Effectiveness of Mindfulness Meditation vs Headache Education for Adults With Migraine

Abstract

IMPORTANCE Migraine is the second leading cause of disability worldwide. Most patients with migraine discontinue medications due to inefficacy or adverse effects. Mindfulness-based stress reduction (MBSR) may provide benefit. OBJECTIVE To determine if MBSR improves migraine outcomes and affective/cognitive processes compared with headache education. DESIGN, SETTING, AND PARTICIPANTSThis randomized clinical trial of MBSR vs headache education included 89 adults who experienced between 4 and 20 migraine days per month. There was blinding of participants (to active vs comparator group assignments) and principal investigators/data analysts (to group assignment).INTERVENTIONS Participants underwent MBSR (standardized training in mindfulness/yoga) or headache education (migraine information) delivered in groups that met for 2 hours each week for 8 weeks. MAIN OUTCOMES AND MEASURESThe primary outcome was change in migraine day frequency (baseline to 12 weeks). Secondary outcomes were changes in disability, quality of life, self-efficacy, pain catastrophizing, depression scores, and experimentally induced pain intensity and unpleasantness (baseline to 12, 24, and 36 weeks). RESULTSMost participants were female (n = 82, 92%), with a mean (SD) age of 43.9 (13.0) years, and had a mean (SD) of 7.3 (2.7) migraine days per month and high disability (Headache Impact Test-6: 63.5 [5.7]), attended class (median attendance, 7 of 8 classes), and followed up through 36 weeks (33 of 45 [73%] of the MBSR group and 32 of 44 [73%] of the headache education group). Participants in both groups had fewer migraine days at 12 weeks (MBSR: −1.6 migraine days per month; 95% CI, −0.7 to −2.5; headache education: −2.0 migraine days per month; 95% CI, −1.1 to −2.9), without group differences (P = .50). Compared with those who participated in headache education, those who participated in MBSR had improvements from baseline at all follow-up time points (reported in terms of point estimates of effect differences between groups) on measures of disability (5.92; 95% CI, 2.8-9.0; P < .001), quality of life (5.1; 95% CI, 1.2-8.9; P = .01), self-efficacy (8.2; 95% CI, 0.3-16.1; P = .04), pain catastrophizing (5.8; 95% CI, 2.9-8.8; P < .001), depression scores (1.6; 95% CI, 0.4-2.7; P = .008), and decreased experimentally induced pain intensity and unpleasantness (MBSR group: 36.3% [95% CI, 12.3% to 60.3%] decrease in intensity and 30.4% [95% CI, 9.9% to 49.4%] decrease in unpleasantness; headache education group: 13.5% [95% CI, −9.9% to 36.8%] increase in intensity and an 11.2% [95% CI, −8.9% to 31.2%] increase in unpleasantness; P = .004 for intensity and .005 for unpleasantness, at 36 weeks). One reported adverse event was deemed unrelated to study protocol.CONCLUSIONS AND RELEVANCE Mindfulness-based stress reduction did not improve migraine frequency more than headache education, as both groups had similar decreases; however, MBSR improved disability, quality of life, self-efficacy, pain catastrophizing, and depression out to 36 weeks, with decreased ...

A Bibliometric Analysis of Research Trends of Acupuncture Therapy in the Treatment of Migraine from 2000 to 2020

“…Migraine is characterized by attacks of throbbing, often unilateral, severe and pulsating headache, and associated with symptoms such as phonophobia, photophobia, vomiting, nausea, and cutaneous allodynia. [1][2][3] As the second leading cause of disability worldwide, 4,5 migraine significantly contribute to individual and societal burdens due to severe pain and environmental sensitivities. [6][7][8] Epidemiological studies have shown a higher prevalence of migraine in recent years.…”

Migraine Disability, Pain Catastrophizing, And Headache Severity Are Associated With Evoked Pain And Targeted By Mind-Body Therapy

“…These findings show that an ensemble of symptoms relating to experimentally evoked pain is targeted by mind-body therapy. Due to the ensemble's relationship with evoked pain, it could serve as a potential endpoint for clinical trials assessing treatments that modify evoked pain, as is the case with MBSR [42]. The present study is not without its limitations.…”

Learning the full impact of migraine through patient voices: A qualitative study

“…As reflected by recent expert international consensus 44 and systematic reviews, 45,46 clinical trials should always include outcomes that reflect the full impact of migraine on patient lives through assessing both disability and quality of life. Both disability and quality of life are worthy of being a primary outcome, including for pharmacological treatments as well as for implementation science and nonpharmacological treatment approaches 20,44,47 …”

“…Of note, the emotional health codes were represented more commonly in those who had participated in MBSR compared with HA Education. This is particularly interesting given that our quantitative RCT results demonstrated that MBSR improved multiple measures of well‐being more than HA Education (depression scores, quality of life, headache‐related disability, self‐efficacy, pain catastrophizing) 20 . However, mindfulness teaches individuals to pay attention to the present moment in a way that may increase their awareness of how migraine impacts quality of life, while minimizing the associated emotional reactivity.…”

“…The Headache (HA) Education intervention served as a comparator group that matched the time commitment/attention of the MBSR intervention but provided participants with information on migraine instead of MBSR. Adults with migraine randomized to the MBSR intervention arm of the pilot study ( n = 10), 19 and the MBSR or HA Education arms of the larger study (MBSR, n = 33; HA Education, n = 38) 20 participated in qualitative in‐person interviews after completion of the intervention. For study inclusion of both studies: (a) United Council for Neurologic Subspecialties‐certified headache physicians conducted in‐person evaluations to confirm International Classification of Headache Disorders migraine diagnoses and (b) prospective diaries captured frequency.…”