Similar improvements in migraine frequency seen with mindfulness meditation vs. headache education

Mindfulness-based stress reduction (MBSR) and headache education were similarly effective at reducing migraine frequency in a randomized clinical trial.

Researchers recruited 89 adults (92% women; mean age, 43.9 years) who experienced four to 20 migraine days per month (mean, 7.3 migraine days per month) from an academic medical center in North Carolina, as well as by advertising in the community. They defined migraine as moderate to severe headache lasting four hours or treated with acute medication. The researchers randomized 45 participants to receive standardized training in MBSR, which included meditation and yoga, and 44 to receive headache education, which included instruction on headaches, triggers, stress, and treatment approaches. Both interventions were delivered in groups that met for two hours per week for eight weeks, although the MBSR group also adopted daily home practices. There was blinding of participants (to active vs. comparator group assignments) and principal investigators and data analysts (to group assignment). The primary outcome was the change in migraines per day from baseline to 12 weeks, as assessed by participant headache logs. Secondary outcomes were changes in disability, quality of life, self-efficacy, pain catastrophizing, depression scores, and experimentally induced pain intensity and unpleasantness (from baseline to 12, 24, and 36 weeks). Results were published online on Dec. 14 by JAMA Internal Medicine.

Overall, most participants attended the sessions (median attendance, 7 of 8 classes) and followed up through 36 weeks (33 of 45 [73%] of the MBSR group and 32 of 44 [73%] of the headache education group). Participants in both groups had similar reductions in migraine days at 12 weeks (−1.6 migraine days per month [95% CI, −0.7 to −2.5] vs. −2.0 migraine days per month [95% CI, −1.1 to −2.9] for MBSR vs. headache education; P=0.50). However, the MBSR group had significantly greater improvements from baseline at all follow-up time points (reported in terms of point estimates of effect differences between groups) on measures of disability (5.92 [95% CI, 2.8 to 9.0]; P<0.001), quality of life (5.1 [95% CI, 1.2 to 8.9]; P=0.01), self-efficacy (8.2 [95% CI, 0.3 to 16.1]; P=0.04), pain catastrophizing (5.8 [95% CI, 2.9 to 8.8]; P<0.001), and depression (1.6 [95% CI, 0.4 to 2.7]; P=0.008) and had decreased experimentally induced pain intensity and unpleasantness (36.3% [95% CI, 12.3% to 60.3%] decrease in intensity and 30.4% [95% CI, 9.9% to 49.4%] decrease in unpleasantness in the MBSR group vs. 13.5% [95% CI, −9.9% to 36.8%] increase in intensity and 11.2% [95% CI, −8.9% to 31.2%] increase in unpleasantness in the headache education group; P=0.004 for intensity and P=0.005 for unpleasantness at 36 weeks).

Among other limitations of the study, headache education was not an inactive control condition, and most participants were White, highly educated, and healthy overall, the authors noted. They concluded that MBSR may help treat the total burden of migraine. “With the tremendous stress and anxiety of the COVID-19 pandemic, patients with migraine may have worsening migraine attacks, and mindfulness may be particularly beneficial,” they wrote.

Although the findings related to the primary outcome of migraine frequency are likely valid, “[I]t would not be appropriate to conclude from this trial that MBSR is ineffective for migraine given the positive results for multiple secondary outcomes,” an accompanying commentary said. “In fact, the preponderance of evidence from this trial suggests otherwise.”