Effects of Synergism of Mindfulness Practice Associated With Transcranial Direct-Current Stimulation in Chronic Migraine: Pilot, Randomized, Controlled, Double-Blind Clinical Trial

Abstract

Chronic migraine is a difficult disease to diagnose, and its pathophysiology remains undefined. Its symptoms affect the quality of life and daily living tasks of the affected person, leading to momentary disability. This is a pilot, randomized, controlled, double-blind clinical trial study with female patients between 18 and 65 years old with chronic migraine. The patients underwent twelve mindfulness sessions paired with anodal transcranial direct-current stimulation (tDCS) over the left dorsolateral prefrontal cortex (DLPFC), with current intensity of 2 mA applied for 20 min, three times a week for 4 weeks. In addition, 20 min of mindfulness home practices were performed by guided meditation audio files. A total of 30 participants were evaluated after the treatment, and these were subdivided into two groups—active tDCS and sham tDCS, both set to mindfulness practice. The FFMQ-BR (Five Facet of Mindfulness Questionnaire), MIDAS (Migraine Disability Assessment), and HIT-6 (Headache Impact Test) questionnaires were used to evaluate the outcomes. After the treatment, the active mindfulness and tDCS group showed better results in all outcomes. The sham group also showed improvements, but with smaller effect sizes compared to the active group. The only significant difference in the intergroup analysis was the outcome evaluated by HIT-6 in the post treatment result. Our results provide the first therapeutic evidence of mindfulness practices associated with left DLPFC anodal tDCS with a consequent increase in the level of full attention and analgesic benefits in the clinical symptoms of patients with chronic migraine.

Stimulated brains and meditative minds: A systematic review on combining low intensity transcranial electrical stimulation and meditation in humans

“…However, the role of combined therapy on the overall improvements is not as clear across the remaining studies. Pimenta et al (2021) had a larger effect size for the group with active tDCS and MM despite including additional MM training. Robinson et al (2019) found significant results at a specific location with LKM, regardless of tDCS intensity, which could be explained by the lack of LKM and tDCS sessions.…”

“…The published studies included 664 participants, after correcting for secondary analyses publications using the same participants, comprising of 56.93% females and 43.07% males ( Table 1 ). Seven out of the 20 studies were conducted in healthy individuals ( Badran et al, 2017 ; Clarke et al, 2020 ; Danilewitz et al, 2021 ; Hunter et al, 2018 ; Nishida et al, 2021 ; Robinson et al, 2019 ; Sefat et al, 2022 ), while the remaining studies tested the combination of tDCS and meditation in patient groups diagnosed with conditions such as chronic pain ( Ahn et al, 2019; Pimenta et al, 2021 ; Pollonini et al, 2020 ; Ramasawmy et al, 2022 ), psychological disorders ( Alizadehgoradel et al, 2021 ; Brooks et al, 2021 ; Brown et al, 2020 ; Gibson et al, 2022 ; Hung, 2019 ; Monnart et al, 2019 ; Witkiewitz et al, 2019 ), mild cognitive impairment ( Liao et al, 2021 ), and movement disorders ( Park et al, 2021 ). All the ongoing studies test the combined intervention in diseased populations ( Table 2 ).…”

“…Approximately less than half of the studies (40%: Ahn et al, 2019 ; Alizadehgoradel et al, 2021 ; Hunter et al, 2018 ; Liao et al, 2021 ; Nishida et al, 2021 ; Pollonini et al, 2020 ; Ramasawmy et al, 2022 ; Sefat et al, 2022 ) showed significant main effects from the combination of a meditation technique with anodal active over sham tDCS stimulation, where all but Nishida et al (2021) and Sefat et al (2022) had more than one active session. Five showed significant improvements without having any main or group effects (25%: Hung, 2019 ; Monnart et al, 2019 ; Pimenta et al, 2021 ; Robinson et al, 2019 ; Witkiewitz et al, 2019 ).…”

“…Lastly, in a study on migraine headache, Pimenta et al (2021) found that 4 weeks (3 days per week) of therapy combining MM and 2 mA anodal tDCS for 20 min over the left dlPFC concurrently in patients with chronic migraine improved results of both mindfulness and clinical headache pain assessments. Both the sham group (sham tDCS+real MM) and the active group benefitted from the therapy, but the effect sizes were larger in the active group than sham one.…”

Chronic Migraine: A Narrative Review on the Use of Botulinum Toxin with Clinical Indications and Future Directions

“…A recent study has shown, for the first time ever, the therapeutic effect of mindfulness practices associated with left dorsolateral prefrontal cortex anodal tDCS in improving the level of full attention and analgesic benefits in this patient population [75,76].…”