Mindfulness & Migraine · •Mindfulness Based Cognitive Therapy (MBCT), New York (Seng, PI) • Patients with 6-30 days/mo migraine • Improvement in Headache related disability

Mindfulness & Migraine

Rebecca Erwin Wells, MD, MPH, FAHSAssociate Professor, Neurology

Founder and Director, Comprehensive Headache Program

Associate Director of Clinical Research, Center for Integrative Medicine

Wake Forest Baptist Health

@RebeccaWellsMD

https://www.google.com/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0ahUKEwj_xY6Q1v_LAhWMRiYKHUClCtEQjRwIBw&url=https://play.google.com/store/apps/details?id%3Dcom.twitter.android&psig=AFQjCNG9ArJkNJNTi6c0hy_6DnQtHZsuUA&ust=1460226584956420

Objectives

• Define mindfulness meditation

• Evaluate evidence for mindfulness in migraine

• Explore the idea of mindfulness and how you may be able to incorporate into your life

Disclosures

• Nothing to report

What is Mindfulness?

The act of paying full attention

to whatever is happening in our

present moments with qualities of

• Openness

• Non-judgment &

• Curiosity

Awareness

Mindfulness

AcceptancePresent Moment

http://www.google.com/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0ahUKEwiZ96jk0enOAhVKMyYKHQbzDMwQjRwIBw&url=http://blog.networklocum.com/2015/04/09/the-power-of-mindfulness-for-patients-and-for-you/&bvm=bv.131286987,d.eWE&psig=AFQjCNEgr1OSyPVaB1SznCjRrOACqFUVTQ&ust=1472663655858696

Mindfulness Meditation• Secular contemplative practice

• Cultivate attention & awareness

https://www.google.com/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0ahUKEwjGi4-wuOnOAhUJYiYKHVi0BM0QjRwIBw&url=https://sites.google.com/a/hcsd.k12.ca.us/medvitz/class-1/mindfulness&psig=AFQjCNFLnH-L5ntYIoeRmu1HFAuqJXyefA&ust=1472656794362650

http://aescoladossentimentos.blogspot.com.es/2016/03/10-actividades-de-mindfulness-para-nins.html

React

Historical Perspective

• Long historical roots (religious)

• Stress Reduction Clinic 1979

• Research

• Media

https://www.google.com/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0ahUKEwjp7be3v-nOAhXHJiYKHf_xACIQjRwIBw&url=https://en.wikipedia.org/wiki/The_Relaxation_Response&psig=AFQjCNExH5z5e7s6Uh4CZiMHF4hBKmMR8A&ust=1472658726138000

http://www.google.com/url?sa=i&rct=j&q=&source=imgres&cd=&cad=rja&uact=8&ved=0ahUKEwj3vfXBv-nOAhUCSyYKHeHwA_EQjRwIBw&url=https://tantor.com/author/herbert-benson.html&psig=AFQjCNHGSxWtAewLrU-XRi-cMzMp6Gha-A&ust=1472658756616546

http://www.google.com/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0ahUKEwi-_MDtv-nOAhWGbiYKHZWNAs0QjRwIBw&url=http://www.soulselfhelp.on.ca/jonkabatzinnbooks.html&bvm=bv.131286987,d.eWE&psig=AFQjCNEAQTDjjcemeqVHnowL6J6bi_hNow&ust=1472658834033946

http://www.google.com/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0ahUKEwjahInTv-nOAhXDRyYKHfohDMUQjRwIBw&url=http://www.umassmed.edu/cfm/about-us/people/2-meet-our-faculty/kabat-zinn-profile/&psig=AFQjCNHB15mZ6KnCiFiWAdtUruIgdSMIwA&ust=1472658784958961

Mindfulness-Based Stress Reduction (MBSR)

• Standardized 8 weekly 2 hr classes + home

• Body scan, sitting meditation, yoga, mindfulness

• Teaches:• Focus on present moment

• Practice without judgment

Mindfulness Meditation--Beyond Relaxation

• Attention regulation

• Body awareness

• Emotion regulation

• Non-reactivity

• Meta-cognition

Kabat-Zinn 1982; Zeidan 2011; Goldin 2010; Farb 2012;

Hoge 2013; Kerr 2013; Creswell 2014.

