Enhanced mindfulness based stress reduction (MBSR+) in episodic migraine: a randomized clinical trial with MRI outcomes

Abstract

We aimed to evaluate the efficacy of an enhanced mindfulness based stress reduction (MBSR+) versus stress management for headache (SMH). We performed a randomized, assessor-blind, clinical trial of 98 adults with episodic migraine recruited at a single academic center comparing MBSR+ (n=50) to SMH (n=48). MBSR+ and SMH were delivered weekly by group for 8 weeks, then bi-weekly for another 8 weeks. The primary clinical outcome was reduction in headache days from baseline to 20 weeks. MRI outcomes included activity of left dorsolateral prefrontal cortex (DLPFC) and cognitive task network during cognitive challenge, resting state connectivity of right dorsal anterior insula (daINS) to DLPFC and cognitive task network, and gray matter volume of DLPFC, daINS, and anterior midcingulate. Secondary outcomes were headache-related disability, pain severity, response to treatment, migraine days, and MRI whole-brain analyses. Reduction in headache days from baseline to 20 weeks was greater for MBSR+ (7.8 [95%CI, 6.9-8.8] to 4.6 [95%CI, 3.7-5.6]) than for SMH (7.7 [95%CI 6.7-8.7] to 6.0 [95%CI, 4.9-7.0]) (P=0.04). 52% of the MBSR+ group showed a response to treatment (50% reduction in headache days) compared with 23% in the SMH group (P=0.004). Reduction in headache-related disability was greater for MBSR+ (59.6 [95%CI, 57.9-61.3] to 54.6 [95%CI, 52.9-56.4]) than SMH (59.6 [95%CI, 57.7-61.5] to 57.5 [95%CI, 55.5-59.4]) (P=0.02). There were no differences in clinical outcomes at 52 weeks or MRI outcomes at 20 weeks, although changes related to cognitive networks with MBSR+ were observed. MBSR+ is an effective treatment option for episodic migraine.

Perceived stress in the time of COVID-19: the association with brooding and COVID-related rumination in adults with and without migraine

“…For instance, implementing the daily use of electric diaries may help to control the level of perceived stress and related rumination. Interventions aiming to reduce stress and rumination, such as mindfulness-based stress reduction and autogenic training may also be effective [64,65]. Making telemedicine available for migraineurs could also contribute to reduce their level of stress by offering help safely [66].…”

Is mindfulness associated with lower pain reactivity and connectivity of the default mode network? A replication and extension study in healthy and episodic migraine participants

“…Mindfulness has been inversely associated with pain intensity in heterogeneous pain groups, including undergraduate students 31 , adolescents 34 and adults presenting for chronic pain treatment 29 ; although, consistent with our results, null associations between mindfulness and pain severity have been reported 42 . Although training in mindfulness-based stress reduction has been shown to reduce headache frequency and impact in migraine 39 , mindfulness as a dispositional characteristic appears less meaningful in this context. Perhaps the active and volitional use of mindfulness strategies as acquired through systematic training is of greater clinical importance and neurobiologically significant 47,48 4,13,17,46 In terms of limitations, it should be noted that the current patient sample was waiting to start a stress reduction program that included meditation for some, and therefore factors like treatment expectations and hypervigilance could have biased how patients reported their mindfulness, pain or pain catastrophizing.…”

“…This was a secondary cross-sectional analysis of baseline data collected during a larger parent trial comparing an enhanced (i.e., 12-week) mindfulness-based stress reduction program (MBSR+) with an active control (i.e., Stress Management for Headache; SMH) condition 39 . The full methodology of the parent project (R01AT007171) has been described elsewhere 5,39 .…”

“…There was a 6-second rest period between stimulations. The stimulus order was 40,42,44,47,41,49,41,45,48,39,49,45,48,47,45,44,43, 49, 47°C. The QST protocol has also been described in previous work by our group 21 .…”

“…Emerging data suggest that mindfulness training reduces experimental 47 and clinical pain 39 , potentially via reduced cognitive-affective reactivity to pain vis-à-vis enhanced nonjudgmental, present moment awareness 25 . Alterations in the default mode network (DMN), a functionally connected network of brain regions underlying self-referential processing 19 and mind-wandering 22 , have been implicated in the attentional changes that occur following mindfulness training 4,9,11 .…”