WHAT Music-based interventions in patients with chronic migraine refractory to pharmacological treatment.
WHO This previously published study is part of a Final Degree and Master’s Project in Medicine at the Complutense University of Madrid. It was carried out by the students Jaime Alonso Maroto and Luis Alberto Nieto, with Dr. Jesús Hernández Gallego, head of the Neurology Department at Hospital 12 de Octubre.
WHY Migraine is a highly disabling neurological condition with a prevalence in our country as high as 12.6%. In a certain number of cases, this condition can evolve into chronic migraine, which causes the patient to experience headaches for more than 15 days a month, accompanied by increased sensitivity to light, noise and even intense odours, as well as a wide variety of neurological symptoms in the form of “auras”, which lead to significant physical and psychological strain. The magnitude of this problem is such that it represents one of the most important causes of anxiety, depression, work absenteeism and deterioration of social life in our society. Music has been used since time immemorial for its healing potential, but discoveries regarding its role in neurobiology are now the subject of articles and conferences in a growing number of medical specialties. The part of our brain that is responsible for receiving and interpreting melodies is closely related to the parts responsible for emotions and feelings, and these in turn exert an influence through different neural circuits in the region that perceives pain. It is therefore logical that, if the appropriate stimuli are applied in the form of music, a chain reaction is triggered in our nervous system that modulates the sensation of pain, relieving symptoms and thus improving the quality of life of these patients.
HOW The study involved live music-based interventions in patients with chronic migraine refractory to pharmacological treatment. Migraine is a pathology characterised by recurrent, very painful and disabling headaches. Its evolution is
associated with parameters of anxiety, depression, quality of life and vital signs in a group of female patients with chronic migraine refractory to at least three drugs.
WHEN The study was carried out between the months of March and June 2018.
Situation of the patients
“When a person is in pain all day, every day… it’s physically and morally draining. Even if they know it’s not a fatal disease, they know they have no option but to live with pain on a daily basis, with much more intense peaks in pain from the age of 18 or earlier until they are 60 or 70 years old. And that’s terribly cruel. And on top of that they can’t sleep well. Their daily lives are severely affected.” This is the blunt explanation given by Dr. Jesús Hernández Gallego, head of the Neurology Department at Hospital 12 de Octubre, when describing the situation of people who suffer from chronic migraine. These are patients with chronic migraine who have already received pharmacological treatment without success.
The place designated for the live music-based interventions was the hospital chapel, which offered a private, noise-free setting.
In patients with chronic migraine refractory to pharmacological treatment who received 36 sessions of music-based interventions over 3 months, the following observations were made:
This research aims to serve as a pilot study that opens the door for new research projects capable of attracting more funding and that persevere in the use of music as a therapeutic instrument in neurology.
The consolidation of the “Musician in Residence” figure and the normalisation of music in healthcare settings would be positive.
After the administration of the music therapy proposed by the Resistant Headaches Unit, the patients presented clinical improvements in their chronic migraine —evaluated using the MIDAS and HIT-6 questionnaires—, and in their perceived quality of life measured through the SF-36 and WHOQoL-BREF scales. They also presented psychopathological improvements in psychiatric comorbidities associated with diseases that cause chronic pain (mainly anxiety, depression and stress). These improvements were quantified through the Beck Anxiety and Depression Inventories.
Therefore, this study presents positive data on the interaction of music at neurological level and opens the way for further research in this field. “These results, despite preliminary, were wonderful and ground-breaking in every way, although the impact of this intervention has not been categorically proven. That would have to be confirmed with many more patients, over a much longer period, through a design involving many more people,” says Dr. Hernández Gallego, the principal investigator in the clinical study.
According to Dr. Jaime Alonso Maroto, “The results obtained represent, on the one hand, a small victory for the scientific community and a great cause for hope among patients with this ailment. This study also opens the door for new fields of research, which, with adequate funding, will enable the performance of more long-term and complex studies to consolidate these results. Who knows, maybe in the future we will actually see “musicians in residence” in the corridors of Spanish hospitals and MIRs will play a key role in complementing medical therapy in our times”.
“The patients who participated in the study appreciated a sophisticated, beautiful and elegant therapeutic activity based on live music. They felt that it had been worth it, they felt better understood, and their general well-being improved”. Dr.
Jesús Hernández Gallego.