http://calgarylifelonglearners.ca/wp-content/uploads/2014/08/mindfulness.jpg

http://www.google.com/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0ahUKEwi5-pKgtenOAhXH6SYKHeqBAs4QjRwIBw&url=http://www.huffingtonpost.com/joanna-piacenza/time-mindfulness-revolution_b_4687696.html&psig=AFQjCNEk9JRT2XiW9JznWJxpNlmcXtJGnw&ust=1472655992438156

http://www.google.com/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&ved=0ahUKEwiHh_y41OnOAhWDKCYKHX3UA8sQjRwIBw&url=http://www.mindful.org/magazine/&bvm=bv.131286987,d.eWE&psig=AFQjCNHzp4VEL6QncTWMY0kcRh-ekzXDhw&ust=1472664367491320

http://www.google.com/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0ahUKEwiAgNWtw-nOAhVOxCYKHcoKCcwQjRwIBw&url=http://www.oprah.com/own/first-look-deepak-chopras-21-day-meditation-challenge-video&bvm=bv.131286987,d.eWE&psig=AFQjCNH-IRmd0Pt44oNeNLaWa7EzgXsQ1w&ust=1472659760582313

http://www.google.com/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0ahUKEwjb6oWYwOnOAhXGQCYKHafeAsoQjRwIBw&url=http://www.yogalifestyle.com/CDSTAWMeditationforOptimumHealth.htm&bvm=bv.131286987,d.eWE&psig=AFQjCNG9Dy1xrY5d1yNn15cpfYwkvYuCeQ&ust=1472658930197425

http://www.google.com/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0ahUKEwiopZKZtunOAhVGSCYKHU9gDMwQjRwIBw&url=http://www.nalandainstitute.org/announce/f14-davidsonLecture.html&psig=AFQjCNHk9KXzhXQey984pCz0mP2I_2GEfA&ust=1472656234934251

http://www.google.com/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0ahUKEwjcoJy41unOAhWD2yYKHSOZA7MQjRwIBw&url=http://www.nbcnews.com/id/16842848/ns/technology_and_science-science/t/scientists-bridging-spirituality-gap/&psig=AFQjCNGxqVUrTw9_hj_8rbj4oVh3Vgn6dQ&ust=1472664899793325

Number of Media Articles Relative to Meditation Published by Year:“Mind the Hype”

Scientific Articles

- - - - - - News Media Articles

Van Dam NT et al: Perspectives on Psychological Science 2018.

• MBSR for adults with episodic migraine (4-14 migraine/mo)

• No drop-outs, no adverse events, daily home practice 34 +/- 11 minutes

• Although underpowered, migraines were:

• Less frequent by 1.4/mo d=0.32

• Less severe (0-10) by 1.3 d=0.61

• Shorter by 3 hrs* d=0.75

• Lower Disability scores*

• MIDAS -13 d=1.37

• HIT-6 -5 d=0.91

• Self efficacy and mindfulness improved* (d=0.8)

• ↓Emotional reactivity, ↓ pain catastrophizing, ↑ pain acceptance

Headache, 2014 Oct;54(9):1484-95

*Statistically significant

Potential Mechanisms• Non-reactive approach to life stressors

• Decreases emotional reactivity

• Decreases affective response to stress

• Practice non-judgmental awareness of sensory events• Detached observation of sensory experiences (pain)

• Reducing affective>sensory component of pain

Wells & Loder, Headache 2012.

Stress Reduction for Migraine Study

Impressions

(number of times post

displayed)

Views/Reach

Engagement

(likes, reactions, shares,

comments)

Clicks

TOTAL 1,073,559 463,946 2,128 1648

99,100

Views 96,900 Views

Significant Provider

Referrals• >1700 online provider

referrals (EMR)

• 133 Direct provider referrals

Wells et al, Headache 2018. Presented at 60th Annual Scientific Meeting American

Headache Society, June 28-July 1, 2018, San Francisco, CA, oral presentation.

Multitude of Studies: Mindfulness in Migraine• Studies conducted: US, Italy, Germany, Iran, Australia

• Cross-cultural interest, applicability

• Mindfulness Based Cognitive Therapy (MBCT), New York (Seng, PI)• Patients with 6-30 days/mo migraine• Improvement in Headache related disability

• Mindfulness for Chronic Migraine-Medication Overuse HA, Italy (Grazzi, PI)• Choice: medication or mindfulness• Both groups: improvement in HA frequency, disability

• Enhanced MBSR vs. stress management, Maryland (Seminowicz, PI)• Decreased HA frequency, disability• MRI evaluation: improvement in cognitive efficiency

Be on the Lookout: The Next 5 Years

• AAN Guidelines: Complimentary and Integrative Medicine-Migraine

PI Intervention Control Population Sample Size

Key Outcomes Location Status

Wells MBSR HA education

Migraine 4-20/mo

91 • HA frequency• HA disability• QST

NC Analyses

Pressman MBSR Usual care Migraine 4-14/mo

66 • Recruitment Adherence CA Analyses

D’Amico Mindfulness Med CM-MOH 170 • HA frequency• fMRI• Cost-efficacy

Italy Recruiting

Napadow Stress Rx VNS Migraine 120 • MRI• PET

MA Not yet Recruiting

https://www.google.com/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=2ahUKEwiW0bf43eXmAhVFhOAKHXlBBQsQjRx6BAgBEAQ&url=https%3A%2F%2Fwww.business2community.com%2Fsales-management%2Fon-the-lookout-for-leads-try-these-5-ideas-0397924&psig=AOvVaw1Zxsx1tJa5GyTl1uktURUF&ust=1578082589859319

https://www.google.com/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=2ahUKEwiW0bf43eXmAhVFhOAKHXlBBQsQjRx6BAgBEAQ&url=https%3A%2F%2Fwww.business2community.com%2Fsales-management%2Fon-the-lookout-for-leads-try-these-5-ideas-0397924&psig=AOvVaw1Zxsx1tJa5GyTl1uktURUF&ust=1578082589859319

