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In the West, the use of the methods of alternative medicine,
including meditation, has been on the rise. In the US, Kabat-Zinn
and associates have pioneered the extensive use of mindfulness
meditation (MM) for the treatment of people facing pain and
illness. Among the essentials of MM is the observation of
bodily sensations, including pain. In Taiwan, despite the
deep cultural roots of meditation, its therapeutic use has
received little attention from institutionalized medicine.
We report on the case of a man who was prone to developing
severe headaches due to activities requiring extreme concentration.
He learned to control his pain and discomfort through mindfulness
meditation, although this practice in fact induced headaches
initially. It is suggested that training in MM may be a medically
superior and cost-effective alternative to pain medication
for the control of headaches with no underlying organic causes
in highly motivated patients. (Chang Gung Med J 2002;25:538-41)
Key words: meditation, mindfulness meditation, headache.
Over the past two decades, "alternative" methods
have gained increasing acceptance in medical practice, especially
in the West.(1) Among others, the practice of mindfulness
meditation, as pioneered and developed by Jon Kabat-Zinn,(2)
"has expanded beyond its traditional religious and spiritual
contexts, to become the foundation of some medical interventions,"
including the relief of headaches and other kinds of pain.(3,4)
Kabat-Zinn and his associates describe meditation as "the
intentional self-regulation of attention. It enhances concentration
and awareness as an individual focuses systematically and
intentionally on particular aspects of his inner or outer
experience." The so-called concentrative meditation emphasizes
"one-pointedness of attention," whereas mindfulness
meditation (MM) practices, the topic of this report, "start
from a degree of one-pointedness and then expand the field
of awareness to include a range of objects of attention as
they change from moment to moment in the field of awareness."(2,3)
The objects in question include both thoughts and bodily sensations,
such as pain. Mindfulness meditation practices can be classified
by the practitioner's concomitant state or activity, such
as sitting meditation, or walking meditation. Meditation is
performed initially with an instructor/ therapist, and then
is continued by the patient alone.(4) We report on the successful
use of MM training in the case of a man who was prone to develop
severe, recurring headaches due to intense concentration.
CASE REPORT
Our report is unusual, in that it does not concern deliberate
treatment of a medical condition. Instead, it involves the
fortuitous discovery of a remedy. In October 1998, the subject,
a man aged 30 years, enrolled in a class of MM, being introduced
first to walking meditation and next to sitting meditation.
The first session of sitting meditation brought on a severe
headache, more painful than any that he had ever experienced
before, with neck stiffness and a feeling of his "head
about to crack". However, acting upon the instructions
he had been given, to observe all bodily phenomena that occurred
during meditation, he continued to meditate and observed his
pain until it disappeared. In continued consultation with
his MM instructor, he mastered the ability to consistently
control his headaches within 1 week. In a typical session,
the headache would appear about 10 min into the sitting meditation,
but would disappear after an additional 15 min of observation.
As it turned out, the subject had suffered from an early age
with severe headaches, brought on by similar circumstances.
At age 11, he had developed an avid interest in Qigong,(5)
which he studied with the help of printed materials, and practiced
15-20 times a month for brief periods of 5-10 min. Qigong
involves concentration on the flow of energy within the body.
The specific form practiced by the subject resembled sitting
MM, but involved an attempt to guide the flow of energy, rather
than merely observing it. On one occasion, at age 13, he felt
a sensation of heat that traveled from his back to his head,
triggering feelings of anxiety and a severe headache with
numbness of the scalp ("a feeling of 'ants crawling'
"), "head-fullness," and dizziness. He suffered
no nausea, vomiting, or blurred vision. Thereafter, for about
8 years, each attempt to practice Qigong would bring on a
debilitating headache.
Because of the headaches, he reduced the frequency of his
attempts to 1 or 2 per month, between the ages of 13 and 20.
Sensing a headache, the subject would stop Qigong and try
to shift his attention to other objects until the headache
passed. The pain would persist for several hours and even
days, during which time he was unable to study and had to
lie down, or even required prolonged bed rest. Starting at
age 20, and for 10 years thereafter, the subject stopped practicing
Qigong, and his severe headaches disappeared.
