Improvements in Migraine Headaches Require Active Meditation and not Cognitive Distraction
By John M. de Castro, Ph.D.
“Mindfulness is a simple, effective method for managing migraines and reducing potential triggers.” – American Migraine Foundation
Migraine headaches are a torment far beyond the suffering of a common headache. It is an intense throbbing pain usually unilateral, focused on only one side of the head and lasts from 4 hours to 3 days. They involve a collection of neurological symptoms, including visual disturbances, nausea, vomiting, dizziness, extreme sensitivity to sound, light, touch and smell, and tingling or numbness in the extremities or face. Migraines are the 8th most disabling illness in the world. While most sufferers experience attacks once or twice a month, about 4% have chronic daily headaches. Migraines are very disruptive to the sufferer’s personal and work lives as most people are unable to work or function normally when experiencing a migraine.
There is no known cure for migraine headaches. Treatments are targeted at managing the symptoms. Prescription and over-the-counter pain relievers are frequently used. There are a number of drug and drug combinations that appear to reduce the frequency of migraine attacks. These vary in effectiveness but unfortunately can have troubling side effects and some are addictive. Behaviorally, relaxation and sleep appear to help lower the frequency of migraines. Mindfulness practices have been shown to reduce stress and improve relaxation. So, they may be useful in preventing migraines. Indeed, it has been shown that mindfulness practice can reduce headache pain. It is not known how the pain relief develops over time and whether meditation benefits simply occur due to distraction from the pain.
In today’s Research News article “A reanalysis of a randomized trial on meditation for migraine headaches: Distraction is not enough but meditation takes time.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8091992/ ) Wachholtz and colleagues recruited otherwise healthy adults who experience at least 2 migraine headaches a month. They were randomly assigned to meditate for 30 minutes per day for 30 days with 1 of 3 specific phrases that was to form their meditation focus. The phrases were spiritual (e.g. God is Peace), positive self-reinforcement (e.g. I am joyful), or cognitive distraction (e.g. Grass is Green). A fourth group practiced systematic muscle relaxation over the same period. They maintained daily logs of headaches and emotions for the 30 days.
They found that over the 30-day practice period participants happiness significantly increased, while pain ratings and anger significantly decreased for all groups except the cognitive distraction group. The spiritual meditation, positive self-reinforcement meditation, and relaxation groups did not show significant improvements in headache pain over the first 20 days of practice. Significant reductions in pain occurred only during the last 10 days.
These are interesting results that replicate previous findings that mindfulness practices produce improvements in emotions , including happiness and anger, and decreases in headache pain. What is new here is the finding that these benefits require over 20 days of practice to develop. The fact that the cognitive distraction group did not decrease in anger or headache pain is important. It suggests that improvements require specific meditation focuses and that a focus on an external characteristic (e.g. Sand is Soft) is not sufficient. So, the process of meditation, sitting down and focusing for 30 minutes per day, isn’t sufficient to produce benefits. The focus during the meditation must be on spiritual, self-reinforcement, or muscle relaxation targets. The benefits are not the result of distraction from the headache pain.
So, improvements in migraine headaches require active meditation and not cognitive distraction.
“Mindfulness may be something that specifically helps people with migraines because it can teach new ways to respond to stress, which is the most commonly reported migraine trigger.” – Judy George
CMCS – Center for Mindfulness and Contemplative Studies
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Study Summary
Wachholtz, A., Vohra, R., & Metzger, A. (2019). A reanalysis of a randomized trial on meditation for migraine headaches: Distraction is not enough but meditation takes time. Complementary therapies in medicine, 46, 136–143. https://doi.org/10.1016/j.ctim.2019.08.011
Highlights
- There are many studies examining a single form of meditation, but few examine multiple meditation techniques to compare key ingredients that make a technique “successful” for patient’s pain management
- In a longitudinal assessment, we found that meditative techniques integrating active cognitive controls work better to reduce migraine frequency, severity, and negative mood compared to passive or distraction techniques
- Across active engagement meditation types, 30 minutes of daily practice for 20 days appeared necessary to reach efficacy
Abstract
OBJECTIVE:
Migraine headaches affect about approximately 15% of the population and some notable efforts have been made to develop meditation interventions to address pain and mood among this population. However, key active ingredients and the necessary duration of meditation interventions to produce an effect are still unknown. The purpose of this study is to assess key meditation ingredients that positively impact mood and headache factors across different meditation techniques and to establish an initial time or ”dose” needed to reach proactive treatment efficacy.
METHOD:
In this longitudinal study, three active management forms of meditation were compared to a cognitive distraction meditation to assess the effects on migraine headaches and emotions over a 30 day period when practiced 20 minutes per day.
RESULTS:
The active group showed significant decreases in anger (p=.005) and migraine pain (p=.002) over time. Further analysis showed that the bulk of the change for the active management group occurred in the final 10 days, after 20 days of practice of the technique (p<.05).
CONCLUSION:
This suggests that cognitively active forms of meditation are more effective in reducing migraine headache pain and negative mood than distraction techniques. However, individuals engaging in these strategies need to consistently practice these techniques for approximately 20 days to proactively reduce migraine headache pain and negative mood.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8091992/