Mind-Body Medicine for Migraine

By: Brooklyn A. Bradley, BS; Medically edited by Dr. Deena Kuruvilla, MD

Introduction:

Today we will be discussing mind-body medicine for migraine, which is a type of complementary and integrative medicine (CIM). There are many mind-body techniques that are used for the treatment of migraine. The most researched include biofeedback, cognitive behavioral therapy (CBT), relaxation, meditation, and yoga. While these techniques may not be a replacement for mainstream medical therapy, they may be an add-on for people who want to explore an integrative approach.

Biofeedback:

Biofeedback is a mind-body technique that aims to improve both physical and mental health. During a biofeedback session, a practitioner will use equipment to measure different bodily functions. From the results, the practitioner will recommend a plan on how to create physiologic change (1). Biofeedback is a well-researched mind-body therapy for migraine, and it can also be used in people diagnosed with other chronic pain conditions, digestive issues, anxiety, depression, and insomnia (1). Temperature, muscle movement, and heart rate are measured with biofeedback. 

Biofeedback is often used as a non-pharmacological approach for people with migraine or tension type headaches. The goal is to decrease the severity, frequency, and degree of disability of chronic headaches and migraine. It has been researched that biofeedback is effective due to its role in modulating oxidative stress, a mechanism common in migraine (2). Oxidative stress occurs when the body’s supplies of antioxidants are low, which can lead to chronic inflammation. In a clinical trial studying the relationship between biofeedback and oxidative stress in people with migraine, the mean Migraine Disability Assessment Score (MIDAS) was higher before biofeedback treatment when compared to after treatment (2). The researchers also reported that there may be a connection to muscular relaxation and decreased oxidative stress when utilizing biofeedback in people with chronic migraine (2). In a study identifying the cognitive changes underlying improvements in tension headache via electromyography (EMG) biofeedback training, people receiving the high-success feedback experienced a 53% greater improvement in headache activity when compared to subjects receiving moderate success feedback (3). 

Biofeedback is a beneficial treatment in a variety of diseases. For people with migraine, biofeedback can be used in addition to mainstream medical therapy. It is important to discuss this mind-body treatment with your provider to make a custom treatment plan.

Cognitive Behavioral Therapy:

Cognitive behavioral therapy (CBT) is a psychological treatment used for a wide range of conditions, including depression, anxiety, alcohol and drug use disorders, and migraine. There are many studies that support the use of CBT for migraine, and suggest that it may improve quality of life (4). The goal of CBT is to change both the patient’s thinking and behavioral patterns to better cope with difficult situations and learn to calm one’s mind. 

In a trial studying the effects of CBT in people with refractory chronic migraine, the mean MIDAS score decreased following CBT treatment. The researchers used Hamilton depression and anxiety inventories, visual analogue scale for assessing severity of pain, and the MIDAS test in the people before and after treatment with CBT. There was a statistically significant difference in pain severity, number of migraine attacks, and disability in people with refractory chronic migraine (5). In a RCT measuring CBT for comorbid migraine and/or tension-type headache and major depressive disorder, a new CBT program was compared with routine primary care (6). The CBT treatment group improved significantly more than the control group from pre- to post-treatment for measures of headaches, depression, anxiety, and quality of life. In addition, improvements were maintained at the four month follow-up (6). 

CBT allows people to gain control of their own thoughts and modify how they react to stressful situations. By focusing on how our thoughts and behavior are connected, it can allow one to improve their response to migraine triggers. Overall, CBT is an effective mind-body therapy for migraine that can be used as a non-pharmacological intervention in addition to mainstream medicine.

Relaxation Training:

Relaxation is another type of mind-body medicine that focuses on the body’s relaxation response. This response consists of slower breathing, lower blood pressure, and a reduced heart rate (7). The main goal of relaxation training is to reduce the body’s stress response, which is often a trigger for migraine. Some of the different types of relaxation techniques include progressive muscle relaxation, autogenic training, guided imagery, biofeedback-assisted relaxation, self-hypnosis, and breathing exercises (7). These techniques are often used for individuals with pain, anxiety and depression, or migraine.

