Meditation may not be the first thing that comes to mind when one thinks of their migraines. In fact, I imagine a number of people immediately conjure up the picture of a bald headed, emaciated yogi in baggy pants, sitting cross-legged with his hands on his knees as he repeats mantras and chants "om" as if in a trance. For some it calls to mind thoughts of Eastern mysticism and long periods of silence, self-reflection, and self-deprivation. Meditation and the meditative process are frequently shrouded in mystery and are relegated to esoteric spiritual processes. Yet, meditation, as we know it today, is a very simple and practical process that has significant applications to the everyday man or woman. (Read about Why Meditation Works.)
Meditation is associated with a number of favorable psychological outcomes, including relaxation, stress reduction and an increased sense of emotional well-being. However, research also suggests that meditation plays a significant role in physical well-being. It has been associated with decreases in blood pressure, mood regulation through the increase of serotonin, decreased muscle tension, and increased energy. A number of studies also show that meditation is an effective tool in helping with pain management in a wide array of chronic pain conditions, including cancer, arthritis and back pain. It has also been shown to improve patients’ perceptions of their illness and their perceptions of their ability to cope with their illness successfully - a skill called self-efficacy. If meditation is such a potent tool in the treatment of chronic pain, it seems logical that it may also be applicable to the treatment of migraines. Research at a headache care clinic associated with Brigham and Women’s Hospital in Boston, Massachusetts, looked at just this issue. Specifically, Rebecca E. Wells, MD, et al., conducted a pilot randomized controlled trial to "assess the safety, feasibility, and effects of the standardized, eight-week mindfulness-based stress reduction (MBSR) course in adults with migraines. Watch for our article on Mindfulness Based Stress Reduction for Migraine and Pain Management.
- "MBSR is feasible and safe in migraineurs."
- "MBSR will decrease migraine frequency, severity, and duration."
- "The MBSR group will demonstrate trends toward improved quality of life and self-efficacy and less depression, anxiety and migraine-related disability."
- "50% of migraineurs have clinically meaningful responses to preventative drug treatments."
- "More than 10% (of migraineurs) discontinue (treatment) due to adverse events."
- 50% " report dissatisfaction with their current treatment strategies."
- "Non-pharmacological options have a number of benefits including:
- fewer side effects
- ability to be used concurrently with medication
- reduction in overall medication reliance
- reduction in possibility of medication overuse headache (MOH)
- "therapeutic effects on other factors contributing to headache burden such as stress or anxiety."
- "Approximately half of US adults with migraines report using complementary and alternative medicine (CAM), especially mind/body therapies such as meditation and yoga. Watch for our article," Complementary and Integrative Medicine Approaches to Migraine Treatment"
- Pilot study - preliminary or initial analysis prior to full-scale research study; frequently for the purpose of determining if the research hypotheses warrant further investigation.
- Mindfulness - "non-judgmental moment-to-moment awareness"
- Self-Efficacy - a person’s perception of their ability to do something
- 19 episodic migraineurs were recruited from academic headache center (John R. Graham Headache Center at Brigham and Women’s Hospital).
- Participants were randomly assigned to a regular treatment group or to a regular treatment plus MBSR group.
- diagnosed with migraine with or without aura according to the ICHD-II,
- had 4-14 migraines a month
- had at least a one year history of migraines
- were at least 18 years of age,
- were fluent in English
- were in good general health with no diseases that might interfere with the study
- had no current, regular practice of meditation or yoga
- were stable medically and psychologically
- were not pregnant or breastfeeding
- had started no new prophylactic migraine medication within four weeks of the start of the study
- had current treatment plans which included prophylactic and abortive medications
- All participants maintained a daily headache record, recording the number of headache days, the severity of the pain on a 0-10 scale, and the medicines taken.
- The MBSR group attended eight weekly, two-hour sessions, plus one six hour retreat led by a facilitator trained and experienced in Kabat-Zinn’s structured MBSR protocol. In addition, the MBSR used guided audio recordings to practice at home for 45 minutes a day five days a week.
