Mindfulness and pharmacological prophylaxis after withdrawal from medication overuse in patients with Chronic Migraine: an effectiveness trial with a one-year follow-up

Abstract

BackgroundChronic Migraine (CM) is a disabling condition, worsened when associated with Medication Overuse (MO). Mindfulness is an emerging technique, effective in different pain conditions, but it has yet to be explored for CM-MO. We report the results of a study assessing a one-year course of patients’ status, with the hypothesis that the effectiveness of a mindfulness-based approach would be similar to that of conventional prophylactic treatments.MethodsPatients with CM-MO (code 1.3 and 8.2 of the International Classification of Headache Disorders-3Beta) completed a withdrawal program in a day hospital setting. After withdrawal, patients were either treated with Prophylactic Medications (Med-Group), or participated in a Mindfulness-based Training (MT-Group). MT consisted of 6 weekly sessions of guided mindfulness, with patients invited to practice 7–10 min per day. Headache diaries, the headache impact test (HIT-6), the migraine disability assessment (MIDAS), state and trait anxiety (STAI Y1-Y2), and the Beck Depression Inventory (BDI) were administered before withdrawal and at each follow-up (3, 6, 12 after withdrawal) to patients from both groups. Outcome variables were analyzed in separate two-way mixed ANOVAs (Group: Mindfulness vs. Pharmacology x Time: Baseline, 3-, 6-, vs. 12-month follow-up).ResultsA total of 44 patients participated in the study, with the average age being 44.5, average headache frequency/month was 20.5, and average monthly medication intake was 18.4 pills. Data revealed a similar improvement over time in both groups for Headache Frequency (approximately 6–8 days reduction), use of Medication (approximately 7 intakes reduction), MIDAS, HIT-6 (but only for the MED-Group), and BDI; no changes on state and trait anxiety were found. Both groups revealed significant and equivalent improvement with respect to what has become a classical endpoint in this area of research, i.e. 50% or more reduction of headaches compared to baseline, and the majority of patients in each condition no longer satisfied current criteria for CM.ConclusionsTaken as a whole, our results suggest that the longitudinal course of patients in the MT-Group, that were not prescribed medical prophylaxis, was substantially similar to that of patients who were administered medical prophylaxis.

Behavioral Approaches for Primary Headaches: Recent Advances

“…In fact, only 7 of the studies discussed in the present review conducted follow-up evaluations at 12 months 39,46 or more, 28,34,36,38,44,48 with drop-out rates ranging between 5% for the 2 studies with 12month follow-up, 39,46 and 37-49% for two studies with a follow-up of 20 months 28,44 and 36-48 months. In fact, only 7 of the studies discussed in the present review conducted follow-up evaluations at 12 months 39,46 or more, 28,34,36,38,44,48 with drop-out rates ranging between 5% for the 2 studies with 12month follow-up, 39,46 and 37-49% for two studies with a follow-up of 20 months 28,44 and 36-48 months.…”

“…As research progresses we are learning that no single causative effect is sufficient. 31,32,34,46,[66][67][68][69] Improvement in the above-mentioned abilities likely further enhances pain coping strategies and simultaneously promotes reductions in catastrophizing about pain. Behavioral treatments produce reductions in stress, 35,42,60,61 increased sense of self-efficacy (ie, the confidence in one's ability to manage different aspects of his/her life), and reductions in the external locus of control (ie, the belief that one has limited to no ability to control life events).…”

“…In 2 randomized trials, the intervention group was compared to a control group, 45,47 while in the third study, participants self-selected their preferred treatment condition between mindfulness training alone or medical prophylaxis alone. 45,46 Cathcart and colleagues 45 recruited patients with chronic tension-type headache (CTTH) who were randomized to either a mindfulness-based therapy intervention based on integration of mindfulness-based stress reduction (MBSR) and mindfulness-based cognitive therapy aspects, or a waiting list control group. 45,46 Cathcart and colleagues 45 recruited patients with chronic tension-type headache (CTTH) who were randomized to either a mindfulness-based therapy intervention based on integration of mindfulness-based stress reduction (MBSR) and mindfulness-based cognitive therapy aspects, or a waiting list control group.…”

Migraine Care Challenges and Strategies in US Uninsured and Underinsured Adults: A Narrative Review, Part 2

“…Deep relaxation, diaphragmatic breathing, and cognitive behavioral techniques to adapt behavioral responses to pain can also be useful . Mindfulness and meditation may also be helpful . Teaching these techniques is simple and there are multiple online resources for downloadable exercises easily found via internet search engines (eg, search term = “downloadable deep relaxation and breathing techniques”).…”

I performed experiments and I have results. Wow, and now?

“…Original articles are the standard of scientific research, and can concern laboratory, field, animal research [29][30][31][32][33][34] or human research 35 . They are structured so that other scientists can replicate that specific experiment.…”