For years, migraine and headache patients have looked to alternative therapies, such as meditation, biofeedback and acupuncture, to help manage their condition. One newer therapy that is gaining traction in the headache community is mindfulness-based cognitive therapy (MBCT), a method of managing pain and negative feelings by focusing on the moment and accepting life’s challenges.
In a study being conducted at the University of Alabama in Tuscaloosa, researchers with grants from the National Headache Foundation and the Marchionne Foundation are investigating the effectiveness of MBCT for chronic headache pain. MBCT teaches people skills to manage pain so it doesn’t get in the way of everyday life, says Melissa Day, a senior graduate student and sub-investigator for the trial.
“The program likely won’t remove your pain, but it will help you work with the pain and potentially remove the extra baggage you pile on top of it,” she says. “It helps one regain appreciation of the things that are often overshadowed by the all-encompassing identity of being a chronic headache pain patient.”
The interest in MBCT as it pertains to migraine and headache stems from a belief that “living in the moment” will be especially beneficial for headache patients.
“Many headache patients are highly driven, detail-oriented individuals,” says Beverly Thorn, PhD, principal investigator on the study. “An approach that deliberately targets cultivating awareness and acceptance of the moment is a radical shift for such persons. We believe people who make this shift will obtain a significant benefit that is sustainable for the rest of their lives.”
The University of Alabama trial integrates mindfulness meditation with traditional cognitive behavioral therapy and mindfulness-based stress reduction. The goal is to extract the key components of each approach to form an integrated treatment package.
As part of the study’s MBCT program, treatment groups meet once a week for two-hour sessions. Each session consists of an extended, guided meditation, which becomes more advanced as the program progresses. Patients also get a series of meditation CDs for daily, at-home practice.
“On the surface, the meditation techniques serve as a relaxation exercise that lowers stress reactions,” Thorn says. “More deeply, meditation exercises are thought to train the brain so it is less prone to react reflexively with negative thoughts, emotions and behaviors that elevate the stress thermostat.”
Sessions also include basic yoga and other group exercises to help patients “get out of their head.” Both Thorn and Day hope to conclude that MBCT will be a feasible treatment alternative or a solid complement to medication-based pain management.
“We know that traditional biomedical approaches can only go so far and [have] substantial side effects,” Thorn says. “Physicians recognize that triggers, such as stress and lifestyle, are important components of overall headache management, yet they lack the time and expertise to address this critical aspect of headache pain.”
The researchers are using a randomized controlled trial that compares MBCT—an immediate treatment strategy—to a delayed treatment control group. Participants complete pre-, mid- and post-treatment assessments, in addition to a six-month follow-up, to determine any long-term benefits.
Throughout the eight-week program, patients in both the MBCT and control group complete a daily headache diary online. MBCT patients also complete a daily practice diary.
“This allows us to track patients on a day-to-day basis and examine patterns of change across individuals,” Day says.
In addition to researching outcomes, such as headache intensity, frequency and pain-related disability, researchers also want to know how patients carve out time for meditation, how they react to mindfulness exercises and how MBCT changes the way they approach their headaches.
“One patient said at the end of [her] program, ‘I still have headache pain, but it doesn’t have me,’” Day says.
While the researchers say it’s too early to report the statistical findings of this trial, interim analysis suggests patients who completed treatment substantially improved on one or more headache-related outcome measures. Patients randomly assigned to the control group experienced minimal change.
“The biggest challenge to patients has been overcoming the obstacle of carving out time from their busy lives for daily meditation practice,” Thorn says. “However, around midway through treatment, most patients have come to place their practice at the top of their to-do list.”
The researchers expect those who stick with MBCT practice to not only experience reductions in the frequency of their headaches and in the amount of medication they take, but also to be more aware and accepting of the present moment—even if that moment brings a headache.
What is Mindfulness?
Mindfulness is “the awareness that emerges through paying attention on purpose, in the present moment, and non-judgmentally to the unfolding of experience, moment by moment,” says Jon Kabat-Zinn, founding executive director of the Center for Mindfulness in Medicine, Health Care, and Society at the University of Massachusetts Medical School. In addition to chronic pain, MBCT has been used to treat a variety of other issues including depression, eating disorders, anxiety and insomnia.
Source: Clinical Psychology: Science and Practice, 2003
This study is currently recruiting patients in the Birmingham and Tuscaloosa, Ala., areas. They are seeking patients age 19 years or older who have suffered from migraine or headache pain for at least three days per month for the past three months. Participants must have no history of seizure or facial neuralgia, as these conditions might preclude the accurate diagnosis of headache. If you are on psychotropic or headache medications, you must have been using them for at least four weeks prior to treatment. Patients can continue to sign up for the study through March 2012. If you are interested in participating, please contact Beverly E. Thorn, PhD, at (205) 348-5024 or [email protected]. You can also contact Melissa Day at (205) 348-5024 or [email protected].
