Enhanced mindfulness based stress reduction (MBSR+) in episodic migraine: a randomized clinical trial with MRI outcomes
D. Seminowicz, S. Burrowes, A. Kearson, Jing Zhang, Samuel R. Krimmel, L. Samawi, Andrew J. Furman, M. Keaser, Neda F. Gould, T. Magyari, Linda White, O. Goloubeva, M. Goyal, B. Peterlin, J. Haythornthwaite
Pain March 13, 2020 DOI: 10.1097/j.pain.0000000000001860 (opens in new tab) via Semantic Scholar
Summary
AI-generated from the abstractIn a randomized, assessor-blind trial, 98 adults with episodic migraine received either enhanced mindfulness-based stress reduction (MBSR+) or stress management for headache (SMH) over 16 weeks. MBSR+ reduced headache days from 7.8 to 4.6 per month by 20 weeks, compared with a reduction from 7.7 to 6.0 for SMH, a statistically significant difference. Response rates (50% reduction in headache days) were 52% for MBSR+ versus 23% for SMH. Headache-related disability also improved more with MBSR+. No differences in clinical outcomes persisted at 52 weeks, and MRI outcomes at 20 weeks showed no group differences, though cognitive network changes were observed with MBSR+.
Study at a glance
| Characteristics | Randomized, assessor-blind, clinical trial Peer reviewed |
|---|---|
| Sample size | 98 |
| Population | Adults with episodic migraine recruited at a single academic center |
| Interventions | Enhanced mindfulness-based stress reduction (MBSR+) Stress management for headache (SMH) |
| Duration | 8-week weekly sessions then 8-week bi-weekly sessions; primary outcome at 20 weeks; follow-up at 52 weeks |
| Keywords | Medicine |
| Key finding | MBSR+ reduced headache days more than SMH at 20 weeks, with a greater response rate and disability improvement, but no differences at 52 weeks or in MRI outcomes. |
Abstract
We aimed to evaluate the efficacy of an enhanced mindfulness based stress reduction (MBSR+) versus stress management for headache (SMH). We performed a randomized, assessor-blind, clinical trial of 98 adults with episodic migraine recruited at a single academic center comparing MBSR+ (n=50) to SMH (n=48). MBSR+ and SMH were delivered weekly by group for 8 weeks, then bi-weekly for another 8 weeks. The primary clinical outcome was reduction in headache days from baseline to 20 weeks. MRI outcomes included activity of left dorsolateral prefrontal cortex (DLPFC) and cognitive task network during cognitive challenge, resting state connectivity of right dorsal anterior insula (daINS) to DLPFC and cognitive task network, and gray matter volume of DLPFC, daINS, and anterior midcingulate. Secondary outcomes were headache-related disability, pain severity, response to treatment, migraine days, and MRI whole-brain analyses. Reduction in headache days from baseline to 20 weeks was greater for MBSR+ (7.8 [95%CI, 6.9–8.8] to 4.6 [95%CI, 3.7–5.6]) than for SMH (7.7 [95%CI 6.7–8.7] to 6.0 [95%CI, 4.9–7.0]) (P=0.04). 52% of the MBSR+ group showed a response to treatment (50% reduction in headache days) compared with 23% in the SMH group (P=0.004). Reduction in headache-related disability was greater for MBSR+ (59.6 [95%CI, 57.9–61.3] to 54.6 [95%CI, 52.9–56.4]) than SMH (59.6 [95%CI, 57.7–61.5] to 57.5 [95%CI, 55.5–59.4]) (P=0.02). There were no differences in clinical outcomes at 52 weeks or MRI outcomes at 20 weeks, although changes related to cognitive networks with MBSR+ were observed. MBSR+ is an effective treatment option for episodic migraine.