Does Yoga Help to Reduce Medication Intake in Migraineurs?

Incorporating yoga into a regular migraine treatment regimen may be superior to medication alone, according to study results published in Neurology, the medical journal of the American Academy of Neurology.

In a prospective randomized open-label trial, researchers set out to evaluate the efficacy of yoga as adjuvant treatment to conventional medical management on clinical outcomes in 114 migraineurs.

All study participants experienced episodic migraine and were between the ages of 18 and 50. Migraineurs were randomly assigned to 2 groups: medication only or yoga plus medication. For 1 month, the yoga group participants completed a 1-hour instructed yoga session 3 days a week. This was followed by an additional 2 months of self-practice 5 days a week. The trial took place in a tertiary care academic hospital in New Delhi, India.

"Migraine is one of the most common headache disorders, but only about half the people taking medication for it get real relief," said study author Rohit Bhatia, MD.

The researchers analyzed headache frequency and intensity, Headache Impact Test (HIT)-6 scores, and changes in the Migraine Disability Assessment (MIDAS) score, pill count, and proportion of headache-free patients. Episodic migraine was defined as having between 4 and 14 headaches per month.

An independent blinded assessor followed-up with patients after 1, 2, and 3 months. In both groups, propranolol was the most commonly used prophylactic medication followed by amitriptyline.

Although improvements were reported in both groups after 3 months, the yoga group exhibited higher improvements in all areas measured, including headache frequency, pain intensity, use of medications, and how much migraine interfered with daily life. In addition, “the trend towards improvement was faster and more consistent in the yoga group compared to the medical group.”

The intervention cohort reported an average of 9.1 headaches per month and ended the study reporting 4.7 headaches per month, which equates to a 48% reduction. In comparison, the control group reported an average of 7.7 headaches per month at study onset and 6.8 after the study, a 12% decrease.

“The average number of pills participants in the yoga group used decreased by 47% after 3 months. Meanwhile, the average number of pills the medication-only group used decreased by about 12%,” the authors said.

The investigators also calculated the delta values in each group. High mean (SD) delta values, along with differences between the delta values, favored the yoga group for all measures:

• Headache frequency: 4.41 (3.99) versus 0.89 (2.27), for a difference of 3.53 (95% CI, 2.52-4.54; P <.001)
• Headache intensity: 2.61 (2.45) versus 1.31 (2.05), for a difference of 1.31 (95% CI, 0.60-2.01; P <.001)
• HIT score: 12.76 (12.04) versus 4.76 (8.23), for a difference of 8.0 (95% CI, 4.78-11.22; P <.001)
• Rescue pill count: 3.11 (4.62) versus 0.83 (3.06), for a difference of 2.28 (95% CI, 1.06-3.51; P <.001)
• MIDAS score: 16.7 (13.45) versus 11.5 (10.10), for a difference of 5.24 (95% CI, 1.52-8.95; P = .006)

They hypothesize yoga may increase nitrous oxide (N₂O) levels in patients, which may lead to reduced migraine attacks. Reduced tension in the neck and shoulder area, as well as the loosening of stiffened muscles, may also account for yoga’s beneficial effects.

It is estimated migraine costs the United States around $13 billion per year due to loss of productivity and reduced performance. When prescription and OTC drugs are taken into consideration, the total increases by an estimated $3.2 billion.

Because of this, researchers argue “low-cost intervention in the form of yoga will reduce both direct and indirect costs significantly (reduction in mean pill count by 47.3% after 3 months, MIDAS reduced by 37.25% over 3 months). This is especially significant for resource-limited and low-income countries.”

One limitation to the study is its reliance on self-reported outcomes, which could be biased. In the future, the researchers suggest biomarkers may be useful to understand exact biological mechanisms behind the benefits of yoga observed in the study.

Reference

Kumar A, Bhatia R, Sharma, G et al. Effect of yoga as add-on therapy in migraine [published online May 6, 2020]. Neurology. doi: 10.1212/WNL.0000000000009473.