Meditation Practice: Can it Have a Positive Impact on Migraine Severity?
By Manijeh “Mani” Berenji
A migraine is a type of headache which can create a throbbing sensation on one side of the head, often accompanied by nausea, vomiting, light and sound sensitivity. It can come on suddenly with or without warning1. Many individuals can experience an aura (which can include visual changes, numbness and tingling along the face) before the onset of the migraine. Migraines can last anywhere from minutes to hours and can create major disturbances in one’s daily life. In the United States, migraines have a significant impact on health. Approximately one in six Americans experience such a migraine over any 3-month period, with the incidence rate higher among women (one in five)2. And the impact of migraines on productivity are well-known: they are the second leading cause of worldwide disability3,4. The standard treatment for migraine headaches include acetaminophen (Tylenol), non-steroidal anti-inflammatories (ibuprofen for example), triptans, anti-emetics (anti-nausea agents), ergot alkaloids, and combination analgesics5. However up to one-third of individuals with migraines end up resorting to narcotics, which can lead to opioid use disorder and refractory condition of medication overuse headache3,6–8.
Since medication management may not always be successful, non-medication based treatments are attracting more attention in the treatment of migraines. Mindfulness-based stress reduction (MBSR) has been postulated to improve migraine outcomes and cognition as compared to other types of non-medication based treatments such as headache education. Recently Wells and colleagues conducted a double-blinded randomized clinical trial of 89 adults with migraines to see if MBSR could make a difference in reducing the number of migraines, optimize quality of life, and enhance cognitive processes3. The researchers hypothesized that MBSR would reduce the intensity of experimentally-induced affective pain (considered to be “unpleasant”) more than sensory (intensity-based) pain. The study participants could continue with their current acute and preventive migraine medications. The MBSR and headache education intervention groups had sessions for 2 hours per week for a total of 8 weeks. Those in MBSR had mindfulness meditation and yoga without migraine modifications. Those in the headache education group had general instruction on headaches, triggers, stress and treatment approaches. The study participants were followed-up through 36 weeks with daily online surveys and logs to capture headache duration, intensity, unpleasantness, symptoms, and medication usage. The researchers performed neurologic assessments (including quantitative sensory testing) in-person to evaluate pain perception. Primary outcome of interest was a change in migraine day frequency from baseline to 12 weeks. This was defined as a calendar day with moderate to severe headache (a 6–10 pain level on a 0–10 pain scale), lasting more than 4 hours. Secondary outcomes included headache day frequency, intensity, unpleasantness, and duration. Headache-related disability was assessed using the Migraine Disability Assessment-1 month and the Headache Impact Test-69–10. At the conclusion of the study, the researchers were able to conclude that compared to traditional headache education, MBSR was not associated with improved migraine frequency. But MBSR participants did have noted improvements in headache-related disability, quality of life, depression scores, self-efficacy, pain catastrophizing, with less experimentally-induced pain intensity and unpleasantness that lasted up to 36 weeks. This study confirms what previous studies have demonstrated: the positive effect of mindfulness on migraine disability but no major changes in headache frequency. Future studies are planning to further understand the effect of mindfulness on migraines.
References
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