Mindfulness, an attention-control technique, can augment medical therapy for migraineurs, with stress reduction, relaxation, and shifting negative self judgement.
Even when migraine frequency can be brought under control through a variety of treatments, many patients struggle with migraine-related disability, or the negative impact that migraine has on their lives. For this, Elizabeth K. Seng, PhD, assistant professor at Yeshiva University and Albert Einstein College of Medicine in New York recommends a variety of mindfulness techniques.
“Migraine is the second specific leading cause of disability behind chronic pain,” she explains. And since migraines tend to be most prevalent in the prime of people’s lives-between their 20s and 40s-the impact on school, career, and family can be significant.
She says that mindfulness has demonstrated efficacy in improving migraine patients’ quality of life, and reducing stress (in those with and without migraine).
“Mindfulness is, at its core, an attention-control technique,” Seng says. “Mindfulness is paying attention to the present moment non-judgmentally.”
She particularly recommends it for patients who have plateaued at a certain level of disability that isn’t improving. “They may be discouraged and still have a difficult time getting to work, to school, or they worry about migraine a lot even on non-migraine days,” she says.
She finds three types of mindfulness training to be clinically useful.
Mindfulness-based stress reduction. The first form of mindfulness training is typically taught in a class format at health centers and YMCAs, she says. The teachers are not required to have any kind of clinical degree, but they do become certified in the technique.
“It’s not tailored in any way to any people. It’s just a really good introduction to mindfulness,” she says. “It has demonstrated the ability to reduce the migraine-related disability in some small groups of people with migraine.”
She recommends that physicians become familiar with where patients can take this sort of class as a resource.
Mindfulness-based cognitive therapy. The second form of mindfulness therapy requires the instructor to have a clinical background, and physicians can actually be trained in the technique if they wish. Most of the time it is taught by a psychologist or licensed counselor of some kind, she says.
This form of mindfulness combines the techniques of cognitive therapy with meditative practices and attitudes.
Acceptance and commitment therapy. The third form of mindfulness therapy also requires clinical training, and is the most intensive, Seng says, because it is teaching a life change. “They’re trying to get people to change how they look at life,” she says.
People in this program are taught pain-related acceptance, which Seng describes as “Even though I’m in pain, it’s not the worst thing that’s ever happened and I can still engage in activities that are meaningful to me.”
She clarifies it does not mean people learn to accept that they will have migraines, but rather to accept that they can get through the pain and continue living a full life.
Relaxation response. In addition to mindfulness trainings, there is a related technique known as the relaxation response, which includes parasympathetic responses to relaxation, including deep breathing, muscle relaxation, and visualizations.
“Relaxation response can work pretty quickly and people can get good at it in several weeks of practice. Whereas mindfulness takes a longer time to get good at,” Seng says.
In the long run, however, she believes the benefits of mindfulness are worth the time and practice it takes to become adept at it.
She recommends that physicians have multiple resources they can provide that offer mindfulness-style therapies. She emphasizes, too, that when a physician recommends the approach, it is important to be very clear with a patient on exactly what aspect of migraine-related health the clinician hopes the therapy may improve.
“We don’t want our patients who are already overwhelmed by their disease to become even more overwhelmed by the lifestyle changes we are asking them to do.”