and perception, as manifested by the subjective verbal response, was investigated. The analysis revealed that the occurrence of ESPs was not related to the stimulus intensity at the pain threshold. There were individually different patterns of progressive response to increasing current intensities within the pre-pain range in many cases. On the other hand, almost half of all the subjects investigated showed no or only occasional ESPs. In view of this variability the concept of ESPs being a nociceptive behavioural response has to be questioned.


Gerber, W.-D., Schellenberg, R., Thom, M., Haufe, C., …, Niederberger, U., & Soyka, D. (1995). Cyclandelate versus propranolol in the prophylaxis of migraine–a double-blind placebo-controlled study. Funct. Neurol., 10(1), 27–35. PMID:7649498.

The aim of the present study was to ascertain the comparative efficacy of cyclandelate, a migraine prophylactic with calcium overload blocking properties, versus propranolol, a non-selective beta-adrenergic blocker, and placebo. Based on different statistical analysis procedures (including time series analysis) a responder and nonresponder evaluation for cyclandelate and propranolol was performed. In addition, an attempt was made to identify the dose relationship of the various drugs on headache parameters. In a double-blind placebo-controlled study 84 patients were treated in a placebo run-in phase (4 weeks). The patients were then randomized by the statistical criterion of placebo responder and nonresponder to either the cyclandelate or the propranolol group. The total treatment period included a low-dosage phase (8 weeks) and high-dosage phase (8 weeks). All patients kept a headache diary before, during and after treatment. The data were assessed by time series analysis (ARIMA), as well as by analysis of variance and nonparametric statistics. Based on ARIMA statistics, 39.3% of the patients showed a significant improvement of migraine during treatment with cyclandelate compared with 29.4% placed on propranolol. Higher doses of cyclandelate and propranolol were more effective. Using the qualitative response-criterion of a 50% reduction in migraine symptoms, cyclandelate showed a response in 67.9% and propranolol in 41.2% of all cases. It can therefore be concluded that cyclandelate as well as propranolol are two comparable substances in the prophylactic treatment of migraine, with cyclandelate showing fewer side effects.

Weinschutz, T. K., & Niederberger, U. (1995). Relevance of acupuncture in migraine therapy. Nervenheilkunde, 14(5 A), 295–301.

Acupuncture is used more and more in the treatment of migraine. In this study responder and non-responder rates for acupuncture in migraine prophylaxis were examined. The treatment was carried out in a controlled design. After exclusion of symptomatic headache forms through our pain clinic 81 patients were randomised to two different treatment groups. One of them used a traditional deep needle insertion on acupuncture points (verum), the other used a superficial needle insertion on non-acupuncture points(control). All patients kept a headache diary before, during and after treatment. The data were assessed by analysis of variance as well as nonparametric statistics and time-series analysis. Overall there was a statistically significant therapeutic effect of acupuncture treatment up to one year as shown by the reduction of migraine attacks and therefore it is a useful interval therapeutical agent for migraine. Further studies for understanding its mechanism should be carried out.


Gerber, W.-D., & Niederberger, U. (1994). Sensory Biofeedback Training in Motor Learning – Peripheral and Central Nervous Effects. Biofeedback Self. Regul., 19, 307.
Niederberger, U., Gerber, W.-D., & Weber, P. (1994). Negative cortical DC-shifts (Bereitschaftspotential) in the course of human motor learning under different forms of sensory feedback. EEG-EMG Zeitschrift fur Elektroenzephalographie Elektromyographie und Verwandte Gebiete, 25(1), 26–33.

Four groups were trained in a novel motor task, the voluntary abduction of the big toe under systematic variation of proprioceptive, tactile, visual and artificial EMG feedback. In addition to measurement of the range of motion and EMG level, the EEG was recorded and the Bereitschaftspotential (readiness potential) during distinct periods of the training course was analyzed. Best training results are reported from the groups with combined artificial EMG and tactile feedback and with combined visual and tactile feedback. Also movement related cortical activity, in form of the amplitude of the Bereitschaftspotential at the EMG onset, was greatest under the above mentioned two groups. Artificial sensoric EMG feedback appears to be useful in motor learning and neuromuscular re-education, evaluated by peripheral and central nervous measurement.

