Mindfulness as an add-on treatment for patients with chronic migraine and medication overuse: a preliminary analysis
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Mindfulness as an add-on treatment for patients with chronic migraine and medication overuse: a preliminary analysis Emanuela Sansone 1 & Licia Grazzi 2 & Alberto Raggi 1 & Matilde Leonardi 1 & Domenico D’Amico 2
# Fondazione Società Italiana di Neurologia 2020
Chronic migraine (CM) is a disabling condition diagnosed when headache episodes occur more than 15 days/month for more than 3 months, and is often associated to medication overuse headache (MOH), i.e. more than 15 intakes/month of nonsteroidal anti-inflammatory drugs (NSAIDs) or more than 10 intakes/month for the other compounds for three consecutive months. MOH has been hypothesized to be one of the chief factors contributing to migraine chronification and it further complicates CM making it particularly difficult to manage. Persons suffering from CM-MOH carry multiple burdens, where personal suffering is accompanied by reduced quality of life, decreased ability to participate in daily work or family activities, and other psychological and social problems. Therefore, it is necessary that the management of CM-MOH combines multiple dimensions. Withdrawal from overused medications represents a first important step as it promotes a basic reset, and it has to be followed by a pharmacological prophylaxis. Such an approach results in a 30–40% reduction in the frequency of headache at 12 months, and 40–50% of patients show a reduction in the frequency of headache ≥ 50%, but about 30% of patients relapse into CM, with or without MOH [1]. The joint use of pharmacological and non-pharmacological techniques has been shown to improve the health status of patients with migraine and to enhance clinical outcomes by teaching and reinforcing patients to implement alternative procedures for coping with headache attacks. In recent years, various types of non-pharmacological treatments such as relaxation techniques, cognitive behavioural therapies, and
* Emanuela Sansone [email protected] 1
Neurology, Public Health and Disability Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, 20133 Milan, Italy
2
Headache and Neuroalgology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, 20133 Milan, Italy
mindfulness have given encouraging results [2, 3]. Mindfulness helps patients to better manage their pain, by avoiding excessive use of medications and by increasing awareness of their inner states and of headache-related pain. This technique promotes an increase in self-efficacy thanks to the discovery of one’s personal skills and increases the internal locus of control. The importance of mindfulness also lies in allowing patients to live with their pain and to fully experience and accept their own present experience in a flexible and nonjudgmental way. In our first investigation on use of mindfulness in patients with CM-MOH, in which two groups (one receiving pharmacological prophylaxis only, and one receiving 6 weekly sessions of guided mindfulness-based training only) were followed up for 12 mon
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