Mindfulness-based practices and treatment programs may be associated with similar changes in plasma levels of catecholamines compared with pharmacologic prophylaxis in patients with migraine and medication overuse headache, according to a study published in Cephalalgia.
Adult patients with a ≥10-year history of chronic migraine and headache and triptans or non-steroidal anti-inflammatory drug overuse for ≥5 years were recruited. Following a 5-day structured withdrawal program consisting of intravenous steroids and ademetionine, patients underwent 6 weekly 45-minute mindfulness-based therapy sessions (n=14) or pharmacologic prophylaxis (n=15). Follow-up occurred at 6 and 12 months. Headache frequency and medication intake were recorded in daily headache diaries and catecholamine (noradrenaline, epinephrine and dopamine) levels and elusive amines were assayed in poor platelet plasma.
Headache frequency was reduced in patients who had received pharmacologic prophylaxis (42% reduction at 6 months and 51% reduction at 12 months; P <.001) and in patients who had attended mindfulness training (33% reduction at 6 months and 21% reduction at 12 months). Medication intake was also reduced in both groups at 6- and 12-month follow-up (pharmacologic prophylaxis: 36% and 49%, respectively; P <.001; mindfulness: 40% and 31%, respectively).
For both outcomes, improvement levels were comparable between groups at both follow-ups. In addition, at 6 months and 12 months there were significant increases in levels of noradrenaline (pharmacologic prophylaxis: 43% and 63%, respectively; mindfulness: 35% and 25%, respectively; P <.001 for all) and epinephrine (pharmacologic prophylaxis: 63% and 121%, respectively; mindfulness: 42% and 81%, respectively; P <.001). Observed changes were comparable in patients who had received pharmacologic prophylaxis vs mindfulness therapy. Levels of elusive amines were unchanged at both follow-ups and comparable in both groups.
The small and selective sample size and the non-randomized design represent the most important limitations of the analysis.
“Our results reinforce the hypothesis of a major role of tyrosine metabolism alterations in migraine and in its chronification process and shed light on the possible biological mechanisms of action of pharmacological prophylaxis as well as of behavioral approaches,” the researchers concluded.
Grazzi L, Raggi A, D’Amico D, et al. A prospective pilot study of the effect on catecholamines of mindfulness training vs pharmacological prophylaxis in patients with chronic migraine and medication overuse headache [published online September 13, 2018]. Cephalalgia. doi:10.1177/0333102418801584