In a RCT measuring the effects of relaxation training and written emotional disclosure for tension or migraine headache, participants were randomized to either the relaxation training group, written emotional disclosure (WED) group, or neutral condition (8). Headache frequency, severity, disability, and general physical symptoms were assessed at baseline and follow-up visits. Relaxation training led to an immediate increase in calmness and improved headache frequency and disability in comparison to both the WED and control group. For migraine, relaxation training improved pain severity in comparison to the control group (8). In a RCT studying smartphone-delivered progressive muscle relaxation (PMR) for the treatment of migraine, the PMR group experienced a greater decrease in mean MIDAS scores when compared to the control group (9). This trial illustrates that a smartphone-delivered PMR may be an accessible form of therapy for migraine.

Relaxation training is an evidence-based behavioral therapy for migraine and may improve disability and frequency of headache scores in migraine. There are many benefits to practicing relaxation training, such as reducing muscle tension and stress, which are common migraine triggers.

Meditation:

Meditation is a mind-body method used to alter the mind’s capacity to control bodily function and symptoms (10). The goal of meditation is to focus attention and become mindful of various thoughts, feelings, and sensations associated with a particular condition. Meditation may allow the patient to achieve calmness, physical relaxation, and psychological balance (10). Meditation is often used for treating migraine as it may alleviate underlying stress, which is closely connected with migraine.

In a RCT measuring the effectiveness of mindfulness meditation versus headache education for people with migraine, both groups experienced decreased migraine frequency (11). The mindfulness meditation group experienced improved disability, quality of life, self-efficacy, and depression in comparison to the headache education group (11). In a study identifying the effects of different meditation types on migraine headache medication use, participants were randomly assigned to one of the four following groups: spiritual meditation, internally focused secular meditation, externally focused secular meditation, or progressive muscle relaxation (12). Migraine frequency decreased in the spiritual meditation group when compared to the other groups (12). However, headache severity ratings did not differ across the groups. Spiritual meditation did improve pain tolerance and led to reduced headache related medication usage (12). 

Meditation is known to have a generally positive effect on emotional and physical health across the world. It is often recommended in a variety of conditions, as it allows people to adapt their response to triggers. Overall, recent RCTs have identified meditation as an effective mind-body intervention for migraine (11,12).

Yoga:

Yoga is often used for the prevention and treatment of medical conditions. This mind-body technique incorporates both physical and mental aspects. Yoga has the capacity to strengthen both the body and the mind (13). Yoga incorporates breathing techniques, mindfulness, and meditation into its practice in order to achieve a strong overall well-being. There are many studies that have shown yoga can improve musculoskeletal ailments, regulate blood glucose levels, and help people with migraine (13).

In a RCT investigating the effectiveness of a holistic approach of yoga therapy for migraine treatment in comparison to self-care, headache intensity, frequency, pain rating index, emotional pain rating index, total pain rating index, anxiety and depression scores, and symptomatic medication use all experienced a significant decrease in the yoga group when compared to the self care group (14). This study illustrates that the yoga group had a significant decrease in migraine attack frequency and associated clinical features (14). In a RCT evaluating the effectiveness of yoga as an add-on to conventional medical management on clinical outcomes in people with migraine, participants were randomized to either a medical or yoga group (15). The yoga group showed a significant mean reduction in headache frequency, headache intensity, and MIDAS score in comparison to the medical therapy group. Yoga as an add-on therapy for migraine was superior to medical therapy alone (15).

Yoga is a cost-effective and safe intervention for migraine, and it may be an efficacious therapy to use in combination with traditional medical therapy. Future research should focus on the impact of yoga on the quality of life in migraine.

