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. 2023 Apr;14(4):769-783.
doi: 10.1007/s12671-023-02105-8. Epub 2023 Apr 4.

Meditation Practice, Mindfulness, and Pain-Related Outcomes in Mindfulness-Based Treatment for Episodic Migraine

Carly A Hunt  1   2 , Janelle E Letzen  1 , Samuel R Krimmel  3 , Shana A B Burrowes  4   5 , Jennifer A Haythornthwaite  1 , Michael Keaser  5   6 , Matthew Reid  1 , Patrick H Finan  1   2 , David A Seminowicz  5   6
Affiliations

Meditation Practice, Mindfulness, and Pain-Related Outcomes in Mindfulness-Based Treatment for Episodic Migraine

Carly A Hunt et al. Mindfulness (N Y). 2023 Apr.

Abstract

Objectives: Mindfulness-based interventions (MBIs) have emerged as promising prophylactic episodic migraine treatments. The present study investigated biopsychosocial predictors and outcomes associated with formal, daily-life meditation practice in migraine patients undergoing MBI, and whether augmented mindfulness mechanistically underlies change.

Methods: Secondary analyses of clinical trial data comparing a 12-week enhanced mindfulness-based stress reduction course (MBSR + ; n = 50) to stress management for headache (SMH; n = 48) were conducted.

Results: Pre-treatment mesocorticolimbic system functioning (i.e., greater resting state ventromedial prefrontal cortex-right nucleus accumbens [vmPFC-rNAC] functional connectivity) predicted greater meditation practice duration over MBSR + (r = 0.58, p = 0.001), as well as the change in headache frequency from pre- to post-treatment (B = -12.60, p = 0.02) such that MBSR + participants with greater vmPFC-rNAC connectivity showed greater reductions in headache frequency. MBSR + participants who meditated more showed greater increases in mindfulness (B = 0.52, p = 0.02) and reductions in the helplessness facet of pain catastrophizing (B = -0.13, p = 0.01), but not headache frequency, severity, or impact. Augmented mindfulness mediated reductions in headache impact resulting from MBSR + , but not headache frequency.

Conclusions: Mesocorticolimbic system function is implicated in motivated behavior, and thus, motivation-enhancing interventions might be delivered alongside mindfulness-based training to enhance meditation practice engagement. Formal, daily-life meditation practice duration appears to benefit pain-related cognitions, but not clinical pain, while mindfulness emerges as a mechanism of MBIs on headache impact, but not frequency. Further research is needed to investigate the day-to-day effects of formal, daily-life meditation practice on pain, and continue to characterize the specific mechanisms of MBIs on headache outcomes.

Preregistration: This study is not preregistered.

Keywords: Headache; Home practice; Meditation practice; Mindfulness; Motivation.

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Conflict of interest statement

Conflict of Interest The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Whole-brain functional connectivity in MBSR + patients based on left (top) and right (bottom) nucleus accumbens regions of interest (ROIs). ROIs used as seeds are shown in blue
Fig. 2
Fig. 2
A Using meditation practice as a predictor, there was significant functional connectivity between the right nucleus accumbens (rNAc) seed and a cluster spanning the ventromedial prefrontal cortex (vmPFC) after multiple comparisons corrections in MBSR + patients. B Association between rNAC-vmPFC functional connectivity values and meditation practice in MBSR + patients
Fig. 3
Fig. 3
Participants in the MBSR + demonstrating higher levels of rNAc-vmPFC connectivity showed greater reductions in headache frequency from pre- to post-treatment
Fig. 4
Fig. 4
Participants who meditated more on average showed more favorable changes from pre- to post-treatment in the helplessness facet of pain catastrophizing (Panel A) and in mindfulness (Panel B)
Fig. 5
Fig. 5
Model of change in trait mindfulness as a mediator of the association between treatment group assignment (MBSR + versus SMH) and change in headache impact from baseline to post-treatment. Confidence intervals obtained via bias-corrected bootstrapping suggested a significant indirect effect of treatment on headache impact via augmented trait mindfulness (dark bolded path). Unstandardized estimates are shown with standard errors in parentheses. Exogenous variables were allowed to covary; *p < 0.05, **p < 0.01, ***p < 0.001
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