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Wells RE, O`Connell N, Pierce CR, et al. Effectiveness of Mindfulness Meditation vs Headache Education for Adults With Migraine: A Randomized Clinical Trial. JAMA Intern Med. 2020 Dec 14. pii: 2774130. doi: 10.1001/jamainternmed.2020.7090. (Original study)

Importance: Migraine is the second leading cause of disability worldwide. Most patients with migraine discontinue medications due to inefficacy or adverse effects. Mindfulness-based stress reduction (MBSR) may provide benefit.

Objective: To determine if MBSR improves migraine outcomes and affective/cognitive processes compared with headache education.

Design, Setting, and Participants: This randomized clinical trial of MBSR vs headache education included 89 adults who experienced between 4 and 20 migraine days per month. There was blinding of participants (to active vs comparator group assignments) and principal investigators/data analysts (to group assignment).

Interventions: Participants underwent MBSR (standardized training in mindfulness/yoga) or headache education (migraine information) delivered in groups that met for 2 hours each week for 8 weeks.

Main Outcomes and Measures: The primary outcome was change in migraine day frequency (baseline to 12 weeks). Secondary outcomes were changes in disability, quality of life, self-efficacy, pain catastrophizing, depression scores, and experimentally induced pain intensity and unpleasantness (baseline to 12, 24, and 36 weeks).

Results: Most participants were female (n = 82, 92%), with a mean (SD) age of 43.9 (13.0) years, and had a mean (SD) of 7.3 (2.7) migraine days per month and high disability (Headache Impact Test-6: 63.5 [5.7]), attended class (median attendance, 7 of 8 classes), and followed up through 36 weeks (33 of 45 [73%] of the MBSR group and 32 of 44 [73%] of the headache education group). Participants in both groups had fewer migraine days at 12 weeks (MBSR: -1.6 migraine days per month; 95% CI, -0.7 to -2.5; headache education: -2.0 migraine days per month; 95% CI, -1.1 to -2.9), without group differences (P = .50). Compared with those who participated in headache education, those who participated in MBSR had improvements from baseline at all follow-up time points (reported in terms of point estimates of effect differences between groups) on measures of disability (5.92; 95% CI, 2.8-9.0; P < .001), quality of life (5.1; 95% CI, 1.2-8.9; P = .01), self-efficacy (8.2; 95% CI, 0.3-16.1; P = .04), pain catastrophizing (5.8; 95% CI, 2.9-8.8; P < .001), depression scores (1.6; 95% CI, 0.4-2.7; P = .008), and decreased experimentally induced pain intensity and unpleasantness (MBSR group: 36.3% [95% CI, 12.3% to 60.3%] decrease in intensity and 30.4% [95% CI, 9.9% to 49.4%] decrease in unpleasantness; headache education group: 13.5% [95% CI, -9.9% to 36.8%] increase in intensity and an 11.2% [95% CI, -8.9% to 31.2%] increase in unpleasantness; P = .004 for intensity and .005 for unpleasantness, at 36 weeks). One reported adverse event was deemed unrelated to study protocol.

Conclusions and Relevance: Mindfulness-based stress reduction did not improve migraine frequency more than headache education, as both groups had similar decreases; however, MBSR improved disability, quality of life, self-efficacy, pain catastrophizing, and depression out to 36 weeks, with decreased experimentally induced pain suggesting a potential shift in pain appraisal. In conclusion, MBSR may help treat total migraine burden, but a larger, more definitive study is needed to further investigate these results.

Trial Registration: ClinicalTrials.gov Identifier: NCT02695498.

Discipline Area Score
Family Medicine (FM)/General Practice (GP) 6 / 7
General Internal Medicine-Primary Care(US) 6 / 7
Neurology 6 / 7
Special Interest - Pain -- Physician 6 / 7
Internal Medicine 5 / 7
Comments from MORE raters

Family Medicine (FM)/General Practice (GP) rater

This small but decently done study showing mindfulness meditation, though not decreasing headache frequency versus education classes, did improving how chronic migraine patients functioned/coped with their headaches. Given medications sometimes do not help these patients much, having another option is useful to know about. Of course, access to an 8 week mindfulness course would be challenging for many.

Internal Medicine rater

Living with mindfulness should be a way of life. Its good to see that Mindfulness Based Stress Reduction has very positive impact on migraine (except the frequency of migraine). The main issue is to get an effective MBSR instructor!

Neurology rater

The article is a well-presented and clear-cut study on nondrug options to prevent the use of opioids. The authors conclude that mindfulness can be practiced anywhere at any time. It may be useful in light of the anxiety caused by COVID-19 pandemic. In fact, patients with migraine may have worsening migraine attacks and mindfulness may be particularly beneficial. In summary, mindfulness may help treat the total burden of migraine. However, a larger, more definitive study is needed to understand the impact of mindfulness on migraine. The paper has correct references and is clear and easy to understand. It has properly been subdivided into paragraphs, and this helps the overall comprehension. Globally, this article might represent a good advancement in the field.
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