Does Mindfulness-Based Cognitive Therapy for Migraine Reduce Migraine-Related Disability in People with Episodic and Chronic Migraine? A Phase 2b Pilot Randomized Clinical Trial

Elizabeth K. Seng, Alexandra B. Singer, Christopher Metts, Amy S. Grinberg, Zarine S. Patel, Maya Marzouk, Lauren Rosenberg, Melissa Day, Mia T. Minen, Richard B. Lipton, Dawn C. Buse

Research output: Contribution to journalArticle

Abstract

Objective: The current Phase 2b study aimed to evaluate the efficacy of mindfulness-based cognitive therapy for migraine (MBCT-M) to reduce migraine-related disability in people with migraine. Background: Mindfulness-based interventions represent a promising avenue to investigate effects in people with migraine. MBCT teaches mindfulness meditation and cognitive-behavioral skills and directly applies these skills to address disease-related cognitions. Methods: Participants with migraine (6-30 headache days/month) were recruited from neurology office referrals and local and online advertisements in the broader New York City area. During the 30-day baseline period, all participants completed a daily headache diary. Participants who met inclusion and exclusion criteria were randomized in a parallel design, stratified by chronic migraine status, to receive either 8 weekly individual MBCT-M sessions or 8 weeks of waitlist/treatment as usual (WL/TAU). All participants completed surveys including primary outcome evaluations at Months 0, 1, 2, and 4. All participants completed a headache diary during the 30-day posttreatment evaluation period. Primary outcomes were the change from Month 0 to Month 4 in the headache disability inventory (HDI) and the Migraine Disability Assessment (MIDAS) (total score ≥ 21 indicating severe disability); secondary outcomes (headache days/30 days, average headache attack pain intensity, and attack-level migraine-related disability [Migraine Disability Index (MIDI)]) were derived from the daily headache diary. Results: Sixty participants were randomized to receive MBCT-M (n = 31) or WL/TAU (n = 29). Participants (M age = 40.1, SD = 11.7) were predominantly White (n = 49/60; 81.7%) and Non-Hispanic (N = 50/60; 83.3%) women (n = 55/60; 91.7%) with a graduate degree (n = 35/60; 55.0%) who were working full-time (n = 38/60; 63.3%). At baseline, the average HDI score (51.4, SD = 19.0) indicated a moderate level of disability and the majority of participants (50/60, 83.3%) fell in the “Severe Disability” range in the MIDAS. Participants recorded an average of 16.0 (SD = 5.9) headache days/30 days, with an average headache attack pain intensity of 1.7 on a 4-point scale (SD = 0.3), indicating moderate intensity. Average levels of daily disability reported on the MIDI were 3.1/10 (SD = 1.8). For the HDI, mean scores decreased more from Month 0 to Month 4 in the MBCT-M group (−14.3) than the waitlist/treatment as an usual group (−0.2; P <.001). For the MIDAS, the group*month interaction was not significant when accounting for the divided alpha, P =.027; across all participants in both groups, the estimated proportion of participants falling in the “Severe Disability” category fell significantly from 88.3% at Month 0 to 66.7% at Month 4, P <.001. For diary-reported headache days/30 days an average headache attack pain intensity, neither the group*month interaction (Ps =.773 and.888, respectively) nor the time effect (Ps =.059 and.428, respectively) was significant. Mean MIDI scores decreased in the MBCT-M group (−0.6/10), whereas they increased in the waitlist/treatment as an usual group (+0.3/10), P =.007. Conclusions: MBCT-M demonstrated efficacy to reduce headache-related disability and attack-level migraine-related disability. MBCT-M is a promising emerging treatment for addressing migraine-related disability.