Niederberger, U., Gerber, W.-D., & Weber, P. (1994). Zum Verlauf des motorischen Bereitschaftspotentials beim Training einer neuartigen Bewegungsaufgabe unter verschiedenen sensorischen Rückmeldebedingungen. Klin. Neurophysiol., 25(01), 26–33. doi:10.1055/s-2008-1060244.


Haag, G., Weinzierl, R., Thoden, U., & Niederberger, U. (1993). Die “Freiburger Migränestudie”. Der Schmerz, 7(4), 298–303. PMID:18415394, doi:10.1007/BF02529866.

This study was designed to evaluate the efficacy of different strategies for migraine prophylaxis over a fairly long period. Metoprolol alone was compared with psychotherapy alone and with a combination of metoprolol and psychotherapy. The psychological programme was planned for future use in preventive treatment. In this paper only the results of the psychological therapy are described. PATIENTS AND METHODS: Criteria for inclusion of patients were: migraine without aura or with short aura for at least 2 years, and 2-10 attacks per month. In all, 63 patients (11 men and 52 women) were each randomized for participation one of the three kinds of treatment. All patients declared their willingness to participate in all three different therapies. After neurological and psychological diagnosis the baseline phase of 2 months was started, followed by the intensive therapy phase lasting 3 months. The end of the intensive therapy is followed by a first 2-month follow-up period. A second follow-up of 2 months was started 6 months after the end of intensive therapy. Psychological diagnosis involved the following elements: a migraine questionnaire, a list of patient's complaints, a depression scale and a psychological exploration. All patients kept a diary during all phases of the study with daily descriptions of their headaches, the therapy and their mood. The psychological programme lasted for 12 sessions of 2 hours each. A psychologist worked with small groups of up to 5 patients This programme was composed of progressive relaxation techniques (Jacobson) and techniques aimed at overcoming pain and stress. The data on diagnosis, the baseline phase, the intensive therapy phase and the two follow-up phases were analysed by conventional statistics (comparison of mean values,t-test, variance analysis, non-parametric tests) and by time series analysis. The parameters analysed were: frequency of attacks, mean headache intensity, duration of headache and migraine, consumption of analgesic drugs and mood. Analysis of the questionnaires and the different diagnostic data revealed no significant differences between the three different groups of therapy. RESULTS: A significant improvement in one or at least two measured parameters is shown in Table 1. The results, with 62.5% responders for one parameter in the first follow-up phase are rather positive. If two variables are required to improve significantly the results become worse. Over the different phases the results improve slightly, probably due to the effect of training. In the time series analysis the percentage of responders was calculated to show the number of responders for a particular variable (Table 3). For the different parameters the percentage of responders varied between 0 and 31.3%. CONCLUSIONS: According to the results, the efficacy of the psychological treatment increases only gradually, as it has also been demonstrated for biofeedback and relaxation training [9]. Subjectively, patients rate the results of psychotherapy higher than those demonstrated by statistics. This may depend on the selection of patients, but also on the fact that subjective criteria of improvement are not contained in statistical evaluation. Responders and non-responders had initial differences regarding vegetative, hormonal and psychological factors. Responders had a more stable circulatory status, suffered more rarely from menstrual migraine and normally took significantly fewer analgesic drugs. On the whole, this psychological programme has proved quite effective.


Niederberger, U., Gerber, W.-D., Weber, P., & Hoge, M. (1992). Learning a Novel Motor Task under Different Kinds and Amounts of Sensory Feedback. Int. J. Psychol., 27, 142.Weinschütz, T., Niederberger, U., Schutz, H. W., & Dieball, U. (1992). Therapy Resistance in Headache Patients – Result of Chronic Drug Administration. Eur. J. Neurosci., p. 196.


