Neurology, Wake Forest University School of Medicine, North Carolina, Winston-Salem, USA.
Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA.
Headache. 2023 Mar;63(3):390-409. doi: 10.1111/head.14481. Epub 2023 Feb 28.
To understand the mechanisms of mindfulness' impact on migraine.
Promising mindfulness research demonstrates potential benefit in migraine, but no data-driven model exists from the lived experiences of patients that explains the mechanisms of mindfulness in migraine.
Semi-structured qualitative interviews were conducted with adults with migraine who participated in two mindfulness-based stress reduction (MBSR) clinical trials (n = 43). Interviews were audio-recorded, transcribed, and summarized into a framework matrix with development of a master codebook. Constructivist grounded theory approach was used to identify themes/subthemes.
Participants who learned mindfulness techniques through MBSR experienced altered pain perception, altered response to migraine attacks and disease, increased awareness of external and internal experiences, improved overall well-being, and group benefits. Mindfulness resulted in earlier stress-body awareness and increased interoceptive awareness resulting in earlier attack recognition, leading to earlier and more effective management. Interictal factors of self-blame, guilt, and stigma decreased while migraine acceptance, hope, empowerment, self-efficacy, and self-compassion increased. Improved emotion regulation resulted in decreased fear of migraine, pain catastrophizing, anticipatory anxiety, and pain reactivity. Although taught as prevention, mindfulness was used both acutely and prophylactically. We created a conceptual model hypothesizing that MBSR skills led to an infusion of mindfulness in daily life, resulting in altered pain perception and experience, ultimately leading to improvement in overall well-being, which may positively feed back to the infusion of mindfulness in daily life. The therapeutic benefit of learning mindfulness in a group setting may moderate these effects.
This study identified several new potential mechanisms of mindfulness' effect on migraine. After learning MBSR skills, participants reported altered pain and migraine perception and experiences. Increased stress-body and interoceptive awareness resulted in earlier migraine awareness and treatment. Mindfulness may target important interictal factors that affect disease burden such as fear of migraine, pain catastrophizing, and anticipatory anxiety. This is the first data-driven study to help elucidate the mechanisms of mindfulness on migraine from patient voices and can help direct future research endeavors.
了解正念对偏头痛影响的作用机制。
有前景的正念研究表明，正念对偏头痛可能有益，但目前还没有从患者的实际生活经验中得出的数据驱动模型来解释正念在偏头痛中的作用机制。
对参加过两项基于正念的减压（MBSR）临床试验的偏头痛患者（n=43）进行了半结构化定性访谈。访谈内容被录音、转录，并总结成一个框架矩阵，同时开发了一个主代码本。采用建构主义扎根理论方法识别主题/子主题。
通过 MBSR 学习正念技术的参与者经历了疼痛感知的改变、对偏头痛发作和疾病的反应改变、对外界和内部体验的意识增强、整体幸福感提高和群体获益。正念导致了更早的压力-身体意识和更高的内感受意识，从而更早地识别发作，更早、更有效地进行管理。自责、内疚和耻辱感等间歇期因素减少，而偏头痛接受度、希望、赋权、自我效能感和自我同情增加。情绪调节的改善导致对偏头痛的恐惧、疼痛灾难化、预期性焦虑和疼痛反应性降低。虽然正念被教导为预防措施，但它也被用于急性和预防性治疗。我们创建了一个概念模型，假设 MBSR 技能导致日常生活中正念的融入，从而改变疼痛感知和体验，最终导致整体幸福感的提高，这可能会对日常生活中正念的融入产生积极的反馈。在小组环境中学习正念的治疗益处可能会调节这些影响。
本研究确定了正念对偏头痛影响的几个新的潜在机制。参与者在学习 MBSR 技能后报告称，疼痛和偏头痛感知及体验发生了改变。更高的压力-身体和内感受意识导致偏头痛更早被察觉和治疗。正念可能针对影响疾病负担的重要间歇期因素，如对偏头痛的恐惧、疼痛灾难化和预期性焦虑。这是第一项从患者角度出发，有助于阐明正念对偏头痛作用机制的基于数据的研究，有助于指导未来的研究工作。
