Migraine is a leading cause of disability, and many patients cannot use or afford medications. Mindfulness-based interventions (MBI), such as mindfulness-based stress reduction (MBSR) and mindfulness-based cognitive therapy (MBCT), offer a potential non-pharmacological treatment. Most research to date consists of small pilot trials with limited rigor, but initial evidence suggests improvements in headache-related disability and psychological well-being. Many questions remain about optimal dosage, duration, delivery, and which patients benefit most. Mindfulness will not cure migraine but may help patients engage in valued activities as part of a comprehensive treatment approach.
Adverse events in mindfulness-based interventions for migraine are underreported due to a lack of standardized measurement and reporting protocols. Although MBIs are increasingly used for chronic pain, including migraine, patients with migraine may be at elevated risk of experiencing adverse events, such as posttraumatic re-experiencing. The paper reviews benefits and adverse events in MBIs broadly and applies these considerations to migraine populations, highlighting the need for providers to understand which adverse events occur.
Pain catastrophizing decreased more over 8 weeks among adults with migraine who received mindfulness-based cognitive therapy for migraine (MBCT-M) than among those on a waitlist receiving treatment as usual. The MBCT-M group's mean Pain Catastrophizing Scale score fell from 22.5 to 15.1, while the waitlist group's score changed from 24.9 to 22.5. Cognitive fusion did not change significantly in either group. Reductions in pain catastrophizing, alone or together with cognitive fusion, mediated improvements in headache disability among those who completed MBCT-M. The authors suggest pain catastrophizing is a promising mechanism of MBCT-M.