Besken, E., Pothmann, R., Niederberger, U., Plump, U., …, & Greis, R. (1991). Metoprolol and dihydroergotamine prophylaxis of migraine: Preliminary results. J. Pain Symptom Manage., 6(3), 153. doi:10.1016/0885-3924(91)91002-Q.
Gerber, W.-D., Diener, H. C., Scholz, E., & Niederberger, U. (1991). Responders and Non-Responders to Metoprolol, Propranolol and Nifedipine Treatment in Migraine Prophylaxis: A Dose-Range Study Based on Time-Series Analysis. Cephalalgia, 11(1), 37–45. PMID:2036669, doi:10.1046/j.1468-2982.1991.1101037.x.

The aim of the present study was to ascertain, on the basis of single case statistics and time-series analysis, responder and non-responder rates for metoprolol, propranolol and nifedipine in migraine prophylaxis. In addition, an attempt was made to identify the dose relationship for the various drugs on headache parameters. In a double-blind dose-finding study, 58 patients were treated in five consecutive dosage steps each lasting 1-3 months. All patients kept a headache diary before, during and after treatment. Serum drug levels were also determined. The data were assessed by time-series analysis, as well as by multiple regression and analysis of variance. A significant improvement was noted in 54.4% of patients with migraine during treatment with metoprolol. The study did not confirm the high success rates in migraine prophylaxis of nifedipine and propranolol quoted in the literature. Administration of nifedipine led to an increase in migraine attacks in 71% of the patients. Nifedipine was of no value in the prophylaxis of migraine. Only 32% of patients showed a reduction in frequency of migraine attacks during administration of propranolol. The analysis of variance failed to show any significant difference between the responder rates for metoprolol and propranolol. Higher doses of propranolol and metoprolol were more effective. Multiple regression analysis explained a considerable part of variance for propranolol (but not for metoprolol) as a result of reduced intake of ergotamine preparations and analgesics. It can therefore be concluded that part of the prophylactic effect of propranolol is attributable to a reduction in the use of migraine medication.

Weinschuetz, T., Engel, H., Niederberger, U., Soyka, D., & Weinschütz, T. (1991). The New Diagnostic Criteria of Ihs: A Predicting Factor for Treatment Outcome? A Two-Year Follow-Up of Chronic Benign Headache Patients. Cephalalgia, 11(11_suppl), 327–328. doi:10.1177/0333102491011S11175.
Weinschütz, T., Engel, H., Niederberger, U., & Soyka, D. (1991). Zweijahreskatamnese von chronischen Kopfschmerzpatienten einer neurologischen Schmerzambulanz. Der Schmerz, 5(4), 226–232. PMID:18415176, doi:10.1007/BF02527802.

The chronic headache patients in our neurological outpatient department treated between 1985 and 1987 were retrospectively studied. One-third (n=44) were examined and questioned about the efficacy of treatment. Initial treatment in the outpatient department had been at least 2 years before the study, thus allowing evaluation of the long-term course of the illness. Age distribution, sex ratio, distance to the therapy center, duration of illness, and the extent and results of the diagnosis are reported. The most common form apart from migraine and tension headache was drug-induced headache. The range of medical and non-medical therapy applied is presented. The therapeutic response (free of pain/distinct improvement) was 43.2% directly following therapy, 40.9% after 1 year, and 34.1% 2 years after therapy. Although the results correspond with those of other studies, they also indicate, however, a high level of resistance to therapy. Long-term medical side effects, as well as psychosocial factors, especially appear to exacerbate chronic headache in the non-responders. Further investigations are necessary to explore this factor. The practical consequences are discussed for outpatient therapy of headache patients. In addition to the exact clinical classification of the headache syndrome, we consider it important to identify the exacerbating factors before starting multidimensional therapy. Adequate consideration of the non-medical therapeutic elements should be ensured in such structures headache therapy. A uniform classification of headache and records of the course in the form of headache diaries are essential for comparing the results. A sufficiantly long post-therapy observation period should be allowed in order to facilitate evaluation of the therapeutic response.


Diener, H.-C., Scholz, E., Dichgans, J., Gerber, W.-D., …, & Niederberger, U. (1989). Central effects of drugs used in migraine prophylaxis evaluated by visual evoked potentials. Ann. Neurol., 25(2), 125–130. PMID:2645824, doi:10.1002/ana.410250204.

