Mindfulness and Migraine: Exploring the Daily Use of Mindfulness-Based Cognitive Therapy for Migraine

Abstract

Objective: To determine the use of mindfulness practice following mindfulness-based cognitive therapy for migraine (MBCT-M) in people with migraine. Methods: This is a mixed-methods study and secondary analysis of a parallel assignment, single blind, randomized clinical trial for MBCT-M where 60 participants with migraine were randomized to receive 8-week individual MBCT-M (n = 31) or waitlist/treatment-as-usual (WL/TAU) (n = 29). Participants completed the Five Facet Mindfulness Questionnaire (FFMQ) and Headache Disability Inventory (HDI) at baseline and Months 1, 2, and 4. Linear mixed effects models were conducted to determine changes in facets of mindfulness over time, and longitudinal mediation was used to examine the effect of changes in mindfulness on the relationship between disability and time. A total of 6 participants with episodic migraine and 6 with chronic migraine from the MBCT-M treatment group completed phenomenological interviews following participation in the parent study. Results: The 60 participants in the parent study were an average age of 40.1 (SD = 11.7), mostly female (n = 55/60, 91.7%), White (n = 49/60, 81.7%) and had a graduate degree (n = 33/60, 55.0%). Linear mixed effects models showed significant increases over time in mindfulness Total scores (P = .001), and mindfulness subscales of Observing (P < .001), and Nonreactivity to Inner Experience (P = .006) in the MBCT-M group compared to WL/TAU group. FFMQ Total scores significantly mediated changes in HDI scores over time (indirect effect B = 7.56, 95% CI = 2.36, 13.69); no FFMQ subscales mediated changes. A total of 10 themes emerged from qualitative interviews. Strengths of mindfulness included: Mindfulness Practice Provides Control, Mindfulness Improved Acceptance, Mindfulness as Acute Treatment, Mindfulness as Preventive Treatment, Increased Awareness of Emotions/Thoughts/Bodily Sensations, Mindfulness Helped Migraine Management/Problem Solving During Migraine, and MBCT-M Study Increased Accountability for Mindfulness Practice; weaknesses included: Discomfort Practicing Mindfulness, Routine Mindfulness Practice is Difficult, and Feelings of Guilt. Conclusion: Certain aspects of mindfulness change during MBCT-M treatment. All five facets of mindfulness are needed to mediate changes between migraine-related disability and time. People with migraine use mindfulness to aide in treatment decision making. Treatment for migraine should include mindful awareness.