At this point, it is important to note that the subject was
a long-practicing physician. As such, in retrospective reporting
(history taking), he characterized his headaches as measuring
6-7/10 on the Visual Analog Scale (VAS), a patient's subjective,
numerical assessment of pain intensity. In addition, he was
in a position to know that he had never suffered from hypertension,
diabetes mellitus, heart disease, epilepsy, or head injury,
or any other physical condition that could be related to his
headaches. He had never abused drugs or alcohol and did not
smoke. At no time did he take pain medication to control his
headaches. As for the headaches caused by MM, the subject
estimated them as measuring 8/10 on the VAS.
Following his MM training period, the subject practiced MM
2-3 times a week, for about 2 years, but at age 32 he began
to work with a master-instructor of Qigong, and shifted his
emphasis once more to this practice, while remaining aware
of the risk of inducing headaches. However, whenever he felt
a headache coming on, he would call upon his MM expertise
to control it. Above all, he felt psychologically secure in
his ability to overcome his headaches whenever necessary.
In the subject's own words: "While observing the change
in my headache, I understood how physical sensations could
be modified and controlled by mental means. When I feared
a headache and tried to avoid it, I was actually bound more
tightly to the pain. But when I put aside my anxious feelings,
my pain and discomfort grew less. This experience helped me
to understand my body more deeply, and to sense its innate
ability to adjust and recover; and it gave me a stronger feeling
of controlling my body."
DISCUSSION
Based on the classification of headaches by the International
Headache Society, our subject suffered from tension-type headaches,
which some researchers believe to be biologically indistinguishable
from migraines.(6) In the past 2 decades, Jon Kabat-Zinn and
associates in the US successfully used MM for the relief of
pain, including headaches.(2,7,8) For example, among participants
in a 10-week training program, 65% showed pain reduction of
greater than 33%, and 50% showed reduction of greater than
50%.(7) In such patients, drug utilization decreased, while
activity levels and feelings of self-esteem increased.(8)
In individual cases, improvements were very dramatic. For
example, Kabat-Zinn reported on a woman with a 20-year history
of migraines who achieved remarkable relief within 2 weeks'
practice. She had not been helped by repeated visits to headache
clinics or by daily use of cafergot.(2)
In Taiwan, despite the fact that meditation practices are
deeply embedded in traditional culture, they have not found
a place in institutionalized medicine. A Chinese literature
search engine for the period 1970-2001, using the key word
meditation, and a Medline search for 1966-2001, using the
key words meditation and Taiwan, found very few scientific
references, none of which involved headaches.(9,10) In this
report, we wish to call attention to the potential of MM for
the non-pharmacological relief of headaches not associated
with organic causes.
Admittedly, the subject of this report is not a typical patient.
As we noted, he did not seek MM training in order to treat
a medical condition, and the benefits he experienced were
fortuitous. Moreover, he was highly motivated, a fast learner,
and very open to exploring meditation practices. Conventional
non-steroid anti-inflammatory headache medications are not
considered curative treatments and can have various side effects,
including damage to organs such as the stomach, intestines,
liver, and kidney. We suggest that physicians consider offering
MM training as an alternative to suitable headache patients.
In our experience, training involves an initial 2-h session
of instruction and practice, followed by several return visits
to discuss individual problems. Understandably, motivation
and readiness to comply with the MM regimen are essential
to success. The cost-effectiveness of meditation training
is also an important factor.(11) Once learned, the practice
involves no financial expense to the patient or to a "third-party"
payer (e.g., Taiwan's Health Insurance Bureau). We also venture
to suggest the fact that this subject was professionally qualified
to evaluate the significance of his own case adds weight to
our argument. In fact, we believe that MM skills might also
be applied to the control of other pain problems, as well
as anxiety.(10)
Acknowledgments
We thank Abraham A. Held, PhD, Professor Emeritus of Biological
Sciences, The City University of New York, for editing the
English translation.
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