“Among the limited treatment options for patients with migraine, many of those used as preventatives are not highly effective and can create challenging side effects,” says David A. Seminowicz, PhD. Conversely, studies have indicated that several nonpharmacologic treatments for migraine and chronic pain appear to be effective and have limited side effects. Recent research has suggested that mindfulness-based stress reduction (MBSR) was effective in reducing pain and improving functional outcomes in patients with chronic lower back pain. Dr. Seminowicz and colleagues conducted a study, published in Pain, to evaluate the effectiveness of enhanced MBSR (MBSR+), an extended program, compared with stress management for headache (SMH) for migraine.
Additionally, the study team sought to determine if MBSR+ was associated with brain changes over time. Questionnaires administered at baseline and weeks 10, 20, and 52 and MRIs conducted at baseline and weeks 10 and 20 were utilized to evaluate treatment outcomes and assess brain structure and function. Participants were randomly selected to MBSR+ or SMH in combination with their prescribed preventative treatments and acute abortives as needed.
Separate groups of MBSR+ and SMH met weekly, for 2-hour sessions, for 8 weeks and then biweekly for an additional 8 weeks. The first 8 MBSR+ sessions were adapted from a program developed by Kabat-Zinn to include trauma-informed methods of teaching and emphasized loving kindness to distress. Participants were also given additional reading on mindfulness and CD-based audio teachings. “The week 8 session was focused on applying learning to migraines before, during, and after an attack and engaging participants in deciding which MBSR practices they wished to increase use of during the second 8 weeks of the MBSR+ program,” explains Dr. Seminowicz. The final four sessions encouraged continued mindfulness practice and self-compassion, emphasizing sympathetic joy, equanimity, and gratitude. Sessions included a personal body scan, yoga, sitting, and walking meditations.
Similarly to MBSR+, participants using SMH attended 12 sessions focused on didactic content about the role of stress and other triggers in headaches. “Topics included stress at work and home, coping with stress mental health and personality, sleep hygiene, pain education, and medications for migraine,” adds Dr. Seminowicz. Sessions also included 10-minute stretching exercises. Additionally, participants were given reading and information on SMH.
The results of the questionnaires and MRIs indicated that at 20 weeks, participants in the MBSR+ group experienced fewer migraine days (4.6) than those in the SMH group (6.0;Table). “In addition to heling reduce headache frequency compared with SMH, MBSR+ also helped reduce migraine-related disability and migraine days,” notes Dr. Seminowicz. “The table also shows the percentage of responders—defined as those with a 50% or greater reduction in number of headache days compared with baseline—was 52% in the MBSR+ group versus 23% in the SMH group.” The MBSR+ group also reported reduced scores from the six-item Headache Impact Text (HIT-6) questionnaire (2.0) compared with the SMH group (3.7).
“The effects observed with MBSR+ were comparable to those achieved with first-line preventive drugs for migraine,” says Dr. Seminowicz. “In addition, there were virtually no side effects, so it can be combined with other pharmacologic or nonpharmacologic treatments. The functional MRI results supported our hypothesis of increased cognitive efficiency, which could be mediating the effects of MBSR+.”
The study provides evidence that MBSR+ (and potentially other types of mindfulness) training can be beneficial for patients with migraine, according to Dr. Seminowicz. “However, a 16-week course might not be a practical option for all patients,” he adds. “Our team is developing a more accessible mindfulness training that can reach a wider patient population. We are focusing on the brain mechanisms of brief mindfulness training, which will allow us to make further improvements to the intervention.”