An investigation was conducted to assess the relative effectiveness of two psychophysiological approaches to migraine treatment. 23 migraineurs were assigned to two treatment groups: Temporal Pulse Amplitude Reduction (TPA, n = 12) or Hand Temperature Biofeedback (HTB, n = 11). During all sessions temporal pulse amplitude, finger pulse amplitude and hand temperature were continuously recorded. Analysis of the clinical outcome data was based on the comparison of one month pre- and one month post-treatment diaries of headache symptomatology and medication intake. Results showed both groups learned significant physiological control during training and testing. The TPA group showed significant reductions in 2 of the 6 measures of headache activity and a trend toward a decrease in a third. The HTB group showed only a trend toward a decrease in I measure, a significant increase in another and a trend toward an increase in a third. While there were no significant differences on any of the measures during the pre-treatment period, the groups were significantly different on 3 of the 6 measures during the post-treatment period, with each difference indicating the superiority of temporal pulse amplitude reduction biofeedback. The results are discussed in terms of the challenge they pose to the commonly held view that migraine is related to a syndrome of sympathetic overactivity.