Intervention: mindfulness-based sessions
headaches, anxiety, pain, headache pain, headache, migraine, sensations
MIGRAINE, DISEASE
The sessions with patients involved mindfulness practice, and patients were trained to meditate; moreover, notions and information on acceptance of their condition and invitations to be more flexible were presented through examples and metaphors. The program consisted of 6 weekly sessions, 90 min each. Small groups of 6–8 patients were invited to sit in a quiet room. The sessions were guided by an experienced mindfulness instructor.In the first session, patients were encouraged to introduce themselves, and share information about their migraine and disease history. They were also instructed to find the right posture for starting the practice by adjusting the chair and the position of their back, legs, and feet on the floor. The Mindfulness practice was introduced in the first session: patients were invited to close their eyes and take 2–3 deep breaths. After this, they were invited to let their breath adjust to the best rhythm for that moment. The first practice session lasted 5 min, leaving patients time enough to explain their sensations and impressions. Each practice session ended with a discussion of any unpleasant sensations, if needed.From the second session onwards, a specific focus was given to mindfulness practice, with an emphasis on its value and the definition: the significance of the practice for facing pain and medication use, the importance of being more flexible, and the importance being trained in mindfulness as part of the treatment strategies for migraine. Such a practice was intended to enhance patients’ ability to recognize their internal feelings and accept them in a non-judgmental way. Acquiring such an ability should enable patients to recognize when they need headache medications and when they do not, and it thus addresses the pain-pill automatism. The mindfulness sessions increased in duration: from 5 min in the first ones, they reached 25 min towards the end of the intervention.Across the sessions, patients were trained to focus on breathing and to reduce judgments by acknowledging arising thoughts, feelings, and emotions, without any emotional reaction. Patients were instructed to gently refocus on their breathing if their attention disengaged, and trained not to change their breathing rate voluntarily.Patients were invited to notice any atypical or unpleasant feeling during the sessions and also during home practice. At the beginning of every session, patients were asked about the previous week, the symptoms they might have experienced – including both migraine-related ones and some psychological reactions they might have noticed, e.g., feelings of anxiety – and how was the therapy going on. As the practice progressed, patients were invited to try practicing at home by using a few-minute session that focused just on breathing from the third session onwards. The home practice session began with a 3-minutes duration and reached the target of 7–10 min within a few days.On the fifth and sixth sessions, the acquired knowledge was integrated and further connected to the recognition of internal sensations as they relate to headache pain and to identifying situations in which patients need to rely on drugs for managing their headaches or when they do not. In the last two sessions, the mindfulness meditations lasted 25 min. Patients were provided with a 12-minute audio file to use at any time after the structured intervention concluded. This allowed them to practice for 7–10 min, or even a little longer over the course of the 12 months’ follow-up.