Mindfulness in migraine: A narrative review

ABSTRACT

Introduction: Migraine is the second leading cause of disability worldwide, yet many patients are unable to tolerate, benefit from, or afford pharmacological treatment options. Non-pharmacological migraine therapies exist, especially to reduce opioid use, which represents a significant unmet need. Mindfulness-based interventions (MBI) have potential as a non-pharmacological treatment for migraine, primarily through the development of flexible attentional capacity across sensory, cognitive, and emotional experiences.

Areas covered: The authors review efficacy and potential mechanisms of MBIs for migraine, including mindfulness-based stress reduction (MBSR) and mindfulness-based cognitive therapy (MBCT).

Expert opinion: While most mindfulness research studies for migraine to date have been pilot trials, which are small and/or lacked rigor, initial evidence suggests there may be improvements in overall headache-related disability and psychological well-being. Many research questions remain to help target the treatment to patients most likely to benefit, including the ideal dosage, duration, delivery method, responder characteristics, and potential mechanisms and biomarkers. A realistic understanding of these factors is important for patients, providers, and the media. Mindfulness will not ‘cure’ migraine; however, mindfulness may be an important tool as part of a comprehensive treatment approach to help patients ‘mindfully’ engage in valued life activities.

KEYWORDS:

• Complementary and alternative medicine
• integrative medicine
• mindfulness
• migraine
• meditation
• mindfulness-based stress reduction
• mindfulness-based cognitive therapy
• mind-body medicine
• mindfulness-based intervention

Article highlights

• Migraine is the second leading cause of disability worldwide

• Current pharmacological options often fall short in providing effective relief for all patients

• There is an unmet need for feasible, available, non-pharmacological approaches

• Mindfulness based interventions (MBIs) are a promising option to reduce stress, anxiety, pain and improve patient well-being on the emotional and cognitive level

• Current studies have investigated mindfulness-based programs along or in combination with standard of care

• Mindfulness-based interventions may not ‘cure’ migraine but may reduce pain severity and improve patients’ quality of life.

Acknowledgments

The authors gratefully acknowledge the editorial assistance of Indra M. Newman, PhD at the Wake Forest Clinical and Translational Science Institute, funded by the National Center for Advancing Translational Sciences (NCATS), National Institutes of Health, through Grant Award Number UL1TR001420.

Declaration of interest

E Seng has consulted for GlaxoSmithKline, Eli Lilly, and Click Therapeutics and has received travel funds from the American Psychological Association, the American Academy of Neurology, and the American Association of Pain Medicine Foundation. V Napadow has a financial interest in Cala Health which is licensing the RAVANS tVNS technology from MGH. V Napadow’s interests were reviewed and are managed by the Massachusetts General Hospital and Partners HealthCare in accordance with their institutional policies. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or conflict with the subject matter or materials discussed in this manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose

Additional information

Funding

RE Wells is supported by the National Center for Complementary & Integrative Health (NCCIH) of the National Institutes of Health under [Award Number K23AT008406]. E Seng is supported by NIH NINDS [NSK23096107; PI: Seng]. V Napadow is funded by US National Institutes for Health (NIH), Office of the Director [OT2-OD023867]; National Center for Complementary and Integrative Health (NCCIH), NIH [P01-AT009965, R61-AT009306, R33-AT009306, R01-AT007550]; and National Institute for Arthritis and Musculoskeletal and Skin Diseases (NIAMS), NIH [R01-AR064367]. Z Schuman-Olivier is funded by NIH NCCIH P01AT009965 (PI-Napadow). RR Edwards is funded by NIH NCCIH P01AT009965 (PI-Napadow) and PCORI [Award OPD-1601-33860].