Seng Elizabeth K, Conway Alexandra B, Grinberg Amy S, Patel Zarine S, Marzouk Maya, Rosenberg Lauren, Metts Christopher, Day Melissa A, Minen Mia T, Buse Dawn C, Lipton Richard B
Ferkauf Graduate School of Psychology (EKS, ZSP, MM, LR, DCB), Yeshiva University, Bronx, New York; Saul R. Korey Department of Neurology (EKS, DCB, RBL), Albert Einstein College of Medicine, Bronx, New York; Montefiore Headache Center (EKS, RBL), Montefiore Medical Center, Bronx, New York; Center for Behavioral and Nutritional Health (ABC), Greenwich Hospital, Connecticut; Psychology Service (ASG), VA Connecticut Healthcare System, West Haven, Connecticut; Pathology and Laboratory Medicine (CM), Medical University of South Carolina, Charleston; School of Psychology (MAD), University of Queensland, Brisbane, QLD, Australia; Department of Rehabilitation Medicine (MAD), The University of Washington, Seattle; and Departments of Neurology and Population Health (MTM), New York University Langone Health, New York.
Neurol Clin Pract. 2021 Jun;11(3):194-205. doi: 10.1212/CPJ.0000000000000984.
Evaluate whether the benefits of Mindfulness-Based Cognitive Therapy for Migraine (MBCT-M) on headache disability differs among people with episodic and chronic migraine (CM).
This is a planned secondary analysis of a randomized clinical trial. After a 30-day baseline, participants were stratified by episodic (6-14 d/mo) and CM (15-30 d/mo) and randomized to 8 weekly individual sessions of MBCT-M or wait list/treatment as usual (WL/TAU). Primary outcomes (Headache Disability Inventory; Severe Migraine Disability Assessment Scale [scores ≥ 21]) were assessed at months 0, 1, 2, and 4. Mixed models for repeated measures tested moderation with fixed effects of treatment, time, CM, and all interactions. Planned subgroup analyses evaluated treatment*time in episodic and CM.
Of 60 participants (MBCT-M N = 31, WL/TAU N = 29), 52% had CM. CM moderated the effect of MBCT-M on Severe Migraine Disability Assessment Scale, (3, 205) = 3.68, = 0.013; MBCT-M vs WL/TAU reduced the proportion of people reporting severe disability to a greater extent among people with episodic migraine (-40.0% vs -14.3%) than CM (-16.4% vs +8.7%). Subgroup analysis revealed MBCT-M (vs WL/TAU) significantly reduced Headache Disability Inventory for episodic ( = 0.011) but not CM ( = 0.268).
MBCT-M is a promising treatment for reducing headache-related disability, with greater benefits in episodic than CM.
ClinicalTrials.gov Identifier: NCT02443519.
This study provides Class III evidence that MBCT-M reduces headache disability to a greater extent in people with episodic than CM.
评估基于正念的偏头痛认知疗法（MBCT-M）对发作性偏头痛和慢性偏头痛（CM）患者头痛残疾程度的益处是否存在差异。
这是一项对随机临床试验的计划二次分析。在30天的基线期后，参与者按发作性偏头痛（每月6 - 14天）和慢性偏头痛（每月15 - 30天）分层，并随机分为接受8次每周一次的MBCT-M个体治疗课程或进入等待名单/照常治疗（WL/TAU）组。在第0、1、2和4个月评估主要结局（头痛残疾量表；严重偏头痛残疾评估量表[得分≥21]）。重复测量的混合模型检验了治疗、时间、慢性偏头痛以及所有交互作用的固定效应的调节作用。计划的亚组分析评估了发作性偏头痛和慢性偏头痛中的治疗*时间。
60名参与者（MBCT-M组N = 31，WL/TAU组N = 29）中，52%患有慢性偏头痛。慢性偏头痛调节了MBCT-M对严重偏头痛残疾评估量表的影响，F(3, 205) = 3.68，P = 0.013；与WL/TAU相比，MBCT-M在发作性偏头痛患者中（-40.0%对-14.3%）比在慢性偏头痛患者中（-16.4%对+8.7%）更大程度地降低了报告严重残疾的人数比例。亚组分析显示，MBCT-M（与WL/TAU相比）显著降低了发作性偏头痛的头痛残疾量表得分（P = 0.011），但未降低慢性偏头痛的得分（P = 0.268）。
MBCT-M是一种有前景的减轻头痛相关残疾的治疗方法，对发作性偏头痛的益处大于慢性偏头痛。
ClinicalTrials.gov标识符：NCT02443519。
本研究提供了III类证据，表明MBCT-M在发作性偏头痛患者中比慢性偏头痛患者更大程度地减轻了头痛残疾。