Original languageEnglish (US)
Pages (from-to)1448-1467
Number of pages20
JournalHeadache
Volume59
Issue number9
DOIs
StatePublished - Oct 1 2019

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Mindfulness
Cognitive Therapy
Disabled Persons
Migraine Disorders
Randomized Controlled Trials
Headache
Pain
Equipment and Supplies
Accidental Falls

Keywords

  • behavioral treatment
  • disability
  • migraine
  • mindfulness
  • therapy

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology

Cite this

Does Mindfulness-Based Cognitive Therapy for Migraine Reduce Migraine-Related Disability in People with Episodic and Chronic Migraine? A Phase 2b Pilot Randomized Clinical Trial. / Seng, Elizabeth K.; Singer, Alexandra B.; Metts, Christopher; Grinberg, Amy S.; Patel, Zarine S.; Marzouk, Maya; Rosenberg, Lauren; Day, Melissa; Minen, Mia T.; Lipton, Richard B.; Buse, Dawn C.

In: Headache, Vol. 59, No. 9, 01.10.2019, p. 1448-1467.

Research output: Contribution to journalArticle

Seng, EK, Singer, AB, Metts, C, Grinberg, AS, Patel, ZS, Marzouk, M, Rosenberg, L, Day, M, Minen, MT, Lipton, RB & Buse, DC 2019, 'Does Mindfulness-Based Cognitive Therapy for Migraine Reduce Migraine-Related Disability in People with Episodic and Chronic Migraine? A Phase 2b Pilot Randomized Clinical Trial', Headache, vol. 59, no. 9, pp. 1448-1467. https://doi.org/10.1111/head.13657
Seng, Elizabeth K. ; Singer, Alexandra B. ; Metts, Christopher ; Grinberg, Amy S. ; Patel, Zarine S. ; Marzouk, Maya ; Rosenberg, Lauren ; Day, Melissa ; Minen, Mia T. ; Lipton, Richard B. ; Buse, Dawn C. / Does Mindfulness-Based Cognitive Therapy for Migraine Reduce Migraine-Related Disability in People with Episodic and Chronic Migraine? A Phase 2b Pilot Randomized Clinical Trial. In: Headache. 2019 ; Vol. 59, No. 9. pp. 1448-1467.
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abstract = "Objective: The current Phase 2b study aimed to evaluate the efficacy of mindfulness-based cognitive therapy for migraine (MBCT-M) to reduce migraine-related disability in people with migraine. Background: Mindfulness-based interventions represent a promising avenue to investigate effects in people with migraine. MBCT teaches mindfulness meditation and cognitive-behavioral skills and directly applies these skills to address disease-related cognitions. Methods: Participants with migraine (6-30 headache days/month) were recruited from neurology office referrals and local and online advertisements in the broader New York City area. During the 30-day baseline period, all participants completed a daily headache diary. Participants who met inclusion and exclusion criteria were randomized in a parallel design, stratified by chronic migraine status, to receive either 8 weekly individual MBCT-M sessions or 8 weeks of waitlist/treatment as usual (WL/TAU). All participants completed surveys including primary outcome evaluations at Months 0, 1, 2, and 4. All participants completed a headache diary during the 30-day posttreatment evaluation period. Primary outcomes were the change from Month 0 to Month 4 in the headache disability inventory (HDI) and the Migraine Disability Assessment (MIDAS) (total score ≥ 21 indicating severe disability); secondary outcomes (headache days/30 days, average headache attack pain intensity, and attack-level migraine-related disability [Migraine Disability Index (MIDI)]) were derived from the daily headache diary. Results: Sixty participants were randomized to receive MBCT-M (n = 31) or WL/TAU (n = 29). Participants (M age = 40.1, SD = 11.7) were predominantly White (n = 49/60; 81.7{\%}) and Non-Hispanic (N = 50/60; 83.3{\%}) women (n = 55/60; 91.7{\%}) with a graduate degree (n = 35/60; 55.0{\%}) who were working full-time (n = 38/60; 63.3{\%}). At baseline, the average HDI score (51.4, SD = 19.0) indicated a moderate level of disability and the majority of participants (50/60, 83.3{\%}) fell in the “Severe Disability” range in the MIDAS. Participants recorded an average of 16.0 (SD = 5.9) headache days/30 days, with an average headache attack pain intensity of 1.7 on a 4-point scale (SD = 0.3), indicating moderate intensity. Average levels of daily disability reported on the MIDI were 3.1/10 (SD = 1.8). For the HDI, mean scores decreased more from Month 0 to Month 4 in the MBCT-M group (−14.3) than the waitlist/treatment as an usual group (−0.2; P <.001). For the MIDAS, the group*month interaction was not significant when accounting for the divided alpha, P =.027; across all participants in both groups, the estimated proportion of participants falling in the “Severe Disability” category fell significantly from 88.3{\%} at Month 0 to 66.7{\%} at Month 4, P <.001. For diary-reported headache days/30 days an average headache attack pain intensity, neither the group*month interaction (Ps =.773 and.888, respectively) nor the time effect (Ps =.059 and.428, respectively) was significant. Mean MIDI scores decreased in the MBCT-M group (−0.6/10), whereas they increased in the waitlist/treatment as an usual group (+0.3/10), P =.007. Conclusions: MBCT-M demonstrated efficacy to reduce headache-related disability and attack-level migraine-related disability. MBCT-M is a promising emerging treatment for addressing migraine-related disability.",
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T1 - Does Mindfulness-Based Cognitive Therapy for Migraine Reduce Migraine-Related Disability in People with Episodic and Chronic Migraine? A Phase 2b Pilot Randomized Clinical Trial

