Mindfulness Meditation as Migraine Treatment

In this podcast, Rebecca Erwin Wells, MD, MPH, discusses her research on using mindfulness-based stress reduction vs headache education for migraine treatment, a topic she presented at the AAN’s 2021 Virtual Meeting.

Additional Resource:

• Wells RE, O’Connell N, Pierce CR, et al. Effectiveness of mindfulness meditation vs headache education for adults with migraine: a randomized clinical trial. JAMA Int Med. 2021;181(3):317-328. doi:10.1001/jamainternmed.2020.7090

Rebecca Erwin Wells, MD, MPH, is the founder and director of the Comprehensive Headache Program at Wake Forest Baptist Medical Center, and an associate professor in the Wake Forest School of Medicine in Winston-Salem, North Carolina. 

TRANSCRIPTION: 

Leigh Precopio:  Hello everyone, and welcome to another installment of Podcast360, your go-to resource for medical news and clinical updates. I'm your moderator Leigh Precopio with Consultant360 Specialty Network.

As the second leading cause of disability worldwide, migraine is an incapacitating disorder. Medication non-adherence is common among patients with migraine as treatment often fall short of expectations because of inefficacy and adverse effects.

In effort to reduce the burden of migraine, researchers conducted a randomized clinical trial examining how mindfulness meditation can be used to improve health outcomes. Mindfulness-based stress reduction was compared with headache education, and the changes in migraine day frequency, disability, quality of life, self-advocacy, pain catastrophizing, depression, and pain intensity and unpleasantness were measured.

Here with us today, to discuss her team study, which was presented at the American Academy of Neurology's 2021 virtual meeting, is Rebecca E. Wells. Dr Wells is the founder and director of the Comprehensive Headache Program at Wake Forest Baptist Medical Center, and an associate professor in the Wake Forest School of Medicine.

Thank you for joining me today, Dr Wells. Let's dive into your study. Your study examined whether mindfulness meditation provides benefits to patients with migraine. What prompted this study?

Dr Rebecca Erwin Wells:  To begin with, many patients with migraine experience medication side effects or medication inefficacy. Medications can even contribute to medication overuse headache and be challenging during pregnancy. One-third of patients with migraine use opioids for treatment despite recommendations against such use, given the risks of migraine chronification, and medication overuse headache.

So we recognize that there is a dramatic need for non‑opioid treatment options for migraine, especially those that may target other factors playing a role, such as stress. Especially since stress is the number one reported trigger of migraine. We began doing research in this area looking at the prevalence of use of integrative treatment modalities in those with migraine.

We found that in adults with severe headaches, the prevalence of use of yoga, meditation, and deep breathing, all modalities that are considered mind‑body interventions, were being used more often than treatment options like biofeedback that historically have had a lot more research evidence to support their use.

This research demonstrated that patients with migraine are interested in mind‑body options, but more research is needed. We conducted a pilot study looking at mindfulness meditation in adults with migraine and found promising results. That led to the creation of the most recent clinical trial that we've just finished conducting.

Leigh Precopio:  The results of your study indicated that patients who completed mindfulness‑based stress reduction had improved disability, quality of life, self‑efficacy, pain catastrophizing, and depression but not migraine frequency compared with headache education. What do these results mean for clinical practice, and how migraine might be managed in the future?

Rebecca Wells:  Yes. This is a great question. Migraine is a severely debilitating disease. It's the second leading cause of disability worldwide. Migraine is not "all in the head," and there's even a hashtag, #notjustheadache.

One aspect is, how do we think that these improvements occurred? Mindfulness can teach new ways to respond to stress. Stress is the most commonly reported migraine trigger. Mindfulness may teach a non-judgmental way of evaluating pain by turning towards the pain, which may change the way individuals perceive pain. 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. Recognizing and treating the full impact that migraine has on a person's life is critical. A multimodal treatment approach may really be helpful.

What was particularly interesting about these findings is that, both mindfulness and the active control group of headache education, both groups had improvements of headache frequency. Only the MBSR group, the mindfulness group, also had improvements on all of the additional secondary outcomes. What's interesting is, when we ask patients with migraine what's important, and how do they want to get better, often people say, "I just want you to cure my headaches, just get rid of them. I don't want them anymore." Once patients learn that often there may not be a cure, but we can get things better, the next thing that patients often say is, "Well, I really just don't want them impacting my life as much."

This aspect of disability is really important. Seeing that our research demonstrated that mindfulness can decrease disability, is really, really promising because that's one of the outcomes that we need to be doing a lot more research in the future of investigating. What and how can we improve disability? These results were very encouraging and promising.

Leigh Precopio:  How does mindfulness‑based stress reduction currently fit into the treatment landscape for patients with migraine? What does this new information about mindfulness‑based stress reduction add to the treatment landscape?

Rebecca Wells:  Yes. This is important. We have found that mindfulness may be an additional tool that may help treat the total burden of migraine. In our clinical trial, participants were able to continue all of their migraine medications. Mindfulness was in addition to what they were already doing.

When we think about interpreting the results of this study, this is not a "practice mindfulness" or "take medications." That's not the way this study was designed. It was rather mindfulness in addition to medication treatment options. While many patients may want to completely avoid medications, that was not what we found in our study in terms of the way this study was designed.

In summary, mindfulness may be a great tool on top of what people are already doing, or an addition too. This is not an either or, but an and. It's important to recognize that at a time when opioids are still being used against recommendations for migraine treatment, finding safe non‑drug options is really important.

Leigh Precopio:  What are the key takeaway messages from your study for migraine care providers?

Rebecca Wells:  Number one, asking patients what they're interested in, and talking to patients about treatment modalities in addition to medications, is really important. We've done prior research demonstrating that over 50% of providers don't even ask patients about integrative treatment approaches that are being used.

So asking patients what they're already doing, and then discussing additional treatment options in addition to medications because mindfulness may be a treatment tool that can be used in addition to other modalities to help treat the total migraine burden.

Leigh Precopio:  What are the next steps in terms of future research in this area?

Rebecca Wells:  We need a larger, more definitive study to confirm these findings in addition to further understanding the mechanisms of improvement. We were surprised at the effect sizes that we found in this study. We were also intrigued by the fact that our study showed through the experimental heat‑pain testing, that individuals may actually have a change in their perception of pain, or change in pain appraisal. Understanding the mechanisms behind how mindfulness improves headache is important.

It's also important to understand how mindfulness can be best incorporated in clinical practice, and finding scalable interventions that can be recommended and delivered across populations to people of all backgrounds. It's very important.

Leigh Precopio:  Great. Thank you so much for taking the time to answer my questions today.

Rebecca Wells:  Thank you so much for hosting me today. This has been a real honor. This is such an important topic. Migraine is incredibly prevalent. Over 45 million Americans have migraine, and finding treatment options that are available for all patients with migraine is so critically important.