Posted 03.14.2017 | by AMRA

Migraines are disabling headaches lasting from several hours to several days that are characterized by severe, pulsating pain usually localized to one side of the head. Migraine sufferers may also experience nausea and sensitivity to light, sound or smell. Their headaches may also be preceded by visual disturbances (e.g., blind spots and zigzag patterns) that signal their impending onset.

Migraines are considered “chronic” when they occur more than 15 days a month over a period of three months. Chronic migraines are often complicated by medication overuse, which tends to make migraines worse and harder to manage. The treatment of chronic migraine complicated by medication overuse is complex, and physicians are interested in behavioral approaches that can either supplement or be used instead of medications.

Grazzi et al. [Journal of Headache and Pain] conducted a non-randomized exploratory clinical trial of a mindfulness-based intervention compared to prescribed medications intended to prevent headache onset for patients with combined chronic migraine and medication overuse.

Patients with chronic migraine and medication overuse who were being treated at a neurology clinic were withdrawn from their medication in a structured day treatment program. At the end of the program, they were invited to participate in a clinical trial of either mindfulness training (MT) or prophylactic medication (MED).

A total of 44 patients (average age = 45) were enrolled in the study, and assignment to treatment was self-selected. The MT intervention, based on Mindfulness-Based Stress Reduction, involved six weekly 45-minute small group sessions. MT participants practiced maintaining a non-judgmental, present-moment focus during sitting meditation.

Patients in the MED condition were prescribed medications to take before their headaches began including valproate, botulinum toxin, pizotifen, amitriptyline, and beta blockers. Patients in both groups could take medication for acute headaches (primarily triptans and NSAIDs) once headaches had begun. Participants in both groups completed daily diaries documenting their headaches and medication use. They also completed self-report measures of headache impact, migraine disability, depression, and anxiety at baseline, and at 3, 6, and 12 months. The researchers also evaluated participants at 3, 6, and 12 months to see whether they had achieved a 50% reduction in headache frequency and whether they still met the diagnostic criteria for chronic migraine.

Headache frequency, medication use, and depression severity significantly decreased for both treatments over time, without significant differences between treatments. Headache-related disability significantly decreased for both groups at 3- and 6-month follow-up, but not at 12 months.

Only one measure called the Headache Impact Test, a self-report measure of pain severity, fatigue and mood, showed different treatment outcomes over time. While the MT group’s scores on that test didn’t change significantly, the MED group’s scores significantly improved at 3 months and 12 months, but not at 6 months.

There was no difference between treatments at 12 months in terms of those meeting the criteria of a 50% reduction in headache frequency (50% of MT patients and 53% of MED patients) or those no longer meeting chronic migraine diagnostic criteria (65% of MT patients and 74% of MED patients).

The results support a role for mindfulness in the treatment of chronic migraine with medication overuse. The results suggest that mindfulness training may be as effective in reducing headache frequency, depression, headache-related disability, and acute medication use as prescribed medication to prevent headache onset. The study is limited by its lack of random assignment, a placebo control, and measures of adherence to treatment and home practice.

Reference:

Grazzi, L., Sansone, E., Raggi, A., DAmico, D., De Giorgio, A., Leonardi, M., . . . Andrasik, F. (2017). Mindfulness and pharmacological prophylaxis after withdrawal from medication overuse in patients with chronic migraine: An effectiveness trial with a one-year follow-up. Journal of Headache and Pain, 18(1), 15.

[Link to abstract]