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Yoga For Migraines: A Non-Pharmacological Intervention

Migraines are characterized as intermittently-occurring, painful, throbbing headaches resulting from transient vasodilation of intracranial blood vessels.  Estimates suggest that for every 1 million persons in the general population, a total of 3000 migraine attacks will be experienced on a daily basis.  Although migraine is among the most common neurological disorders in both men and women, nearly double the number of women are diagnosed with the condition.

Most individuals with migraines utilize a combination of prophylactic and abortive medications for symptomatic relief.  Outcomes among migraine patients using combined prophylactic and abortive pharmacology are generally favorable.  However, pharmaceutical interventions are not always utopian – some patients may find them ineffective, intolerable, and/or too costly.

Others may experience a worsening of migraine symptoms resulting from medication overuse.  Furthermore, many individuals remain concerned with potentially deleterious long-term effects of migraine prophylactics and adverse events associated with abortive therapy (e.g. triptans).  As a result, some migraine patients have turned to non-pharmacological such as yoga in attempt to prevent migraine attacks.

Emerging research indicates that yoga therapy may effectively decrease the frequency of migraine attacks, as well as enhance the antimigraine properties of prophylactic medications.  The antimigraine effect provided by yoga is mediated via the autonomic nervous system – markedly altering neurophysiology to buffer future migraine attacks.  If you suffer from debilitating migraines, and haven’t tried yoga, it may be something to consider.

How Yoga May Prevent Migraine Headaches (Mechanisms)

It is difficult to pinpoint the specific mechanism(s) by which yoga may prevent or reduce the occurrence of migraine attacks.  There are numerous types of yoga that a migraine patient may choose to practice.  Certain types of yoga may yield neurophysiological adaptations (over time) that are slightly or markedly different from those resulting from another.

Therefore, it must be questioned whether the mechanisms associated with yoga’s therapeutic value could be related to the specific yoga subtype practiced.  In any regard, most types of yoga are thought to promote mental and physical relaxation.  For this reason, some speculate that the chief mechanism by which yoga reduces occurrence of migraine attacks is through modulation of the ANS (autonomic nervous system).

Imbalanced ANS activity may perpetuate sympathetic dysfunction, thereby increasing proneness to migraine attacks.  Regularly practicing yoga may facilitate an ANS-mediated antimigraine effect characterized by synergistic changes in: brain waves, endothelial function, hormones, inflammatory biomarkers, neurotransmitters, oxidative stress, etc.  Alterations in neurophysiology (as mediated by the ANS) may not only decrease migraine frequency, but also attenuate migraine-related pain and/or improve quality of life.

Moreover, since the pathoetiological underpinnings of migraine are subject to interindividual variation – the mechanisms by which yoga aids in migraine management may be patient-specific.  For example, one patient with abnormal neurochemistry may derive some benefit from altered catecholamine concentrations after yoga, whereas another may benefit more from a reduction in oxidative stress.  Outlined below are various mechanisms by which yoga may prevent and lessen the severity of migraines.

ANS Modulation: When practiced regularly, yoga modulates ANS (autonomic nervous system) function to reverse imbalances in sympathetic and parasympathetic tone.  The modulatory effect exerted by yoga upon the ANS may be a critical mechanism by which it effectively prevents migraine and/or reduces severity of migraine symptoms.  The ANS is known to mediate vasodilatory and vasoconstrictive processes, and autonomic dysfunction is commonly implicated in migraine.

A myriad of studies document significant improvement in migraine symptoms as a result of interventions such as biofeedback, meditation, and yoga – all of which modulate ANS activity.  One study that measured parameters of ANS function such as HRV (heart-rate variability) discovered that yoga therapy (in addition to medication) significantly altered R-R intervals and heart rate among migraine patients after 6 weeks. Alterations in R-R intervals and heart rate did not occur among migraine patients receiving standalone medication.

Based on this information, it was apparent that yoga therapy had significantly enhanced parasympathetic tone and reduced sympathetic tone.  An abnormally overactive sympathetic nervous system and concurrently underactive parasympathetic nervous system – is a sign of high stress and poor sleep (and diseased states) – all of which increase risk of migraine.  In short, correcting a lopsided ratio of sympathetic to parasympathetic activity may account for a majority of the antimigraine effect generated by yoga.

