Polk Ashley N, Smitherman Todd A
Department of Psychology, University of Mississippi, Oxford, Mississippi, USA.
VA Salt Lake City Health Care System, Salt Lake City, Utah, USA.
Headache. 2023 Oct;63(9):1271-1284. doi: 10.1111/head.14614. Epub 2023 Aug 27.
To determine the efficacy of acceptance and mindfulness-based interventions on migraine disability, medication use, and attack frequency.
Acceptance-based approaches to headache management are those in which individuals learn to mitigate the influence of pain-related experiences on their general functioning without controlling pain itself. Treatment approaches include acceptance and commitment therapy (ACT) and mindfulness-based practices. Both have shown promise in improving broad functioning and disability among individuals with headache. Despite a growing body of research examining acceptance-based interventions for headache broadly and migraine specifically, no meta-analytic review of ACT interventions for headache exists, and two meta-analytic reviews of mindfulness-based practices yielded conflicting results.
The present study aimed to systematically and quantitatively review the literature related to the efficacy of acceptance-based interventions among adults with migraine. A multi-database search (PubMed/MEDLINE, Scopus, PsycINFO, and the Cochrane Central Register of Controlled Trials) identified clinical trials among individuals with migraine that compared structured ACT or mindfulness-based interventions to control treatment. Random-effects meta-analyses were performed using RevMan 5.4 meta-analytic software, and standardized mean differences (SMD) with 95% confidence intervals (CIs) quantified effect sizes on outcomes of disability, medication use, and headache frequency. Heterogeneity was quantified via I index and explored via subgroup analyses.
Acceptance-based interventions yielded significant improvements in disability (SMD = -0.38, 95% CI = -0.56 to -0.20; I = 25%, p = 0.20) but not in medication use (SMD = -0.25, 95% CI: -0.57 to 0.06; I = 0%, p = 0.82) or headache frequency (SMD = -0.16, 95% CI = -0.37 to 0.05; I = 0%, p = 0.73).
Results suggest that acceptance-based interventions are effective in improving disability among adults with migraine and are a viable non-pharmacological treatment option, in addition to well-established behavioral migraine management approaches, for patients seeking functional improvement.
确定基于接纳和正念的干预措施对偏头痛残疾、药物使用及发作频率的疗效。
基于接纳的头痛管理方法是指个体学会减轻疼痛相关经历对其总体功能的影响，而不直接控制疼痛本身。治疗方法包括接纳与承诺疗法（ACT）和基于正念的练习。两者在改善头痛患者的广泛功能和残疾状况方面均显示出前景。尽管越来越多的研究广泛地考察了基于接纳的头痛干预措施，特别是针对偏头痛的干预措施，但尚无对ACT头痛干预措施的荟萃分析综述，且两项基于正念练习的荟萃分析综述得出了相互矛盾的结果。
本研究旨在系统地、定量地回顾与基于接纳的干预措施对成年偏头痛患者疗效相关的文献。通过多数据库检索（PubMed/MEDLINE、Scopus、PsycINFO和Cochrane对照试验中央注册库），识别出偏头痛患者中比较结构化ACT或基于正念的干预措施与对照治疗的临床试验。使用RevMan 5.4荟萃分析软件进行随机效应荟萃分析，并采用标准化均数差值（SMD）及95%置信区间（CI）对残疾、药物使用和头痛频率等结局的效应量进行量化。通过I指数对异质性进行量化，并通过亚组分析进行探究。
基于接纳的干预措施在改善残疾方面有显著效果（SMD = -0.38，95% CI = -0.56至 -0.20；I = 25%，p = 0.20），但在药物使用方面（SMD = -0.25，95% CI：-0.57至0.06；I = 0%，p = 0.82）或头痛频率方面（SMD = -0.16，95% CI = -0.37至0.05；I = 0%，p = 0.73）无显著效果。
结果表明，基于接纳的干预措施在改善成年偏头痛患者的残疾状况方面是有效的，并且对于寻求功能改善的患者来说，除了成熟的行为性偏头痛管理方法外，它是一种可行的非药物治疗选择。
