Mindfulness Promising in Episodic Migraine, Related Pain

Susan Kreimer for Medscape

February 10, 2022

The report covered in this summary was published in medRxiv.org as a preprint and has not yet been peer reviewed.

Key Takeaways

  • Mesocorticolimbic system function is involved in motivated behavior, and therefore it could be a target of augmentative interventions intended to improve meditation practice engagement.

  • While meditation practice seems to benefit pain-related cognitions but not clinical pain, mindfulness appears as a mechanism of mindfulness-based interventions (MBIs) on headache impact but not frequency.

  • Further research would be necessary to explore the day-to-day effects of meditation practice on pain and continue to describe the specific mechanisms of MBIs on headache outcomes.

Why This Matters

  • Nonpharmacologic treatments have been identified as an important aspect in managing episodic migraine, a severe and debilitating chronic pain disorder. MBIs show promise as prophylactic episodic migraine treatments.

  • The current study examined biopsychosocial predictors and outcomes linked to formal, daily-life meditation practice in migraine patients undergoing MBI and whether augmented mindfulness mechanistically is at the basis of change.

Study Design

  • The authors conducted secondary analyses of clinical trial comparing data 12-week mindfulness-based stress reduction (MBSR+; n = 50) to stress management for headache (SMH; n = 48).

  • Data were collected from meditation-naive individuals who met the International Classification of Headache Disorders criteria for migraine without aura and had been living with migraine for at least 1 year.

  • The study excluded individuals if they reported severe psychiatric symptoms, opioid medication use, previous mindfulness experience, or participation in any treatment expected to affect mindfulness training.

Key Results

  • Pretreatment mesocorticolimbic system functioning (that is, greater resting state ventromedial prefrontal cortex–right nucleus accumbens [vmPFC-rNAC] functional connectivity) positively predicted meditation practice duration over MBSR+ (r = .58, P = .001).

  • This moderated change in headache frequency from before treatment to post treatment (b = -12.60, p = .02). As a result, patients with greater vmPFC-rNAC connectivity demonstrated more significant decreases in headache frequency.

  • Patients who meditated more exhibited higher increases in mindfulness (b = .52, P = .02) and reductions in the helplessness aspect of pain catastrophizing (b = -.13, P = .01) but not headache frequency, severity, or impact.

  • There were augmented mindfulness-mediated reductions in headache impact resulting from MBSR+ but not headache frequency.

Limitations

  • The authors could not obtain meditation practice data when participants failed to come to the weekly class and submit their home practice logs, and they do not have an objective measure of meditation use (for example, smartphone meditation app utilization), both of which may have injected bias. Real-time, smartphone-based evaluation of meditation use could be helpful to delve into these issues in future research.

  • It is not possible to unravel whether participants were engaging in mindfulness meditation, lovingkindness, or hatha yoga, all of which are learned in MBSR.

  • The results characterizing the associations between meditation practice and outcomes are simply correlational.

  • The study sample consisted of mostly White and well-educated subjects, and additional research is needed to investigate these phenomena in diverse groups.

Study Disclosures

  • The authors have declared no competing interest.

This is a summary of a preprint research study, "Mindfulness and Pain-Related Outcomes in Mindfulness-Based Treatment for Episodic Migraine," led by Carly Hunt, from Johns Hopkins University School of Medicine, Baltimore, Maryland, provided to you by Medscape. This study has not yet been peer reviewed. The full text of the study can be found on medRxiv.org.

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