- At each of three study visits, all participants completed the following standardized measures:
- Headache Impact Test-6 (HIT-6)
- 1-month Migraine Disability Assessment (MIDAS)
- Migraine Specific Quality of Life Questionnaire, Version 2.1
- PRIME-MD Patient Health Questionnaire-depression module (PHQ-9)
- State Trait Anxiety Inventory
- Five Facet Mindfulness Questionnaire
- Headache Management Self-Efficacy Scale
Overview of MBSR:
The MBSR included:1
- mindful eating
- "mindful breathing with sitting and walking meditation"
- "mindful movement" - yoga
- body scan - "sequential mindful attention to different body parts" (see video belos)
- Participants were taught to use MBSR skills
- "to reduce the negative effects of stress reactivity"
- “to develop more effective ways of responding positively and proactively in stressful situations and experiences”
- "to build their capacity to attend to physical and mental percepts by repeatedly bringing attention back to the natural rhythm of the breath"
- "The ultimate goal is for patients to build their mindfulness practice and MBSR skills to develop a more flexible capacity to utilize mindfulness in a variety of everyday situations."
- Fewer migraines per month (1.4 fewer)
- Severity and duration of all headaches decreased
- -1.3 points/headache on 0-10 scale
- -2.9 hours per headache
- Disability decreased based on HIT-6 and 1-month MIDAS.
- "Self-efficacy and mindfulness increased."1
- "Migraine-specific quality of life, anxiety, and perceived stress showed improvement."1
- Small sample size - Effect size for outcome was used rather than statistical significance. (Effect size is "the magnitude of difference between two groups.)
- Some headaches may have been misclassified since "inclusion criterion for migraine frequency was based on a patient’s interpretation of their headaches as migraines, while results were analyzed according to diagnostic criteria for migraine."
"MBSR is safe and feasible for adults with migraines. Secondary outcomes demonstrated this intervention had a beneficial effect on headache duration, disability, self-efficacy, and mindfulness. Further studies with larger sample sizes are warranted to further evaluate this intervention for adults with migraines."1
Comments From the Researchers:
Dr. Rebecca Wells commented:
"We found that the MBSR participants had trends of fewer migraines that were less severe. Secondary effects included headaches that were shorter in duration and less disabling, and participants had increases in mindfulness and self-efficacy - a sense of personal control over their migraines. In addition, there were no adverse events and excellent adherence."2
From My Perspective:
As individuals with migraines, we frequently feel that we have little or no control over our migraines. At times we feel that we are at the mercy of doctors and medicines to "work their magic" to help us manage our migraines and our lives with migraines. However, meditation is a tool that can easily be employed by anyone and appears to have a direct effect not only on our perception of pain but also on our perceived ability to handle pain and life with migraines. Meditation taps into the mind/body connection, allowing us to use the mind to create change in the body. As Trish Magyari is quoted in Meditation A Hit for Pain Management saying, "The point of it (meditation) is to train our mind where we want it to go, instead of letting the mind wander into worry or be held hostage by the panic of pain."
This study does not suggest that migraines are "all in our minds" or can be completely treated by meditation or other alternative measures. While meditation does help reduce stress, it is important to remember that stress does not cause migraine disease, and although it may be a migraine trigger for some, it’s important to determine if there are things we do or don’t do during stressful times that may be our triggers rather than stress itself. (Check out Can Stress Be a Migraine Trigger?) Meditation is a potentially helpful addition to our migraine tool kit. It is something that may not only reduce pain but also increase our ability to handle pain. No in-depth training or spiritual affiliation is needed for meditation to be successful. Best of all, it’s free of charge and can be used anywhere, at any time, by anyone.
1 Wells, Rebecca, MD; Burch, Rebecca, MD, MPH; Paulsen, Randall, MD; Wayne, Peter, PhD; Houle, Timothy, PhD; Loder, Elizabeth, MD,MPH. "Meditation for Migraines: A Pilot Randomized Controlled Trial." Headache. Early view: First published online July 18, 2014.
2 Matilda, Benita. “Meditation Effective in Reducing Migraines, Study.” Science World Report. September 13, 2014.
Wishing you health, hope & happiness,
_**Reviewed by David Watson, MD.
© Cyndi Jordan, 2014, - Last updated September 23, 2014.