Mindfulness in migraine: A narrative review

Abstract

Introduction: Migraine is the second leading cause of disability worldwide, yet many patients are unable to tolerate, benefit from, or afford pharmacological treatment options. Non-pharmacological migraine therapies exist, especially to reduce opioid use, which represents a significant unmet need. Mindfulness-based interventions (MBI) have potential as a non-pharmacological treatment for migraine, primarily through the development of flexible attentional capacity across sensory, cognitive, and emotional experiences.Areas covered: The authors review efficacy and potential mechanisms of MBIs for migraine, including mindfulness-based stress reduction (MBSR) and mindfulness-based cognitive therapy (MBCT).Expert opinion: While most mindfulness research studies for migraine to date have been pilot trials, which are small and/or lacked rigor, initial evidence suggests there may be improvements in overall headache-related disability and psychological well-being. Many research questions remain to help target the treatment to patients most likely to benefit, including the ideal dosage, duration, delivery method, responder characteristics, and potential mechanisms and biomarkers. A realistic understanding of these factors is important for patients, providers, and the media. Mindfulness will not 'cure' migraine; however, mindfulness may be an important tool as part of a comprehensive treatment approach to help patients 'mindfully' engage in valued life activities.

Keywords: Complementary and alternative medicine; integrative medicine; meditation; migraine; mind-body medicine; mindfulness; mindfulness-based cognitive therapy; mindfulness-based intervention; mindfulness-based stress reduction.

Figure 1.. An evidence-based, specific, testable model of the mechanisms of mindfulness-based interventions for chronic pain management.

Potential moderators, mediators, and improved outcomes of mindfulness-based research are included to inform future research. Reprinted with permission from Elsevier. [1] MBI, mindfulness-based intervention; MBCT, mindfulness-based cognitive therapy; MBSR, mindfulness-based stress reduction.

Figure 2.. A revised organizing framework for understanding the six key factors involved and their intertwined relationships in psychosocial pain treatments.

Since decreased pain and suffering are typically desirable endpoints, pain, emotion, and affect are shown as “downstream” factors that are interconnected with (and can also influence) the “upstream” cognitive and behavioral factors, all of which have bidirectional relationships with brain states and environmental/social factors. All factors interact with the others and no factor influences pain and functioning in isolation. Reprinted with permission from Elsevier.[1]

Figure 3.. Fear-avoidance model of chronic pain incorporating the suggested role of trigger(s) and mindfulness in individuals with chronic headache/migraine. This model demonstrates how mindfulness may target the experience of pain through its impact on the negative appraisal of the pain (catastrophic thoughts), which often leads to the development of pain-related fear and subsequent maladaptive coping behaviors (escape, avoidance, hypervigilance) with resulting depression/disability and increased pain experience. Triggers may lead to avoidance/escape behaviors and resulting increased sensitivity to the pain experience.

Reprinted with permission from Wolters Kluwers Health [2] Adapted with permission from the version presented by Vlaeyen and Linton, and Schutze and colleagues (2009).[3] In this adjusted version, ‘Trigger(s)’ has replaced ‘Injury’ and ‘Mindfulness’ has been added.

Fig. 4.. Scientific and news media articles on mindfulness and/or meditation by year from 1970 to 2015.

Empirical scientific articles (black line) with the term mindfulness or meditation in the abstract, title, or keywords, published between 1970 and 2015 were searched using Scopus. Media pieces (dashed gray line) with the term mindfulness or meditation, published in newspapers, using a similarity filter to minimize double-counting, published between 1970 and 2015 were searched using LexisNexis. Reprinted with permission from SAGE publications.[4]