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Clinical Question
Is a mindfulness-based stress reduction strategy more effective than a headache-specific stress management strategy to reduce the number of migraines in adults?
Bottom line
Mindfulness-based stress reduction classes are more effective than headache-specific stress management classes to reduce the reported number of days with headaches and to increase the likelihood of having at least a 50% reduction in headache frequency. The difference, however, wanes once classes end. 1b
Reference
Study design: Randomized controlled trial (single-blinded)
Funding: Unknown/not stated
Setting: Outpatient (any)
Synopsis
The investigators recruited 98 patients from the community, primary care offices, and headache clinics. The patients were mostly women (91%), white (72%), not taking prophylaxis (85%), and had an average 7.8 days with headaches over the 28 days before randomization. These patients were randomized, using concealed allocation, to be enrolled in either mindfulness-based stress reduction classes based on the work of Jon Kabat-Zinn or stress management for headaches classes. The classes met weekly for 8 weeks, then biweekly for another 8 weeks. Reduction in headache days from baseline to the end of the study was greater for the mindfulness group (3.2 vs 1.1 fewer headache days over 28 days; P = .04). Significantly more participants also showed a 50% or greater reduction in headache days: 52% vs 23% (P = .004, number needed to treat = 3.4). The difference in effects between groups was not maintained for either outcome, however; at one year from the start of the study, rates were similar in both groups.
Reviewer
Allen F. Shaughnessy, PharmD, MMedEd
Professor of Family Medicine
Tufts University
Boston, MA
Comments
Mindfulness
Mindfulness is a great technique and works well but has to be practiced regularly. Best bet is to leave a small volume of mindfulness exercises by the bedside table and spend a few minutes each evening. Eckhard Tolle is great!
Mindfulness
Though there was no difference at one year after good early results, is there a follow up controlled study looking at repeat therapy on, say six-monthly repeats?
headaches
The problem with mindfulness is that it is not a pill. The public's expectation is for something simple. Mindfulness attacks the source of the problem. Not many want to go there. There are other spiritual approaches that work as well.