Mindfulness-based stress reduction has long-lasting benefits for migraine
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Mindfulness-based stress reduction appeared to safely treat total migraine burden with long-lasting effects, according to findings presented at the annual meeting of the American Neurological Association.
“Many patients with migraine experience medication side effects or inefficacy, and one-third of patients with migraine use opioids for treatment,” Rebecca Erwin Wells, MD, MPH, associate professor in the department of neurology and director of the Comprehensive Headache Program at Wake Forest Baptist Health, said during a virtual presentation. “There is a dramatic need for non-opioid treatment options for migraine, especially those that target other factors playing a role, such as stress. Stress is the number one reported trigger for migraine.”
Wells and colleagues conducted a randomized clinical trial of mindfulness-based stress reduction (MBSR) compared with an active comparator group of headache education. The MBSR intervention consisted of a standardized protocol of eight weekly, approximately 2-hour in-person classes that incorporated experiential practices, dialogue and inquiry, as well as provided audio files for experiential home practices. The headache education intervention matched the time and attention of the MBSR intervention.
Researchers randomly assigned 89 adults with between 4 and 20 migraine days per month to one of the interventions, with blinding to treatment assignment of both the study team and participants, according to the study abstract. Participants could continue all medications for study duration. They kept a daily headache log.
Study visits occurred at baseline for the screening visit, with follow-up time points at 12, 24 and 36 weeks after starting the headache log. Each study visit included questionnaires and quantitative sensory testing to assess experimental heat pain responses. Reduction of migraine days per month from baseline to 12 weeks, without statistical differences between groups, served as the primary outcome for both groups.
Results showed both groups met the primary outcome, with reductions in migraine days per month of 1.6 days for MBSR and 2 days for headache education, which were not statistically significant differences, according to the study abstract. However, compared with headache education, only MBSR was linked to clinically significant improvements in a multitude of secondary outcomes, including pain catastrophizing, disability, self-efficacy, depression and quality of life. For experimental heat pain, MBSR participants showed decreases in intensity and unpleasantness, whereas the headache education group showed increases.
“Mindfulness may safely treat the total migraine burden with long-term effects,” Wells said during the presentation. “Additional research is needed to further evaluate the results of the secondary outcomes of the study.”