Mindfulness During COVID• Headache physicians leading mindfulness sessions for patients

• Virtual mindfulness session available anytime (with brief pre/post survey)• If interested, email: [email protected]

• Live virtual sessions continue• Available for patients/providers, contact if interested

• [email protected]

Licia Grazzi, MD

Milano, Italy

[email protected]

Rebecca Erwin Wells, MD, MPH, FAHS

Winston-Salem, NC

[email protected]

A Mindful Moment

http://www.google.com/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0ahUKEwiY-p-fx-nOAhVFSCYKHdC5ABoQjRwIBw&url=http://blog.mentallycharged.com/mindfulness-5-reasons-how-itll-improve-your-game/&psig=AFQjCNEQhJNZ67PpK8DqEsLWi_TlZEzHVQ&ust=1472660820933633

http://www.google.com/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0ahUKEwiY-p-fx-nOAhVFSCYKHdC5ABoQjRwIBw&url=http://blog.mentallycharged.com/mindfulness-5-reasons-how-itll-improve-your-game/&psig=AFQjCNEQhJNZ67PpK8DqEsLWi_TlZEzHVQ&ust=1472660820933633

How to Learn More: Books (Ideas, NOT Endorsements)

https://www.amazon.com/Enlightenment-Changes-Your-Brain-Transformation/dp/1594633452/ref=sr_1_1?ie=UTF8&qid=1472578571&sr=8-1&keywords=How+Enlightenment+Changes+your+brain

http://www.google.com/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0ahUKEwiAvNzs0-nOAhVKQSYKHdLFCeIQjRwIBw&url=http://www.soundstrue.com/store/the-mindful-brain-4144.html&bvm=bv.131286987,d.eWE&psig=AFQjCNG8Mgu-VGJqbdPRJ272TV8fMeFPMw&ust=1472664207673162

http://www.google.com/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0ahUKEwiipM750-nOAhWLKCYKHRU7BcUQjRwIBw&url=http://www.sharonsalzberg.com/real-happiness-the-power-of-meditation/&psig=AFQjCNGMGuc0MScydATrACsbu86hra37YA&ust=1472664238789297

http://www.google.com/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0ahUKEwjbjN-I1OnOAhVDRSYKHSnZB8oQjRwIBw&url=http://www.topsixlist.com/2014/09/29/6-best-books-meditation-for-beginners/&bvm=bv.131286987,d.eWE&psig=AFQjCNFo9Im9sCk7mhNuudY9y92APmpW6A&ust=1472664264132168

https://www.google.com/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0ahUKEwjDnMCb1OnOAhXQdSYKHd8WCMgQjRwIBw&url=https://www.amazon.com/Thich-Nhat-Hanh/e/B000AP5YRY&bvm=bv.131286987,d.eWE&psig=AFQjCNEQ_L1W6rXexEuai_Eu0OQNVEJMEg&ust=1472664309051545

How to Learn More: Retreats (Ideas, NOT endorsements)

https://www.google.com/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0ahUKEwitoKbD3OnOAhWKNiYKHbvSCskQjRwIBw&url=https://en.wikipedia.org/wiki/Mind_and_Life_Institute&psig=AFQjCNFEQLAP-V6EvNh0aeakpNRFPp1_ng&ust=1472666541637527

https://www.dharma.org/

https://www.google.com/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0ahUKEwiowt_z3OnOAhUD0iYKHevDAIIQjRwIBw&url=https://secured.sirvoy.com/engine/html/56083c1b5adf0.html&psig=AFQjCNGiv4FwVWpiY1frIzNKyvpRxp4l1A&ust=1472666637320983

http://www.jeanhaner.com/2016-clear-home-clear-heart-retreat-omega-institute/

https://www.google.com/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0ahUKEwi72sfz3enOAhVJJiYKHU7WCsYQjRwIBw&url=https://www.glassdoor.com/Overview/Working-at-Spirit-Rock-Meditation-Center-EI_IE459208.11,40.htm&psig=AFQjCNFopRE9jl3ED4cWZd-ONWuLmB3GEA&ust=1472666907885733

https://www.google.com/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0ahUKEwiY65G23unOAhUD3SYKHfpMDckQjRwIBw&url=https://kripalu.org/&psig=AFQjCNFhmpVKEER2_ZXrBwNgO_6AdHXRTA&ust=1472667048804112

http://www.google.com/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0ahUKEwjYt6eR3unOAhXJ5CYKHZQ1D_AQjRwIBw&url=http://www.fleetwoodonsite.com/index.php?cPath%3D388&psig=AFQjCNHY4Bj0NF4HeCSNB1597nNwafPhHg&ust=1472666968768760

