Meditation Practice, Mindfulness, and Pain-Related Outcomes in Mindfulness-Based Treatment for Episodic Migraine

Carly A Hunt; Janelle E Letzen; Samuel R Krimmel; Shana A B Burrowes; Jennifer A Haythornthwaite; Michael Keaser; Matthew Reid; Patrick H Finan; David A Seminowicz

doi:10.1007/s12671-023-02105-8

Meditation Practice, Mindfulness, and Pain-Related Outcomes in Mindfulness-Based Treatment for Episodic Migraine

Mindfulness (N Y). 2023 Apr;14(4):769-783. doi: 10.1007/s12671-023-02105-8. Epub 2023 Apr 4.

Authors

Carly A Hunt^{1

2}, Janelle E Letzen¹, Samuel R Krimmel³, Shana A B Burrowes^{4

5}, Jennifer A Haythornthwaite¹, Michael Keaser^{5

6}, Matthew Reid¹, Patrick H Finan^{1

2}, David A Seminowicz^{5

6}

Affiliations

¹ Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
² Department of Anesthesiology, University of Virginia, VA, Charlottesville, USA.
³ Department of Neurology, Washington University School of Medicine, St. Louis, MO 63110, USA.
⁴ Department of Medicine, Section of Infectious Diseases, Boston University School of Medicine, Boston, MA 02218, USA.
⁵ Department of Neural and Pain Sciences, School of Dentistry, University of Maryland Baltimore, Baltimore, MD 21201, USA.
⁶ Center to Advance Chronic Pain Research, University of Maryland Baltimore, Baltimore, MD 21201, USA.

Abstract

Objectives: Mindfulness-based interventions (MBIs) have emerged as promising prophylactic episodic migraine treatments. The present study investigated biopsychosocial predictors and outcomes associated with formal, daily-life meditation practice in migraine patients undergoing MBI, and whether augmented mindfulness mechanistically underlies change.

Methods: Secondary analyses of clinical trial data comparing a 12-week enhanced mindfulness-based stress reduction course (MBSR + ; n = 50) to stress management for headache (SMH; n = 48) were conducted.

Results: Pre-treatment mesocorticolimbic system functioning (i.e., greater resting state ventromedial prefrontal cortex-right nucleus accumbens [vmPFC-rNAC] functional connectivity) predicted greater meditation practice duration over MBSR + (r = 0.58, p = 0.001), as well as the change in headache frequency from pre- to post-treatment (B = -12.60, p = 0.02) such that MBSR + participants with greater vmPFC-rNAC connectivity showed greater reductions in headache frequency. MBSR + participants who meditated more showed greater increases in mindfulness (B = 0.52, p = 0.02) and reductions in the helplessness facet of pain catastrophizing (B = -0.13, p = 0.01), but not headache frequency, severity, or impact. Augmented mindfulness mediated reductions in headache impact resulting from MBSR + , but not headache frequency.

Conclusions: Mesocorticolimbic system function is implicated in motivated behavior, and thus, motivation-enhancing interventions might be delivered alongside mindfulness-based training to enhance meditation practice engagement. Formal, daily-life meditation practice duration appears to benefit pain-related cognitions, but not clinical pain, while mindfulness emerges as a mechanism of MBIs on headache impact, but not frequency. Further research is needed to investigate the day-to-day effects of formal, daily-life meditation practice on pain, and continue to characterize the specific mechanisms of MBIs on headache outcomes.

Preregistration: This study is not preregistered.

Keywords: Headache; Home practice; Meditation practice; Mindfulness; Motivation.

Abstract

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