Posted 10.15.2019 | by AMRA

Episodic and chronic migraines affect approximately one billion people worldwide. Symptoms including migraine aura, headache, nausea, and light sensitivity can significantly impair functioning at work, home, and in social situations. Existing behavioral treatments including biofeedback, relaxation and cognitive therapy, and pharmacological treatments have limited efficacy, but no treatment works for everyone.

Seng et al. [Headache] evaluated the efficacy of Mindfulness-Based Cognitive Therapy for Migraine (MBCT-M) compared to a control in reducing migraine-related disability.

The authors randomly assigned 60 migraine patients (average age=40 years; 82% Caucasian; 92% female; average headache days per month=16) to MBCT-M or a treatment-as-usual waitlist control. Thirty-six percent of MBCT-M participants and 62% of control participants came to the study on prescribed prophylactic migraine medication that was continued throughout the study. The groups did not differ on headache frequency, intensity, or disability at baseline.

All participants kept a 30-day headache diary both before and after intervention. In addition, participants were assessed on two measures of headache disability: the Headache Disability Inventory (HDI) and Migraine Disability Assessment (MIDAS) at baseline, and 1, 2, and 4 months.

MBCT-M consisted of once weekly 75-minute individual training sessions for 8 weeks. Sessions included didactic training, cognitive exercises, mindfulness meditation practice and homework review. Most sessions were conducted in person; however, participants were allowed up to 3 telephone-delivered sessions when headaches prevented in-person attendance.

The trainers were clinical psychology graduate students with 12 hours of MBCT training. The trainers received continuous supervision from licensed psychologists with expertise in headaches, and sessions were monitored to assure treatment fidelity. The control group continued whatever treatment they were getting prior to the onset of the study and were placed on an MBCT-M waiting list.

Mindfulness participants reported a significantly greater average decrease in disability (-14.3 points) on the HDI than did controls (-0.2 points). Group differences on the MIDAS trended toward significance in the same direction. Mindfulness participants reported a significantly greater decrease in average daily disability ratings in their headache diaries (-0.6 points) than did controls who reported an average increase (+0.3).

The groups did not differ in headache frequency or intensity. There were two adverse events in the MBCT-M group: one person re-experienced a traumatic memory, and another reported a dramatic increase in headache frequency and intensity. There were no adverse events in the control group. Two thirds of MBCT-M participants gave exit interviews, and of those, 86% stated they derived benefit from the treatment and would recommend it to others.

The results support the use of MBCT-M for migraine-related disability reduction. MBCT-M may be most useful when significant disability remains, and other treatments have achieved maximum benefit in decreasing headache frequency and intensity. The researchers hypothesize that MBCT-M works by changing one’s relationship to headache-related pain and thinking rather than by reducing headache frequency and intensity.

The study was limited by its failure to reach its recruitment goal, thereby lowering its power to detect study group differences. It also did not measure mindfulness or headache-related catastrophizing and rumination.

Reference:

Seng, E. K., Singer, A. B., Metts, C., Grinberg, A. S., Patel, Z. S., Marzouk, M., . . . Buse, D. C. (2019). Does mindfulness-based cognitive therapy for migraine reduce migraine-related disability in people with episodic and chronic migraine? A phase 2b pilot randomized clinical trial. Headache.

[Link to study]