AU - Seng, Elizabeth K.

AU - Singer, Alexandra B.

AU - Metts, Christopher

AU - Grinberg, Amy S.

AU - Patel, Zarine S.

AU - Marzouk, Maya

AU - Rosenberg, Lauren

AU - Day, Melissa

AU - Minen, Mia T.

AU - Lipton, Richard B.

AU - Buse, Dawn C.

PY - 2019/10/1

Y1 - 2019/10/1

N2 - Objective: The current Phase 2b study aimed to evaluate the efficacy of mindfulness-based cognitive therapy for migraine (MBCT-M) to reduce migraine-related disability in people with migraine. Background: Mindfulness-based interventions represent a promising avenue to investigate effects in people with migraine. MBCT teaches mindfulness meditation and cognitive-behavioral skills and directly applies these skills to address disease-related cognitions. Methods: Participants with migraine (6-30 headache days/month) were recruited from neurology office referrals and local and online advertisements in the broader New York City area. During the 30-day baseline period, all participants completed a daily headache diary. Participants who met inclusion and exclusion criteria were randomized in a parallel design, stratified by chronic migraine status, to receive either 8 weekly individual MBCT-M sessions or 8 weeks of waitlist/treatment as usual (WL/TAU). All participants completed surveys including primary outcome evaluations at Months 0, 1, 2, and 4. All participants completed a headache diary during the 30-day posttreatment evaluation period. Primary outcomes were the change from Month 0 to Month 4 in the headache disability inventory (HDI) and the Migraine Disability Assessment (MIDAS) (total score ≥ 21 indicating severe disability); secondary outcomes (headache days/30 days, average headache attack pain intensity, and attack-level migraine-related disability [Migraine Disability Index (MIDI)]) were derived from the daily headache diary. Results: Sixty participants were randomized to receive MBCT-M (n = 31) or WL/TAU (n = 29). Participants (M age = 40.1, SD = 11.7) were predominantly White (n = 49/60; 81.7%) and Non-Hispanic (N = 50/60; 83.3%) women (n = 55/60; 91.7%) with a graduate degree (n = 35/60; 55.0%) who were working full-time (n = 38/60; 63.3%). At baseline, the average HDI score (51.4, SD = 19.0) indicated a moderate level of disability and the majority of participants (50/60, 83.3%) fell in the “Severe Disability” range in the MIDAS. Participants recorded an average of 16.0 (SD = 5.9) headache days/30 days, with an average headache attack pain intensity of 1.7 on a 4-point scale (SD = 0.3), indicating moderate intensity. Average levels of daily disability reported on the MIDI were 3.1/10 (SD = 1.8). For the HDI, mean scores decreased more from Month 0 to Month 4 in the MBCT-M group (−14.3) than the waitlist/treatment as an usual group (−0.2; P <.001). For the MIDAS, the group*month interaction was not significant when accounting for the divided alpha, P =.027; across all participants in both groups, the estimated proportion of participants falling in the “Severe Disability” category fell significantly from 88.3% at Month 0 to 66.7% at Month 4, P <.001. For diary-reported headache days/30 days an average headache attack pain intensity, neither the group*month interaction (Ps =.773 and.888, respectively) nor the time effect (Ps =.059 and.428, respectively) was significant. Mean MIDI scores decreased in the MBCT-M group (−0.6/10), whereas they increased in the waitlist/treatment as an usual group (+0.3/10), P =.007. Conclusions: MBCT-M demonstrated efficacy to reduce headache-related disability and attack-level migraine-related disability. MBCT-M is a promising emerging treatment for addressing migraine-related disability.

