Mindfulness-Based Cognitive Therapy Excels in Episodic Migraine

Elizabeth K. Seng, PhD, associate professor, Ferkauf Graduate School of Psychology, Yeshiva University, and research associate Professor, Department of Neurology, Albert Einstein College of Medicine

Elizabeth K. Seng, PhD

The use of mindfulness-based cognitive therapy has shown promise in a recent trial in reducing disability in patients with migraine, with emphasis on those suffering from episodic migraine.¹

Ultimately, as measured the Migraine Disability Assessment (MIDAS), significant reductions in the proportion of patients with episodic migraine experiencing severe disability (P = .013), as well as Headache Disability Inventory (HDI) score (P = .011) were observed.

The data were presented at the 2019 American Headache Society (AHS) Annual Meeting, July 11-14, 2019, in Philadelphia, Pennsylvania, in a poster by Elizabeth K. Seng, PhD, associate professor, Ferkauf Graduate School of Psychology, Yeshiva University, and research associate professor, department of neurology, Albert Einstein College of Medicine. Previous work has suggested that mindfulness-based interventions can reduce disability in other high burden conditions, such as chronic musculoskeletal pain.²

“It is well known that behavioral and lifestyle factors ranging from sleep to one’s daily schedule and stress level can have a negative impact on one’s health, and that mindfulness therapies can improve some of these factors,” Seng said in a statement. “When we tailored mindfulness-based cognitive therapy to migraine, we saw a positive impact on patients’ perceived social and emotional difficulties, adding to the total standard of care when treating migraine.”

The trial included 60 patients stratified by episodic migraine (defined as 6 to 14 headache days per month) or chronic migraine (defined as 15 to 30 headache days per month) who were randomized to either receive mindfulness-based cognitive therapy (n = 31) or waitlist/treatment as usual (n = 29) for 8 weeks. At baseline, 48.3% (n = 29) of the participants met criteria for episodic and 51.7% (n = 31) met criteria for chronic migraine.

All patients completed a 30-day period of dairy monitoring as baseline. The mindfulness sessions lasted 75 minutes each. Surveys were completed at Months 0, 1, 2, and 4, while daily diaries were also completed during the 30-day post-treatment evaluation period.

The group-time interaction was not significant (P =.027), though the predicted proportion of subjects who reported severe disability decreased by 21.6% through Month 4 (P <.001). Headache pain intensity group-time interaction also was not significant (P <.589), but the predicted average pain intensity decreased by 0.5 points through Month 4 (P =.005).

For headache attack days per month, neither the group-time (P =.312), nor the time (P =.590) effect was significant. For the HDI, the chronic migraine group saw a reduction in score, though not a significant one (P =.268). There was no statistically significant effect of mindfulness-based cognitive therapy on monthly headache days or average headache attack pain intensity in either the episodic or chronic migraine groups.

American Headache Society President Kathleen Digre, MD, said in a statement that “we know migraine has an impact on everyday life beyond the pain associated with migraine itself. People with migraine often hold back from attending social functions and traveling when the onset of migraine is beginning, or feel frustrated, angry and isolated. These study results can help healthcare providers and patients as they evaluate additional, non-traditional treatment options for migraine.”

Chronic migraine status was found to not be associated with demographic variables. Although, at baseline, people with chronic migraine reported higher HDI scores (mean, 57.6 (standard deviation [SD], 16.7) than those with episodic migraine (mean, 45.5; SD, 19.4; P = .015). Likewise, those in the chronic group experienced more monthly headache days, at 20.5 (SD, 3.0) compared to episodic, at 11.2 (SD, 4.2; P <.001).

“Surprisingly, [mindfulness-based cognitive therapy for migraine] produced larger changes on both primary outcomes in the [episodic migraine], rather than [chronic migraine], subgroup. It is possible this treatment is most useful for people who experience high levels of disability relative to headache days reported,” Seng and colleagues wrote.

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REFERENCES

1. Seng E. Response to Mindfulness-Based Cognitive Therapy for Migraine in Chronic and Episodic Migraine: Planned Secondary Analyses of a Randomized Clinical Trial. Presented at: 2019 American Headache Society Annual Meeting. July 11-14, 2019; Philadelphia, Pennsylvania.

2. New Data on Efficacy of Mindfulness-Based Interventions in Migraine to be Shared at the American Headache Society 61st Annual Scientific Meeting [press release]. Philadelphia, PA: American Headache Society; Published July 10, 2019. americanheadachesociety.org/news/new-data-on-efficacy-of-mindfulness-based-interventions-in-migraine. Accessed July 10, 2019.