Add-On Yoga May Benefit Patients With Migraine

Padma Srivastava, MD, DM, professor and head, department of neurology, and chief, Neurosciences Centre, All India Institute of Medical Sciences (AIIMS)

Padma Srivastava, MD, DM

Findings from the CONTAIN study suggest that yoga, when utilized as add-on therapy, has a superior impact for patients with migraine compared to medical therapy alone. The study authors noted this suggests that integrating a cost-effective and safe intervention such as yoga into the management of migraine would be beneficial.

Data showed that compared with medical therapy alone, at 3 months, the yoga group showed a significant mean delta value reduction in headache frequency (delta difference, 3.53 [95% CI, 2.52—4.54]; P <.0001), headache intensity (difference, 1.31 [95% CI, 0.60—2.01]; P = .0004), Headache Impact Test (HIT) score (difference, 8.0 [95% CI, 4.78—11.22]; P <.0001), and Migraine Disability Assessment (MIDAS) score (difference, 7.85 [95% CI, 4.98—10.97]; P <.0001).

Additionally, those in the yoga group had a significantly lower rescue pill count amount (0.83 [±3.06]) compared to those in the medical care group (3.11 [±4.62]; difference, 2.28 [95% CI, 1.06—3.51]; P <.0003).

Conducted by Padma Srivastava, MD, DM, professor and head, department of neurology, and chief, Neurosciences Centre, All India Institute of Medical Sciences (AIIMS), and colleagues at single tertiary care academic hospital in New Delhi, India, the assessment included 160 patients (114 completed) with episodic migraine randomized 1:1 to either only medical care or medical care and yoga intervention.

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“The results of our study are consistent with results of other investigators who used yoga as an intervention for migraine headache management,” Srivastava et al. wrote. “Though there was a significant reduction in clinical measures in the yoga group as compared to self-care group in 1 of the studies, it did not specify the yoga type, duration, or timing, and the patients were advised to practice yoga only during prodromal stage of migraine.”

The authors noted that future assessments of yoga in migraine in additional areas of the world would be of interest. As they note, yoga is ingrained in the Indian culture, thus raising concern on the generalizability of the results of this study. Although, Srivastava et al. acknowledge that results of a recent study in the US suggest that a large number of adults use yoga for varied reasons.²

“The UN declaration of June 21 as an International Day of Yoga has made a further impact worldwide,” the authors added. “It is important to observe the long-term benefit of yoga intervention among patients with episodic and chronic migraine. Specific yoga modules taking into account specific comorbidities in patients with migraine would be of potential benefit. It will be of scientific interest to compare yoga versus best medical management. Blood and imaging biomarkers could further enhance our understanding about the beneficial effects of yoga on migraine.”

All told, at 3 months, the medical care group reported a headache frequency of 4.41 (±3.99) compared to the yoga group’s frequency of 0.89 (±2.27). Headache intensity was reported as 2.61 (±2.45) in the medical care group vs 1.31 (±2.05) in the yoga group. HIT scores were 12.76 (±12.04) and 4.76 (±8.23), and MIDAS scores were 16.7 (±13.45) and 11.5 (±10.10) for the medical care and yoga groups, respectively.

Srivastava et al. acknowledged that the study did have limitations. First, there was no sham yoga group, though they noted that the standard advice given emphasized physical activity. Next, there was attrition to the follow-up, though this was considered in sample size calculations, and the follow-up period was not long enough to evaluate the persistence of the yoga intervention. Finally, the outcome measures were subjective and questionnaire-based, so the group reiterated that further research should utilize biomarkers to assess the exact biological mechanisms behind the benefits of yoga which were observed.

REFERENCES

1. Kumar A, Bhatia R, Sharma G, et al. Effect of yoga as add-on therapy in migraine (CONTAIN): a randomized clinical trial. Neurology. 2020; 94 (21). doi: 10.1212/WNL.0000000000009473

2. Cramer H, Ward L, Steel A, Lauche R, Dobos G, Zhang Y. Prevalence, patterns, and predictors of yoga use: results of a U.S. Nationally representative survey. Am J Prev Med. 2016;50:230—235. doi: 10.1016/j.amepre.2015.07.037