Antioxidant effect: A study by Lim and Cheong (2015) discovered that practicing yoga alters level of oxidative stress – as well as other biological parameters such as immune function and secretion of stress hormones.  In their study, they compared 12 individuals practicing yoga to 13 individuals not practicing yoga – for a duration of 12 weeks.  Yoga practice was done with an instructor for 90 minutes once per week and those in the yoga group were recommended to practice yoga for 40 minutes with guidance from a DVD.

Blood samples of the participants were collected prior to the study, as well as after 12 weeks.  Results indicated that concentrations of glutathione (GSH), an important antioxidant, significantly increased as a result of yoga compared to the control group.  Additionally, serum levels of nitric oxide, F2-isoprostane, and lipid peroxide were decreased.

This suggests that yoga increases antioxidant activity and decreases oxidative stress.  Okay, so how would an increased antioxidant effect help patients with migraines?  It appears as though migraine patients, on average, exhibit significantly greater levels of oxidative stress than healthy non-migraine controls.

Consider a report by Lucchesi et al. (2015) documenting results of a cross-sectional study that aimed to compare oxidative stress levels among 33 migraine patients to 33 non-migraine patients.  Results from this study indicated that individuals with chronic migraine exhibited significantly lower expression of antioxidant power compared to the healthy non-migraine controls.  It was concluded that antioxidant capacity is reduced in chronic migraine patients.

Although we cannot be sure that heightened oxidative stress causes or contributes to migraine, evidence indicates that it could.  A study by Chayasirisobhon (2006) noted that administration of antioxidants is therapeutically effective for prevention of migraine.  Therefore, the ability of yoga to reduce oxidative stress or increase antioxidant capacity may be an important mechanism by which it prevents migraines.

  • Source: http://www.ncbi.nlm.nih.gov/pubmed/26129705
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  • Source: http://www.ncbi.nlm.nih.gov/pubmed/16643582
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Brain waves: A means by which yoga may reduce the occurrence of migraines is via modulation of neuroelectrical activity or “brain waves.”  Neuroelectrical activity is understood to be abnormal among individuals with migraines prior to, as well as during an attack.  It may also be that aberrant brain wave patterns play a more significant role in the pathogenesis of migraine than is expected.

Regular and proper practice of yoga appears to increase production of slower brain wave frequencies such as delta, theta, and alpha – while simultaneously decreasing activity of beta.  These changes are to be expected when considering that yoga is relaxing and increases parasympathetic tone.  Relaxation has been shown (via EEG neuroimaging) to enhance production of slower brain waves, whereas stimulation resulting from anxiety, stress, or anger –has an opposite effect.

A study by Walker (2011) used a QEEG (quantitative electroencephalograph) to analyze the neuroelectrical activity of 71 individuals diagnosed with recurrent migraines.  All QEEG recordings indicated that the patients exhibited excessive high-frequency beta wave activity (sometimes called Beta-2) within the 21-30 Hz range in up to 4 specific cortical sites.  Walker then tested the effect of neurofeedback on 46 patients and the remaining 25 continued on standard medication.

The neurofeedback protocols involved decreasing Beta-2 activity (21-30 Hz) and increasing alpha activity (specifically 10 Hz).  Over half of all patients (54%) receiving neurofeedback experienced complete migraine relief as a result of the neuroelectrical modulation.  An additional 39% of patients receiving neurofeedback experienced a reduction in migraine frequency exceeding 50%.

This suggests that manipulating neuroelectrical activity can be highly therapeutic for migraine management.  Although yoga may be less effective and targeted in terms of decreasing Beta-2 and increasing alpha compared to neurofeedback, it still is capable.  A study by Ganpat, Nagendra, and Muralidhar (2011) noted 15.4% increases in alpha waves with 1.67% decreases in beta waves as a result of a yoga-based stress management program.

As a result of this research, we must speculate that brain wave modulation resulting from yoga practice could contribute to its antimigraine effect.  The consistency and duration over which a person has practiced yoga may dictate the degree to which they experience brain wave changes, and ultimately migraine relief.

  • Source: http://www.ncbi.nlm.nih.gov/pubmed/21309444
  • Source: http://www.ncbi.nlm.nih.gov/pubmed/23362721

Neurogenic inflammation: Activation of the sympathetic nervous system is associated with stimulation and should theoretically yield a cerebral vasoconstrictive effect to inhibit migraine.  Migraine is associated with dilation of intracranial blood vessels and administration of agents that constrict intracranial blood vessels tend to effectively abort an attack.  That said, it is commonly reported that patients with migraine attacks exhibit heightened sympathetic tone – suggestive of vasoconstriction and a stimulatory stress response.

