Meditation practice, mindfulness and pain-related outcomes in mindfulness-based treatment for episodic migraine

ObjectivesMindfulness-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. MethodsSecondary analyses of clinical trial comparing data 12-week mindfulness-based stress reduction (MBSR+; n = 50) to stress management for headache (SMH; n = 48) were conducted. ResultsPre-treatment mesocorticolimbic system functioning (i.e., greater resting state ventromedial prefrontal cortex-right nucleus accumbens [vmPFC-rNAC] functional connectivity) positively predicted meditation practice duration over MBSR+ (r = .58, p = .001), and moderated change in headache frequency from pre to post-treatment (b = -12.60, p = .02) such that patients with greater vmPFC-rNAC connectivity showed greater reductions in headache frequency. Patients who meditated more showed greater increases in mindfulness (b = .52, p = .02) and reductions in the helplessness facet of pain catastrophizing (b = -.13, p = .01), but not headache frequency, severity or impact. Augmented mindfulness mediated reductions in headache impact resulting from MBSR+, but not headache frequency. ConclusionsMesocorticolimbic system function is implicated in motivated behavior, and thus could be a target of augmentative interventions designed to enhance meditation practice engagement. Meditation practice 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 meditation practice on pain, and continue to characterize the specific mechanisms of MBIs on headache outcomes.