Migraine is a common and debilitating neurological disease that is best managed with a comprehensive and multipronged treatment plan. One of the pillars of effective migraine management is lifestyle and behavioural strategies that can help prevent and treat attacks, and importantly, help individuals live well with migraine. During a webinar sponsored by Migraine Canada, Christie Tait, a nurse practitioner specialized in migraine and wellness, and Natanya Mandel, a migraine coach and mindfulness teacher, shared the latest evidence supporting the brain benefits of mindfulness and meditation and practical tips to integrate these approaches into a multipronged migraine management plan.
Defining mindfulness and meditation
Mindfulness has become a buzzword in lifestyle and behavioural strategies for chronic disease management, but it is poorly understood, and misconceptions are numerous. In a nutshell, Ms. Mandel described mindfulness as being in the present and aware of what is happening in the moment but not placing any value or judgment on thoughts. This description of mindfulness applies particularly well to migraine since it encourages non-judgmental awareness and acceptance towards thoughts, emotions, and physical sensations that can occur throughout the phases of a migraine attack.
Mindfulness is the awareness that arises when we pay attention, with intention and without judgment, to what is happening in the present moment
Whereas mindfulness can be applied anytime, meditation is a formal task that involves attention and concentration on a specific area of focus for a period of time. It is a versatile tool that can take on numerous forms, with a key principle being to adopt whatever form is kindest to one’s body at that time. Ms. Mandel remarked that it is especially important for people living with physical, neurologic, and/or painful conditions to respect and support their body’s needs in the moment.
Meditation can take on numerous forms including walking, moving, standing, lying or sitting with eyes open or closed
The science behind mindfulness and the brain
There is accumulating evidence that regular meditation and mindfulness can positively influence brain structure and function. For example, practicing regular formal meditation has been shown to increase neural activation and neuroplasticity in the insula, prefrontal and anterior cingulate cortex – brain areas that are involved in self-awareness and interoceptive experiences, attentional control, and emotion regulation.1 Studies have also demonstrated that mindfulness can improve psychological flexibility, depression and anxiety,2 which is important for dealing with the unpredictability of living with migraine. In one study that compared an 8-week mindfulness-based stress reduction (MBSR) program to headache education in 89 adults with migraine, both groups showed a significant reduction from baseline in migraine days, but the MBSR group additionally benefited from significant improvements in migraine-related disability, quality of life, self-efficacy, depression, pain catastrophizing, and a reduction in induced pain thresholds.3
Mindfulness and meditation can alter brain plasticity and neural pathways to improve psychological flexibility and reduce detrimental reactions to stress
Ms. Tait concluded that these observations suggest that mindfulness and meditation could help individuals live better with migraine by increasing acceptance, reducing anxiety, and fostering a sense of control of a condition that often feels out of control.
Practical strategies for practicing mindfulness
Mindfulness and meditation are versatile tools in the migraine toolbox that can be practiced and applied almost anytime and anywhere. This distinguishes them from medications, which are another essential tool in the migraine toolbox but that follow more rigid schedules in terms of timing and dose. Several resources are available for people who want to learn to practice meditation or incorporate mindfulness into their daily routine, including apps (e.g., Calm, BetterSleep), YouTube videos of guided meditation exercises, and formal courses that teach about the foundational skills of meditation and mindfulness. Mindfulness has also been integrated into behavioural therapies such as cognitive behaviour therapy (CBT).
There is no limit to how often mindfulness can be practiced and there are no negative side effects
Anecdotally, participants in migraine mindfulness-based chronic pain management (MBCPM) programs have described gratitude for the life-changing impact on pain, coping, and daily activities. Importantly, practitioners of MBCPM endorse a more positive outlook even when they experience bad headache episodes. Ms. Tait attributes this to improved self-efficacy, tolerance of discomfort, and sense of control, and increased awareness of early symptoms of migraine attacks that can prompt early treatment of acute episodes.
Mindfulness and meditation require time and consistent practice
Mindfulness and meditation are learned skills that take practice and Ms. Mandel and Ms. Tait advise giving these approaches at least 8 weeks to take effect. It is imperative that people with migraine have realistic expectations and recognize that meditation and mindfulness are not a ‘quick fix.’ But once practitioners start to notice the benefits, it can motivate them to continue practicing consistently.
For more information and resources, visit Ms. Tait’s website at www.structureclinic.ca and Ms. Mandel’s at www.natanyacoaching.com or follow them at @the.headache.np and @natanyacoaching.
Our correspondent’s highlights from the symposium are meant as a fair representation of the scientific content presented. The views and opinions expressed on this page do not necessarily reflect those of Lundbeck.