The present study used recordings of visual potentials evoked by pattern reversal (VEPs) to investigate the central effects of three drugs used in migraine prophylaxis: the calcium channel blocker nifedipine, the beta-1-selective blocker metoprolol, and the nonselective beta adrenoreceptor blocker propranolol. The study involved 58 patients with common or classical migraine who were treated in a double-blind randomized study over a period of 7 months, while the effectiveness of prophylactic treatment was recorded in headache diaries that were subjected to time series analysis. VEPs were recorded at the beginning of a 2-month baseline period without treatment, after 4 months of treatment, and at the end of a 3-month washout period. At baseline, migraine patients had significantly higher VEP amplitudes and longer latencies than did a group of 87 healthy control subjects. Patients were separated by statistical analysis into responders and nonresponders to each prophylactic treatment. Nifedipine had no effects on the frequency, intensity, and duration of migraine attacks, nor on amplitude and latency of the VEPs. In contrast, the use of beta blockers resulted in a significant decrease in VEP amplitude, both in responders and nonresponders, whereas VEP latency remained unchanged. VEP amplitudes returned to the initial values at follow-up in the nonresponders, but stayed at lower levels in responders. Beta blockers thus appear to have a significant effect on the increased excitability of the visual system in patients with migraine, although their action is not directly related to their reduction of migraine frequency.

Gerber, W.-D., Diener, H. C., Kropp, P., Niederberger, U., & Scholz, E. (1989). The Efficacy of Flunarizine and Etilefrinepivalate in Migraine: An Empirical Double-Blind and Placebo Controlled Study. Cephalalgia, 9(10_suppl), 450–451. doi:10.1177/0333102489009S10239.
Pfaffenrath, V., Niederberger, U., & Kaube, H. (1989). Untersuchungen von Prädiktoren des Behandlungserfolges beim Kombinationskopfschmerz. Der Schmerz, 3(4), 204–208. PMID:9127120, doi:10.1007/BF02527380.

Sixty-five patients (51 women, 14 men), who were 41.9 years on average, suffered from combination headache (migraine and tension headache) and were under therapy with propranolol and amitriptyline-N-oxide. The following predictive factors were tested with regard to the success of therapy: age, sex, duration of the migraine and tension headache illness, and frequency of use of analgesic and ergotamine preparations. The prerequisite was a statistically valid classification of responders and non-responders. Responders were defined as patients with at least 50% reduction in their symptomatic parameters (duration and frequency of migraine attacks or tension headaches between the beginning (t(0)) and end of the 3-month treatment (t(3)). Both the migraine treatment and the tension headache were standardized and headache records were kept. The statistical procedure used permitted clear differentiation between responders and non-responders, but these predictive factors did not make it possible to distinguish a subgroup of potential responders.


Gerber, W.-D., Soyka, D., Niederberger, U., & Haag, G. (1987). Probleme und Ansätze zur Anlage und Bewertung von Therapiestudien bei Kopfschmerzpatienten. Der Schmerz, 1(2), 81–91. PMID:18415553, doi:10.1007/BF02527734.

A review of studies on migraine therapy shows a large heterogeneity in the clinical evaluation of different drugs and behavioral approaches. The percentages of efficacy of beta-blockers or behavior therapy (relaxation, biofeedback) range from 30% to 80%. Methodological differences from one author to another in the design and conduct of the studies might be causes of this variation. For both clinical practice and empirical research (e.g. replication of treatment studies) an uniformity in the application of different methodological techniques should be sought. This paper discusses the influence of methodological aspects on the success rates of treatment for chronic headaches, especially migraine. We question the present practice of applying traditional group experiments in headache research. Double-blind and placebo-controlled studies are often required, but this demand often cannot be niet in empirical reality because of the individuality of the patient or the heterogeneity of the symptoms. We discuss some alternative approaches that could be used in empirical research on headache therapy. The application of single-case experiments as well as methods of time-series analysis are described as a more appropriate approach to the evaluation of studies on chronic headaches.

Niederberger, U., Engemann, A., & Radtke, M. (1987). Extent of Information-Processing in Decision-Making – the Influence of Memory Strain and Action Orientation. Z. Exp. Angew. Psychol., 34, 80–100.