Can Mindfulness-Based Cognitive Therapy Reduce Episodic Migraine Severity and Disability?

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

In a recent presentation at the 2019 American Headache Society (AHS) Annual Meeting, July 11-14, 2019, in Philadelphia, Pennsylvania, data suggested that the use of mindfulness-based cognitive therapy (MBCT-M) can result in significant reductions in the severity and disability experienced by patients with migraine.

in a recent trial in reducing disability in patients with migraine, with emphasis on those suffering from episodic migraine, there were statistically significant decreases of proportion of patients with episodic migraine experiencing severe disability (P = .013) as measured by the Migraine Disability Assessment (MIDAS), as well as Headache Disability Inventory (HDI) score (P = .011). The investigators were led 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.

As previous work has suggested that mindfulness-based interventions can reduce disability in other high burden conditions, Seng shared a number of insights into this new work with NeurologyLive^®.

NeurologyLive^®: What prompted this work into MBCT-M and migraine?

Elizabeth K. Seng, PhD: 50% of people with migraine report already using complementary and integrative health strategies to manage migraine. Mindfulness is the most popular of these strategies. We were interested in whether these strategies actually produce any benefit for people with migraine. Previous earlier stage pilot studies suggested the strongest signal for mindfulness-based therapies would be in headache-related disability, rather than headache days. Therefore, we considered headache-related disability the primary outcome of the study.

Were any of the data particularly surprising or exciting in any way?

It was surprising that MBCT-M produced such a large effect on headache-related disability, but absolutely no effect on headache days. The graphs were striking to our team. This suggests that headache-related disability can be separated from headache days and that people with migraine can actually experience large decreases in headache-related disability even when their changes in days are insubstantial. It provides hope for patients whose migraine disease is difficult to manage, that they can still improve their quality of life and daily functioning. The second surprising finding was the people with episodic migraine experienced larger treatment-related reductions in disability than people with chronic migraine. We had hypothesized the opposite. I believe this finding goes along with the first described. For people with chronic migraine, who experience headache days on half of more days of the month, they are really in need of effective strategies to reduce headache frequency before they can experience the full benefit of mindfulness-based treatments to reduce headache disability. However, when people either have slightly less frequent headache to begin with or have an effective migraine preventive strategy on board, mindfulness-based treatments can help them improve their day-to-day functioning with the disease activity that remains.

What should clinicians take away from these findings?

Mindfulness-based interventions seem to have an important role to play in migraine treatment. However, it does not appear that they are appropriate first lines of defense. Evidence-based behavioral treatments that reduce both headache days and disability in people with migraine include relaxation (deep breathing, progressive muscle relaxation), biofeedback, and migraine-specific cognitive-behavioral therapies that target migraine-related behaviors like stress, medication adherence, sleep, and keeping a consistent schedule. These strategies, along with effective pharmacotherapies for migraine prevention, should be the first line of defense for people with migraine experiencing frequent attacks. However, for people who have already received effective prevention, or for whom their disability is greater than you would expect given their headache days per month, mindfulness-based interventions may provide important complementary strategies to reduce disability.

Transcript edited for clarity. For more coverage of AHS 2019, click here.

REFERENCE

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.