Mindfulness-Based Cognitive Therapy for the Management of Migraine-Related Disability

Mindfulness-based cognitive therapy was shown to reduce headache-related disability and disability related to migraine attack-level in adult patients with migraine, according to a study published in Headache.

This phase 2b study was designed to evaluate the impact of mindfulness-based cognitive therapy on migraine-related disability for participants with migraine who experience 6 to 30 headache days per month. The mindfulness-based cognitive therapy for migraine (MBCT-M) protocol taught participants cognitive-behavioral coping skills and mindfulness meditation, as well as methods to apply these skills to disease-related cognitions.

Participants completed a daily headache diary during the 30-day baseline period after which they were randomly assigned 1:1 to receive 8 weeks of individual MBCT-M sessions or 8 weeks of waitlist/treatment as usual (WL/TAU). All primary outcome data were collected by September 2018.

Primary study outcomes included changes in migraine-related disability as measured by the headache disability inventory (HDI) and the Migraine Disability Assessment (MIDAS), and all participants completed surveys that included evaluations for this outcome at months 0, 1, 2, and 4. Secondary outcomes included the number of headache days per month, Migraine Disability Index (MIDI) score, and attack pain intensity levels.

Of the 60 participants included, 31 were assigned to the MBCT-M group and 29 of were assigned to the WL/TAU group (mean age 40.1, SD=11.7; 81.7% white, 91.7% women, 55.0% with a graduate degree, and 63.3% working full-time).

The average baseline HDI score was 51.4 (SD=19.0), representing moderate disability, however the majority of participants (83.3%) fell into the MIDAS “severe disability” range. An average of 16.0 headache days a month (SD=5.9) was reported, with an average pain intensity of 1.7 (SD=0.3; moderate intensity). The average daily disability level according to the MIDI was 3.1/10 (SD=1.8).

From month 0 to month 4, a greater decrease in mean HDI scores in the MBCT-M group (-14.3) compared to the WL/TAU group (-0.2; P <.001) was reported. When accounting for the divided alpha, group/month interaction was not significant (month 0 vs 4 B=1.6; 95% CI, −0.7 to 3.9). When the model was evaluated without the interaction, the month effect was significant across all participants in all groups (P <.001), with the estimated proportion in the “severe disability” category falling from 88.3% at Month 0 to 66.7% at Month 4 (B=−2.4; 95% CI, −3.3 to −1.4). For reported headache days per month and average pain intensity, neither the group/month interaction (P =.773 and P =.888, respectively) nor the time effect (P =.059 and P =.428, respectively) was significant. Mean scores for diary-reported attack-level migraine-related disability (MIDI) decreased in the MBCT-M group and increased in the WL/TAU group (-0.6/10 vs +0.3/10; P =.007).

Study investigators concluded that despite limitations, including small sample size, data being self-reported, and homogeneity of the study population, “participants generally adhered to treatment and reported a favorable attitude toward the experience.” They go on do add that “MBCT-M is a promising emerging treatment for addressing migraine-related disability.”

Multiple authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.

Follow @ClinicalPainAdv

Reference

Seng EK, Singer AB, Metts C, et al. Does mindfulness-based cognitive therapy for migraine reduce migraine-related disability in people with episodic and chronic migraine? A phase 2b pilot randomized clinical trial [published online September 26, 2019]. Headache. doi:10.1111/head.13657

This article originally appeared on Neurology Advisor