Enhanced mindfulness based stress reduction (MBSR+) in episodic migraine: a randomized clinical trial with MRI outcomes.

Author: Seminowicz DA1,2, Burrowes SA1,2,3, Kearson A4, Zhang J1,2, Krimmel SR1,2,5, Samawi L1,2, Furman AJ1,2,5, Keaser ML1,2, Gould NF4, Magyari T6, White L7, Goloubeva O8, Goyal M9, Peterlin BL10, Haythornthwaite JA4
Author Information:
1Department of Neural and Pain Sciences, School of Dentistry, University of Maryland Baltimore, Baltimore, MD, USA 21201.
2Center to Advance Chronic Pain Research, University of Maryland Baltimore, Baltimore, MD, USA 21201.
3Department of Epidemiology and Public Health, School of Medicine, University of Maryland Baltimore, Baltimore, MD, USA 21201.
4Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA 21224.
5Program in Neuroscience, School of Medicine, University of Maryland Baltimore, Baltimore, MD, USA 21201.
6Private Mindfulness-based Psychotherapy Practice, 3511 N Calvert St, Baltimore, MD 21218.
7Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA 21224.
8University of Maryland Greenebaum Comprehensive Cancer Center, University of Maryland Baltimore, Baltimore, MD, USA 21201.
9Department of Medicine, Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD USA 21287.
10Neuroscience Institute, Penn Medicine Lancaster General Health, Lancaster, PA, USA 17601.
Conference/Journal: Pain.
Date published: 2020 Mar 13
Other: Special Notes: doi: 10.1097/j.pain.0000000000001860. [Epub ahead of print] , Word Count: 234


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.

PMID: 32187119 DOI: 10.1097/j.pain.0000000000001860

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