AB - Objective: The current Phase 2b study aimed to evaluate the efficacy of mindfulness-based cognitive therapy for migraine (MBCT-M) to reduce migraine-related disability in people with migraine. Background: Mindfulness-based interventions represent a promising avenue to investigate effects in people with migraine. MBCT teaches mindfulness meditation and cognitive-behavioral skills and directly applies these skills to address disease-related cognitions. Methods: Participants with migraine (6-30 headache days/month) were recruited from neurology office referrals and local and online advertisements in the broader New York City area. During the 30-day baseline period, all participants completed a daily headache diary. Participants who met inclusion and exclusion criteria were randomized in a parallel design, stratified by chronic migraine status, to receive either 8 weekly individual MBCT-M sessions or 8 weeks of waitlist/treatment as usual (WL/TAU). All participants completed surveys including primary outcome evaluations at Months 0, 1, 2, and 4. All participants completed a headache diary during the 30-day posttreatment evaluation period. Primary outcomes were the change from Month 0 to Month 4 in the headache disability inventory (HDI) and the Migraine Disability Assessment (MIDAS) (total score ≥ 21 indicating severe disability); secondary outcomes (headache days/30 days, average headache attack pain intensity, and attack-level migraine-related disability [Migraine Disability Index (MIDI)]) were derived from the daily headache diary. Results: Sixty participants were randomized to receive MBCT-M (n = 31) or WL/TAU (n = 29). Participants (M age = 40.1, SD = 11.7) were predominantly White (n = 49/60; 81.7%) and Non-Hispanic (N = 50/60; 83.3%) women (n = 55/60; 91.7%) with a graduate degree (n = 35/60; 55.0%) who were working full-time (n = 38/60; 63.3%). At baseline, the average HDI score (51.4, SD = 19.0) indicated a moderate level of disability and the majority of participants (50/60, 83.3%) fell in the “Severe Disability” range in the MIDAS. Participants recorded an average of 16.0 (SD = 5.9) headache days/30 days, with an average headache attack pain intensity of 1.7 on a 4-point scale (SD = 0.3), indicating moderate intensity. Average levels of daily disability reported on the MIDI were 3.1/10 (SD = 1.8). For the HDI, mean scores decreased more from Month 0 to Month 4 in the MBCT-M group (−14.3) than the waitlist/treatment as an usual group (−0.2; P <.001). For the MIDAS, the group*month interaction was not significant when accounting for the divided alpha, P =.027; across all participants in both groups, the estimated proportion of participants falling in the “Severe Disability” category fell significantly from 88.3% at Month 0 to 66.7% at Month 4, P <.001. For diary-reported headache days/30 days an average headache attack pain intensity, neither the group*month interaction (Ps =.773 and.888, respectively) nor the time effect (Ps =.059 and.428, respectively) was significant. Mean MIDI scores decreased in the MBCT-M group (−0.6/10), whereas they increased in the waitlist/treatment as an usual group (+0.3/10), P =.007. Conclusions: MBCT-M demonstrated efficacy to reduce headache-related disability and attack-level migraine-related disability. MBCT-M is a promising emerging treatment for addressing migraine-related disability.

KW - behavioral treatment

KW - disability

KW - migraine

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KW - therapy

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