PHILADELPHIA — Mindfulness-based cognitive therapy tailored for migraine (MBCT-M) improves migraine-associated disability but does not reduce headache frequency or pain intensity, new research suggests.
Results of a phase 2b pilot randomized clinical trial showed that patients who used MBCT-M experienced a significant reduction in migraine-related disability, possibly owing to improved coping skills.
"The fact that people can improve the way they live in their daily life even with the same headache days and the same pain intensity is remarkable," lead author Elizabeth Seng, PhD, research associate professor of neurology, Albert Einstein College of Medicine, and assistant professor of psychology, Yeshiva University, New York City, told delegates attending the American Headache Society (AHS) Annual Meeting 2019.
Reduced Disability
Complementary behavioral and integrative health therapies can augment medical treatment for migraine by promoting specific migraine management skills, said Seng.
More than 50% of patients with severe headaches report using complementary approaches, such as relaxation techniques or biofeedback, she added.
"I was fairly skeptical, but I really wanted to understand what many patients were already using," said Seng.
Mindfulness is an attention regulation technique that involves a nonjudgmental awareness of the present moment. Previous studies have shown that mindfulness-based cognitive therapy can increase tolerability to pain as well as engagement in meaningful activities despite symptoms.
To learn more, the investigators assessed 60 adults with migraine. Participants were randomly assigned to undergo 8 weeks of 75-minute MBCT-M (n = 31) or to a be in wait list/usual-care group (n = 29).
Patients completed a 30-day baseline diary before group assignment and had experienced six or more headache days per month. The population was mostly white, well-educated women. About 50% met diagnostic criteria for chronic migraine.
The primary outcomes were any changes on the Henry Ford Disability Inventory (HDI) and the Migraine Disability Assessment (MIDAS). Secondary endpoints included any change in headache days per month or average headache pain intensity at a 1 month after end of treatment.
The MBCT-M group experienced a 15-point greater reduction on the 0 to 100 HDI score compared to the usual-care group (P < .001). MIDAS scores also dropped more in the mindfulness group, but the difference was not statistically significant (P = .027).
In both groups, the proportion of participants with severe disability, as determined by the MIDAS, dropped by 22% from baseline to month 4.
The researchers classified patients as having episodic migraine or chronic migraine (≥15 headache days/month).
Unexpected Finding
An unanticipated finding emerged in an analysis by subgroup. The investigators expected to see more mindfulness efficacy in patients with chronic migraine. However, "the MIDAS scores were significantly reduced, but only in the episodic migraine patients," Seng said.
"It's fun when your hypothesis is not only wrong but opposite," Seng said.
The investigators also assessed attack level disability. They found that the MBCT-M group experienced a significant reduction compared to the usual-care patients.
The investigators conducted exit interviews in a subgroup of 21 participants; 18 of the 21 said they would recommend MBCT-M to others. The daily diary was the most dissatisfying component of treatment. About half asked for referrals to continue their mindfulness training after study completion.
Because there was no reduction in headache frequency or pain intensity, Seng said she would not recommend MBCT-M for these indications.
There were two treatment-related adverse events in the MBCT-M group. Two participants had a vivid recollection of a traumatic event. Both continued the mindfulness training and were satisfied at the end of the study. However, Seng suggested warning patients who have history of trauma about this possibility.
In future research, Seng would like to explore the role of telehealth for mindfulness training and determine other ways to incorporate mindfulness-based interventions into clinical care.
"Very Useful" Results
Commenting on the findings for Medscape Medical News, Gretchen Tietjen, MD, professor and chair of neurology and director of the Headache Treatment and Research Program at the University of Toledo in Ohio, said the study is "very useful."
"As a headache neurologist and researcher, I've been interested in people with early-life stress, which can lead to migraine, fibromyalgia, and other pain syndromes later in life. These people are also at higher risk for vascular problems, including stroke and heart attacks," said Tietjen.
The study, she said, helps explain what mindfulness can do to alter the stress response associated with migraine. Because there is little evidence of the benefits of mindfulness on migraine, it has been difficult to get funding for such research.
"To have [the researchers] look at this and present these counterintuitive results is very useful," Tietjen said.
The findings that mindfulness can reduce the interference that pain causes in the activities of daily life align with Tietjen's own anecdotal clinical experience. "[Patients] had more self-efficiency, and I was not getting as many phone calls from patients — I noticed that," she said.
The study was supported by funding from the International Headache Academy, a grant from the National Institute of Neurological Disorders and Stroke, and the Yeshiva University Hollander Seed Fund. Seng and Tietjen have disclosed no relevant financial relationships.
American Headache Society (AHS) Annual Meeting 2019. Presented July 12, 2019.
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Cite this: Mindfulness-Based Cognitive Therapy Cuts Migraine Disability - Medscape - Jul 15, 2019.
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