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Mindfulness-based stress reduction tied to less disability, depression with migraine

JAMA Internal Medicine
Reuters Health - 14/12/2020 - People with chronic migraines who receive training in yoga and mindfulness-based stress reduction may experience less disability, pain catastrophizing, and depression, a clinical trial suggests.

Researchers randomly assigned 89 adults who experienced 4 to 20 migraine days per month (mean 7.3 at baseline) to receive either training in Mindfulness Based Stress Reduction (MBSR) or headache education for two hours a week for eight weeks.

At the 12-week follow-up, there was no significant difference between groups in reduction of headaches. With MBSR, mean reduction of migraine days per month was 1.6, and 2.0 in the headache education group.

However, researchers did find a significant difference between groups at 36 weeks in several secondary outcomes including disability (point estimate of effect difference between groups 5.9); pain catastrophizing (effect difference 5.8); depression (effect difference 1.6); and migraine-related quality of life (effect difference 5.1).

"Mindfulness-based stress reduction is a mind-body treatment that teaches moment-by-moment awareness through mindfulness meditation and yoga," said lead study author Dr. Rebecca Erwin Wells, an associate professor of neurology at Wake Forest School of Medicine in Winston-Salem, North Caroline.

Training in mindfulness may teach patients new ways to manage stress, the most common migraine trigger, Dr. Wells said by email. It can also teach patients a non-judgmental way of evaluating that changes the way individuals perceive pain associated with migraine, Dr. Wells added.

"Mindfulness helps people learn to live each moment in the present, acknowledging thoughts, feelings, and sensations but not getting wrapped up in them, which may have a positive impact on overall well-being," Dr. Wells said.

Participants in the study who were randomized to MBSR followed a standardized curriculum of mindfulness meditation and yoga with two hours a week of instruction. They also received electronic audio files for home practice and were encouraged to practice at home for 30 minutes each day.

The headache education group received instruction on headaches, pathophysiology, triggers, stress and treatment approaches, but there was no home practice component.

Because the study included two groups with active interventions, there was no inactive control group and there was the potential for meaningful behavior changes to occur in both arms of the study, the researchers note in JAMA Internal Medicine. One limitation is that most participants were white and female, and the results might not be generalizable to other populations, they add.

Even so, the results are in line with the intention of mindfulness-based stress reduction training to foster greater self-awareness of how to think about and react to difficulties of all types, said Dan Cherkin, a senior scientific investigator emeritus at Kaiser Permanente Health Research Institute in Seattle who wrote a commentary accompanying the study.

"As a result, it is not surprising that the mindfulness meditation training and practice reduced patients' catastrophic thoughts about their pain, improved patients' perceptions of their mood and overall quality of life, and improved their ability to function," Cherkin said by email.

The study results suggest that a mindfulness meditation program can reduce disability and improve the quality of life for patients with migraines, Cherkin added.

"While such programs offer clinicians and their patients a safer and often more effective alternative to opioids and other pharmacological treatments, they are not currently available in most communities and usually are not covered by insurance," Cherkin said.

SOURCE: https://bit.ly/3qTXmNX and https://bit.ly/3qZZx2K JAMA Internal Medicine, online December 14, 2020.

By Lisa Rapaport

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