Enhanced mindfulness-based stress reduction in episodic migraine: A randomized clinical trial with magnetic resonance imaging outcomes

David A. Seminowicz, Shana A.B. Burrowes, Alexandra Kearson, Jing Zhang, Samuel R. Krimmel, Luma Samawi, Andrew J. Furman, Michael L. Keaser, Neda F. Gould, Trish Magyari, Linda White, Olga Goloubeva, Madhav Goyal, B. Lee Peterlin, Jennifer A. Haythornthwaite

Research output: Contribution to journalArticle

Abstract

We aimed to evaluate the efficacy of an enhanced mindfulness-based stress reduction (MBSR+) vs 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) with SMH (n = 48). MBSR+ and SMH were delivered weekly by group for 8 weeks, then biweekly for another 8 weeks. The primary clinical outcome was reduction in headache days from baseline to 20 weeks. Magnetic resonance imaging (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 to DLPFC and cognitive task network, and gray matter volume of DLPFC, dorsal anterior insula, 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). Fifty-two percent 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. Enhanced mindfulness-based stress reduction is an effective treatment option for episodic migraine.

Original languageEnglish (US)
Pages (from-to)1837-1846
Number of pages10
JournalPain
Volume161
Issue number8
DOIs
StatePublished - Aug 1 2020

Keywords

  • Brain
  • Headache
  • Intervention
  • Nonpharmacological
  • Treatment
  • fMRI

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology
  • Anesthesiology and Pain Medicine

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  • Cite this

    Seminowicz, D. A., Burrowes, S. A. B., Kearson, A., Zhang, J., Krimmel, S. R., Samawi, L., Furman, A. J., Keaser, M. L., Gould, N. F., Magyari, T., White, L., Goloubeva, O., Goyal, M., Peterlin, B. L., & Haythornthwaite, J. A. (2020). Enhanced mindfulness-based stress reduction in episodic migraine: A randomized clinical trial with magnetic resonance imaging outcomes. Pain, 161(8), 1837-1846. https://doi.org/10.1097/j.pain.0000000000001860