Conclusion:

In conclusion, mind-body medicine is an integrative treatment option for those wishing to explore non-pharmacological treatments for migraine. Not only can these therapies be used in addition to mainstream medical therapy, but also as a preventive therapy for migraine. It is vital to discuss these treatment options with your headache specialist to decide what the best treatment plan is for you.

 

 

References:

  1. Biofeedback: What Is It & Procedure Details. In: Cleveland Clinic. https://my.clevelandclinic.org/health/treatments/13354-biofeedback. Accessed 15 Aug 2022
  2. Ciancarelli I, Tozzi-Ciancarelli MG, Spacca G, et al (2007) Relationship between biofeedback and oxidative stress in patients with chronic migraine. Cephalalgia 27:1136–1141. https://doi.org/10.1111/j.1468-2982.2007.01398.x
  3. Rains JC (2008) Change Mechanisms in EMG Biofeedback Training: Cognitive Changes Underlying Improvements in Tension Headache. Headache 48:735–736. https://doi.org/10.1111/j.1526-4610.2008.01119_1.x
  4. What is Cognitive Behavioral Therapy? In: https://www.apa.org. https://www.apa.org/ptsd-guideline/patients-and-families/cognitive-behavioral. Accessed 15 Aug 2022
  5. Onur OS, Ertem DH, Karsidag C, et al (2019) An open/pilot trial of cognitive behavioral therapy in Turkish patients with refractory chronic migraine. Cogn Neurodyn 13:183–189. https://doi.org/10.1007/s11571-019-09519-y
  6. Martin PR, Aiello R, Gilson K, et al (2015) Cognitive behavior therapy for comorbid migraine and/or tension-type headache and major depressive disorder: An exploratory randomized controlled trial. Behaviour Research and Therapy 73:8–18. https://doi.org/10.1016/j.brat.2015.07.005
  7. Relaxation Techniques for Health. In: NCCIH. https://www.nccih.nih.gov/health/relaxation-techniques-what-you-need-to-know. Accessed 15 Aug 2022
  8. D’Souza PJ, Lumley MA, Kraft CA, Dooley JA (2008) Relaxation Training and Written Emotional Disclosure for Tension or Migraine Headaches: A Randomized, Controlled Trial. Ann Behav Med 36:21–32. https://doi.org/10.1007/s12160-008-9046-7
  9. Minen MT, Adhikari S, Padikkala J, et al (2020) Smartphone-Delivered Progressive Muscle Relaxation for the Treatment of Migraine in Primary Care: A Randomized Controlled Trial. Headache 60:2232–2246. https://doi.org/10.1111/head.14010
  10. Goyal M, Singh S, Sibinga EM, et al (2014) Introduction. Agency for Healthcare Research and Quality (US)
  11. Wells RE, O’Connell N, Pierce CR, et al (2021) Effectiveness of Mindfulness Meditation vs Headache Education for Adults With Migraine: A Randomized Clinical Trial. JAMA Intern Med 181:317–328. https://doi.org/10.1001/jamainternmed.2020.7090
  12. Wachholtz AB, Malone CD, Pargament KI (2017) Effect of Different Meditation Types on Migraine Headache Medication Use. Behav Med 43:1–8. https://doi.org/10.1080/08964289.2015.1024601
  13. Stephens I (2017) Medical Yoga Therapy. Children (Basel) 4:12. https://doi.org/10.3390/children4020012
  14. John PJ, Sharma N, Sharma CM, Kankane A (2007) Effectiveness of yoga therapy in the treatment of migraine without aura: a randomized controlled trial. Headache 47:654–661. https://doi.org/10.1111/j.1526-4610.2007.00789.x
  15. Kumar A, Bhatia R, Sharma G, et al (2020) Effect of yoga as add-on therapy in migraine (CONTAIN): A randomized clinical trial. Neurology 94:e2203–e2212. https://doi.org/10.1212/WNL.0000000000009473

 

Published On: August 19th, 2022