Effectiveness of mindfulness-based stress reduction as a non-drug preventive intervention in patients with migraine - a systematic review with meta-analyses

Introduction Migraine is a neurological disorder characterized by recurrent, severe headaches that are often accompanied by other symptoms. There are various factors that can be trigger a migraine in sufferers. Stress can be such a trigger. Drug and non-drug treatments are available for the preventive treatment of migraine. According to a german guideline, mindfulness can be recommended for the prophylaxis of migraine. Therefore, the aim was to investigate the effectiveness of MBSR in relation to patient-relevant outcomes in adult patients with migraine. Patient-relevant outcomes in this context are migraine frequency, headache intensity during a migraine attack, depressive symptoms and quality of life. Material and Methods The conduct of this study was guided by the PRISMA 2020 statement. A systematic literature search for randomized controlled trials of the effectiveness of MBSR in adult migraine patients was conducted in December 2021 in three databases: MEDLINE via PubMed, the Cochrane Library, and Web of Science. In addition, a review of reference lists and a search of study registries were performed. Last search was conducted on October 7, 2022. In a two-step process, studies were selected based on predefined inclusion and exclusion criteria. The potential for bias was assessed using the Cochrane Risk of Bias Tool 2. The results were summarized descriptively and by means of quantitative synthesis. Results Four RCTs with a total of 275 patients and the follow-up publication of one of these studies were included. The risk of bias in one study each was judged to be low or of some concern, and high in two studies. Four studies were included in the quantitative analysis. For the endpoint migraine frequency, the meta-analytic summary of three studies failed to show a statistically significant benefit for MBSR (SMD -0.23; 95% CI -0.79 to 0.32). For the endpoint depressive symptoms, a meta-analytic summary of three studies showed a statistically significant benefit for MBSR (SMD -0.59; 95% CI -0.93 to -0.25). No study had examined the severity of headaches during a migraine episode. Conclusion Some results suggest that migraine patients may benefit from MBSR. However, the evidence base is currently insufficient for recommendations on the use of MBSR as a non-drug treatment option. Further adequately powered, high-quality RCTs are needed.