How to Learn More: YouTube/Websites (Ideas, NOT endorsements)

• Wisdom 2.0

• Dr. Kristen Neff, Self-Compassion

• UCLA Mindful Awareness Research Center

• Osmosis

• UC Berkeley Mindful Breathing, Greater Good Science Center

• Heart Alchemy Yoga

• The Chopra Well

• UC San Diego Health

• Angel Souls

• Dr. Karthik Ramanan

• Psychocongress.com

How to Learn More: Apps (Ideas, NOT endorsements)

https://www.google.com/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0ahUKEwjO_I-z4-nOAhWMNiYKHdLDD8QQjRwIBw&url=https://www.amazon.co.uk/Spotlight-Six-Software-LLC-Insight/dp/B006HL9G10&psig=AFQjCNHpNJXMfQkyF5WnbZ4TIqgI3uWRNA&ust=1472668384069375

https://www.google.com/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0ahUKEwizteTk3unOAhVMOiYKHYZlBM0QjRwIBw&url=https://play.google.com/store/apps/details?id%3Dcom.calm.android&psig=AFQjCNEbUU16Ohlf1UEXRR6_MB5ooRgrfA&ust=1472667138889681

http://www.google.com/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0ahUKEwiZxseE4unOAhVG7SYKHXAvCMoQjRwIBw&url=http://www.stopbreathethink.org/press.html&psig=AFQjCNH1mg2G51qyXHs4w68gO-cnImhpNQ&ust=1472667883535971

https://www.google.com/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0ahUKEwi46M6-vOrOAhXE7yYKHVR6A94QjRwIBw&url=https://twitter.com/meditationsapp/status/677978196969525249&psig=AFQjCNHhZ1y5rbTicaCVCfVUOkQg-W2lvA&ust=1472692299504672

http://itunes.apple.com/ca/app/the-mindfulness-training-app/id687853790?mt=8

Research Support• NIH National Center For Complementary &

Integrative Health (NCCIH) K23AT008406

• American Pain Society Sharon S. Keller Chronic Pain Research Grant

• National Research Service Award T32AT000051 from NCCAM at the NIH

• 2011 American Headache Society Fellowship Award

• National Institutes of Health (NIH) Loan Repayment Program

Acknowledgements

Special Thanks to:

• Claudia Nielson, Steve Thomas, the Creative Communications

Design Team & Sarah Diamont from Marketing

• Zeidan Lab: Brain Mechanisms of Pain and Health

• CTSI, Research Coordinator Pool, CRU

• Referring Providers

• Charles Pierce

• Carolyn Hedrick

• Imani Randolph

• Rosalia Arnolda

• Geena George

• Obiageli Nwamu

• Grace Posey

• Nicholas Contillo

• Easton Howard

• Paige Brabant

• Vinish Kumar

• Caitlyn Margol

• Mariam Shakir

• Flora Chang

• Danika Berman

• Jason Collier

• Hudaisa Fatima

• Nicole Rojas

• Ann McCarty

• Camden Nelson

• Carson DeLong

• Anissa Berger

• Summer Beeghly

• Reid Anderson

• Megan Irby

• Lauren Strauss

• Fadel Zeidan

• Elizabeth Loder

• Tim Houle

• Don Penzien

• Jaime Speiser

• Nate O’Connell

http://www.google.com/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0ahUKEwiJ-d23yIXNAhVHQyYKHWz1CNYQjRwIBw&url=http://www.wakehealth.edu/Faculty/Penzien-Donald-Baird.htm&psig=AFQjCNF0E76eNMACIrhLHKzMA14o-ICauQ&ust=1464827119218880

http://www.google.com/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0ahUKEwj9p5_fyIXNAhXKKyYKHaesDXAQjRwIBw&url=http://www.wakehealth.edu/Neurosciences/Researchers-Probing-Potential-Power-of-Meditation-as-Therapy.htm&bvm=bv.123325700,d.cWw&psig=AFQjCNEyObQ2NuMvyirWb_fBEPbWdlWuGw&ust=1464827201516402

Documents

Mindfulness & Migraine · •Mindfulness Based Cognitive Therapy (MBCT), New York (Seng, PI) • Patients with 6-30 days/mo migraine • Improvement in Headache related disability