Mindfulness intervention reduces impact of migraine on quality of life
Mindfulness-based stress reduction improved disability, quality of life and other measures related to migraine, although it did not reduce frequency more than headache education, according to a study published in JAMA Internal Medicine.
“Our objective was to determine if mindfulness-based stress reduction (MBSR) improves migraine frequency, disability, quality of life, self-efficacy (a person’s belief in his or her ability to handle migraine), pain catastrophizing (magnification of pain-related thoughts/feelings), depression scores and experimentally induced pain compared to headache (HA) education,” Rebecca Erwin Wells, MD, MPH, associate professor of neurology at Wake Forest School of Medicine in Winston-Salem, North Carolina, told Healio Neurology.
Wells and colleagues conducted a randomized clinical trial comparing daily migraine frequency among 89 participants (women, 92%; mean age, 43.9 years; Headache Impact Test-6 score: 63.5) who experienced between 4 and 20 headache days per month.
“We did not recruit participants to a ‘mindfulness meditation study,’” Wells said. “Rather, we recruited patients interested in “non-drug treatments.”
Participants received either MBSR, which involved standardized training in mindfulness/yoga, or headache education (migraine information). Both groups met for 2 hours per week for 8 weeks. Wells said the participants “were blinded to course content and treatment assignment (to active vs. comparator group assignment),” as blinding reduces bias and strengthens the validity of the intervention.
Change in daily migraine frequency from baseline to 12 weeks served as the primary outcome; secondary outcome measures included changes in disability, quality of life, self-efficacy, pain catastrophizing, depression scores and experimentally induced pain intensity and unpleasantness (baseline to 12, 24 and 36 weeks).
Most participants attended class (median attendance, 7 of 8 classes) and completed follow-up through 36 weeks (33 of 45 [73%] in the MBSR group and 32 of 44 [73%] in the headache education group).
Both interventions reduced migraine day frequency at 12 weeks (MBSR: -1.6 days per month [95% CI, –0.7 to –2.5] vs. headache education: -2.0 days per month [95% CI, –1.1 to –2.9).
“However, only MBSR also decreased disability and improved quality of life, depression scores, self-efficacy and pain catastrophizing, which are measures of emotional well-being,” Wells said.
Compared with participants who received headache education, participants in the MSBR group experienced improvements from baseline to weeks 12, 24 and 36 in measures of disability (5.92; 95% CI, 2.8-9), quality of life (5.1; 95% CI, 1.2-8.9), self-efficacy (8.2; 95% CI, 0.3-16.1), pain catastrophizing (5.8; 95% CI, 2.9-8.8) and depression scores (1.6; 95% CI, 0.4-2.7).
At 36 weeks, participants in the MBSR group had lower pain intensity (MBSR: 36.3% [95% CI, 12.3 to 60.3] decrease; headache education: 13.5% [95% CI, –9.9 to 36.8] increase) and reduced unpleasantness (MBSR: 30.4% decrease [95% CI, 9.9 to 49.4] vs. headache education: 11.2% increase [95% CI, –8.9 to 31.2]). Wells said that the effects at 36 weeks “demonstrate potential for long-term benefit” and that the differences between groups suggest “a shift in pain appraisal.”
“[W]e did not expect to see a positive impact of headache education on migraine frequency. This study shows how important headache education can be, providing information that is helpful for people with migraine,” Wells said. “We also did not expect to see a positive effect of the intervention on both experimental pain intensity and pain unpleasantness. We had hypothesized that we would only see an effect on pain unpleasantness (the affective, or emotional, aspect of pain) and not pain intensity (the sensory component of pain).”
Wells told Healio that the next step in this research would be a larger study in a diverse population.
“We want to further understand the mechanisms that help explain the benefits of mindfulness in migraine and we want to know the best methods for implementation,” she said.