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Enhanced mindfulness-based stress reduction in episodic migraine: a randomized clinical trial with magnetic resonance imaging outcomes
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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.
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“Recent clinical trials of mindfulness interventions in patients with migraine are promising.2, 7, 8”
From Mechanisms of mindfulness in patients with migraine: Results of a qualitative study. (2023) · cites this paper as [8]
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“Our findings of improved cognitive well-being are consistent with recent MRI evidence suggesting mindfulness improves cognitive efficiency in adults with migraine.8”
From Mechanisms of mindfulness in patients with migraine: Results of a qualitative study. (2023) · cites this paper as [8]
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“The reduction of about two headache days from baseline to follow-up is comparable to observed improvements in recent randomized clinical trials on non-medical treatments (19, 55).”
From Efficacy of Cognitive-Behavioral Therapy for the Prophylaxis of Migraine in Adults: A Three-Armed Randomized Controlled Trial (2022) · cites this paper as [55]
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Wells, R. E., O’Connell, N., Pierce, C. R., Estave, P., Penzien, D. B., Loder, E., Zeidan, F., & Houle, T. T. (2021) · JAMA Internal Medicine · doi:10.1001/jamainternmed.2020.7090 · Cited by 183
Applying a biopsychosocial model to migraine: rationale and clinical implications
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“Neuroimaging findings have further demonstrated the impact of behavioural treatments, and especially mindfulness, in producing functional modifications in brain areas involved in the cognitive and affective components of pain, including the dorsolateral medial prefrontal cortex, dorsal anterior insula, and anterior mi…”
BackgroundLifestyle factors and migraine
Seng, E. K., Martin, P. R., & Houle, T. T. (2022) · The Lancet Neurology · doi:10.1016/s1474-4422(22)00211-3 · Cited by 116
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Metadata
- Authors
- 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.
- Affiliations
- University of Maryland, Baltimore (US)
- Johns Hopkins University (US)
- Private Mindfulness-based Psychotherapy Practice, Baltimore, MD, United States
- Lancaster General Hospital (US)
- Corresponding author
- Seminowicz, David A.
- ORCID
- Venue
- Pain
- Published
- 2020-03-13
- Volume
- 161
- Issue
- 8
- Pages
- 1837-1846
- ISSN
- 0304-3959 (ISSN-L)
- 1872-6623
- PMC
- PMC7487005
- OpenAlex
- W3011034657
- Semantic Scholar
- 3d5ba40ad69901727f6798ee12e8fd95d3480d26
- Cited by
- 110
- References
- 81
- Citations by year
- 2026: 5 · 2025: 18 · 2024: 18 · 2023: 21 · 2022: 22 · 2021: 17 · 2020: 7
- FWCI
- 12.15
- Type
- journal article
- Language
- en
- Open access
- green
- doi.org
- Licence
- cc-by-nc-nd
- Locations
- Pain (publishedVersion)
- medRxiv (acceptedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health (NIH-R01)
- National Center for Complementary and Integrative Health (AT007176, R01AT007176)
- Topics
- Health Sciences › Medicine › Clinical Neurology › Migraine and Headache Studies
- Social Sciences › Psychology › Clinical Psychology › Mindfulness and Compassion Interventions
- Health Sciences › Dentistry › Oral Surgery › Temporomandibular Joint Disorders
- Keywords
- episodic migraine, mindfulness-based stress reduction, headache days, headache-related disability, dorsolateral prefrontal cortex, dorsal anterior insula, anterior midcingulate cortex, resting-state functional connectivity, gray matter volume
- MeSH terms
- Adolescent, Adult, Aged, Female, Headache, Humans, Magnetic Resonance Imaging, Male, Middle Aged, Migraine Disorders, Stress, Psychological, Treatment Outcome, Young Adult, Neuroimaging, Mindfulness
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