A prospective pilot study of the effect on catecholamines of mindfulness training vs pharmacological prophylaxis in patients with chronic migraine and medication overuse headache

Cephalalgia. 2019 Apr;39(5):655-664. doi: 10.1177/0333102418801584. Epub 2018 Sep 13.


Aim: To address whether, in patients with chronic migraine and medication overuse headache, mindfulness-based treatment is associated with changes in plasma levels of catecholamines and elusive amines that are similar to those observed in patients undergoing pharmacological prophylaxis.

Methods: In this non-randomized, clinic-based effectiveness study, patients aged 18-65, with a history of chronic migraine ≥ 10 years and overuse of triptans or non-steroidal anti-inflammatory drugs ≥ 5 years, were enrolled. Upon completion of a structured withdrawal program, patients received either pharmacological prophylaxis or six weekly sessions of mindfulness-based treatment and were followed for 12 months. Daily headache diaries were used to record headache frequency and medication intake; catecholamines (noradrenaline, epinephrine and dopamine) and levels of elusive amines were assayed from poor platelet plasma.

Results: Complete follow-up data were available for 15 patients in the pharmacological prophylaxis-group (14 females, average age 44.1) and 14 in the mindfulness treatment-group (all females, average age 46.4), and all variables were comparable between groups at baseline. At 12 months, significant improvement ( p < .001) was found in the pharmacological prophylaxis group for headache frequency and medication intake (by 51% and 48.7%, respectively), noradrenaline, epinephrine and dopamine (by 98.7%, 120.8% and 501.9%, respectively); patients in the mindfulness treatment-group performed similarly. For elusive amines, no longitudinal changes were found.

Conclusions: The similar improvement trends observed in the two groups of patients further support the utility of mindfulness-based treatment in migraine care, and reinforce the hypothesis that alteration and normalization of tyrosine metabolism are implicated in migraine chronification and in remission of chronic migraine.

Keywords: Chronic migraine; catecholamines; generalized estimating equation (GEE) models; mindfulness; pharmacological prophylaxis.

Publication types

  • Clinical Trial

MeSH terms

  • Adult
  • Analgesics / therapeutic use*
  • Catecholamines / blood*
  • Female
  • Headache Disorders, Secondary / blood
  • Headache Disorders, Secondary / therapy*
  • Humans
  • Male
  • Middle Aged
  • Migraine Disorders / blood
  • Migraine Disorders / therapy*
  • Mindfulness*
  • Pilot Projects
  • Treatment Outcome


  • Analgesics
  • Catecholamines