PO-04 | Mindfulness-based behavioral intervention for adolescents with high-frequency primary headaches: feasibility of a prospective multicenter study

Beatrice Baldo,¹ Giulia De Lorenzi,¹ Valeria Marletta,¹ Ilaria Bonemazzi,¹ Alessia Raffagnato,² Cristina Vassia,³ Emanuela Serri,³ Antonella Versace,⁴ Daniela D’Agnano,⁴ Vittorio Sciruicchio,⁴ Licia Grazzi,⁵ Irene Toldo¹ | ¹Juvenile Headache Center, Department of Woman’s and Child’s Health, University of Padua; ²Child and Adolescent Neuropsychiatric Unit, Department of Women's and Children's Health, University of Padua; ³Pediatric Headache Center, Department of Pediatric Emergency, Regina Margherita Children's Hospital, Turin; ⁴Children Epilepsy and EEG Center, San Paolo Hospital, ASL Bari; ⁵Neuroalgology Unit and Headache Center, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy

Background: Primary headaches are common in pediatric age and can significantly impact children's quality of life especially when they have a high frequency. Best practices in headache management involve a multidisciplinary approach combining pharmacological and non-pharmacological strategies. Among the latter, psychological interventions targeting cognitive, behavioral, and emotional factors have shown efficacy in reducing migraine-related pain, distress, and disability. Mindfulness is a recent behavioral approach that offers an effective option for adolescents with headache, helping reduce pain and disability by increasing awareness and teaching techniques alternative to medications.

Methods: This is a prospective study involving patients aged 11–18 years, referred to four juvenile headache centers and meeting defined inclusion and exclusion criteria. Selected patients participated in eight weekly online 1-hour sessions of guided mindfulness-based meditation combined with education on healthy lifestyle habits to prevent or reduce the impact of headache. Follow-up assessments are scheduled at 3, 6 and 12 months, including clinical evaluations and standardized questionnaires completed by both patients and parents.

Results: Twenty-eight adolescents with frequent primary headaches (migraine or tension-type headache) were enrolled. The intervention demonstrated good feasibility with high participation and adherence rates to the weekly sessions. Only 3 participants have dropped out, with an overall adherence rate of 89.3%. No significant side effects were reported; in one case, dropout was due to increased anxiety. In preliminary analysis, patients reported a subjective impression of global improvement. We expect positive changes in standardized tests at 3, 6 and 12-months follow up.

Conclusion: This study investigated a well-tolerated, promising and feasible behavioral intervention for adolescents with high-frequency primary headaches. Our preliminary results showed high compliance and favorable disease progression in our population, demonstrating that mindfulness (made online in small groups) is a valuable and safe approach in adjunct to preventive drugs.