Efficacy of Yoga Treatment for Migraine Treatment

Key Points

Yoga, when compared with control interventions across six studies for migraine management, was associated with a large reduction in pain (SMD, –1.21) as well as impressive reductions in headache frequency, duration, and disability (HIT-6 and MIDAS). The therapy across studies was quite heterogeneous, so special care is needed when recommending this therapy.

Relevance

Migraine is a common and debilitating neurological condition well known to primary care clinicians. Of the 40 million Americans living with migraine, we know that more than half report a significant reduction in work and/or school productivity and two-thirds report a significant reduction in household work productivity.¹ While many effective treatment options are available, we’ve known for some time that compliance with preventive therapy in migraine is low with some studies noting that only about one-third of patients are compliant with prophylactic therapy.² There are many factors to this including hesitancy related to perceived side effects, especially as migraine occurs in the prime years of productivity. Also important is that psychosocial triggers, most commonly stress, as a cause for migraines are present in 70% of individuals and often require comprehensive approaches to effectively manage.³ While behavioral therapies including biofeedback are effective, they also suffer from a lack of incorporation for additional reasons such as availability, access, and coverage.

Comment

Yoga may provide an accessible and effective middle ground as an increasingly common mind–body activity widely available through in-person and online formats. As it incorporates a package of mind–body approaches including diaphragmatic breathing, stretching, and meditation, which are known to approach the autonomic and myofascial dysfunction in migraine, yoga may be just what the doctor ordered in helping those with migraine approach these often-overlooked areas.⁴

The biggest challenge is finding a class that supports those with migraine. Recommending patients find gentle hatha yoga (which focuses on breathing) is a good place to start and to advance as tolerated while informing instructors of their condition for individualized support. For patients with advanced needs such as cervical disease, it would be wise to find physical therapists who are increasingly adding aspects of yoga to their offerings before jumping into open classes.⁵

Details

Several limitations are important to consider, most notably that the six trials were quite heterogeneous and of smaller sample size. These limitations are not surprising given the intervention itself is quite heterogeneous in its available variations. The studies were also predominately done on participants from Asia. A larger evaluation of a standardized intervention in the US would be welcome to bolster clinician confidence in recommending yoga to patients with migraine.

References

1. Facts About Migraine. National Headache Foundation. Accessed July 7, 2022. https://headaches.org/facts-about-migraine/ 
2. Kovalchuk NA, Kiryanova EA, Tabeeva GR. Medication Adherence in Migraine Patients (data of an online survey). Neurol Neuropsych Psychosom. 2021;13(4):81-87. https://doi.org/10.14412/2074-2711-2021-4-81-87
3. Maleki N, Becerra L, Borsook D. Migraine: Maladaptive Brain Responses to Stress. Headache. 2012;52 Suppl 2 (Suppl 2):102-106. https://doi.org/10.1111/j.1526-4610.2012.02241.x
4. Sathyaprabha T, Kisan R, Adoor M, et al. Effect of Yoga on migraine: A comprehensive study using clinical profile and cardiac autonomic functions. Int J Yoga. 2014;7(2):126-132. https://doi.org/10.4103/0973-6131.133891
5. Wims ME, McIntyre SM, York A, et al. The Use of Yoga by Physical Therapists in the United States. Int J Yoga Ther. 2017;27(1):69-79. https://doi.org/10.17761/1531-2054-27.1.69