Knowing that the sympathetic nervous system promotes vasoconstriction, one may theorize that its heightened sympathetic tone would serve as a migraine prophylactic.  However, evidence indicates that this is clearly not the case.  Migraine patients often report a worsening of attacks as a result of stress, and the stress response is known to increase sympathetic tone (which increases peripheral vasoconstriction).

How might an overactive sympathetic nervous system contribute to a migraine attack? Neurogenic inflammation.  Activation of the sympathetic nervous system may provoke neurogenic inflammation and corresponding increases in proinflammatory biomarkers including:  CGRP (calcitonin gene-related peptide), PGE2 (prostaglandin E2), and substance P.  Yoga is known to decrease sympathetic activity, possibly also reducing neurogenic inflammation and proinflammatory neuropeptides implicated in migraine.

  • Source: http://link.springer.com/referenceworkentry/10.1007%2F978-3-540-29805-2_2644
  • Source: http://www.ncbi.nlm.nih.gov/pubmed/25035622

Neurotransmission: As was already mentioned, the primary means by which yoga influences neurophysiology is by altering ANS activity.  Alterations in ANS activation have widespread implications in regards to synthesis of neurotransmitters, neuropeptides, and neuromodulators.  Specifically, the degree to which each branch of the ANS is active will dictate production of neurochemicals, neuropeptides, neurohormones, etc.

In other words, a person with an overactive sympathetic / underactive parasympathetic nervous system will generate different concentrations of neuromodulators compared to a person with relatively balanced sympathetic / parasympathetic activity.  Since most migraine patients are dealing with ANS dysfunction, this dysfunction may yield abnormal concentrations of neurotransmitters – possibly increasing susceptibility to an attack.

Abnormalities in central concentrations of neurotransmitters such as acetylcholine, dopamine, GABA, nitric oxide, and serotonin may play a role in the occurrence of migraine attacks. D’Andrea et al. (2012) propose that unbalanced concentrations of neurotransmitters can activate downstream release of proinflammatory biomarkers (via the trigeminal system) to cause migraine.  Yoga may ameliorate some of these imbalances in migraine patients, thereby contributing to its antimigraine effect.

Numerous studies show that consistent yoga practice alters concentrations of important neurochemicals that may be implicated in migraine.  For example, Streeter et al. (2010) discovered that 12 weeks of yoga practice increased GABA levels significantly in the thalamus.  GABA can prevent states of hyperexcitability that may trigger migraine, as well as interact with ion channels – particularly voltage-gated sodium channels (VGSCs) and voltage-gated calcium channels (VGCCs), which may in turn correct disruptions in excitation-inhibition balance to prevent migraine attacks.

A report by Hamel (2007) suggested that low serotonergic disposition may provoke migraine via a cascade that activates the trigeminovascular nociceptive pathway.  Regular yoga practice has been shown to increase serotonin levels and decrease monoamine oxidase (an enzyme that scavenges monoamines).  The increases in serotonin resulting from yoga could be significant enough to inhibit migraine – especially when factoring in concurrent modulation of other [perhaps lesser researched] neurotransmitter systems.

  • Source: http://www.ncbi.nlm.nih.gov/pubmed/22671857
  • Source: http://www.ncbi.nlm.nih.gov/pubmed/20722471
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Hormones: It is well-documented that women are more likely to suffer from migraine than men.  Estimates indicate that at least 3-fold more females experience migraine compared to their male counterparts.  Although a variety of hormones have been investigated as possible causes of migraine, estrogen seems to have the strongest link.

A review by Chai, Peterlin, and Calhoun (2014) assessed the relationship between migraine and estrogen.  Results from their review of literature indicated that migraine is more common among women than men, is most common during reproductive years, and is associated with decreased concentrations of estrogen.  Researchers went as far as to suggest that pharmaceutical regimens to prevent decreases in estrogen may reduce likelihood of migraine.

Research by Afonso et al. (2016) shows that yoga is capable of increasing serum estrogen levels in postmenopausal women.  It is unclear as to whether this effect occurs in non-postmenopausal women as well, but it is a possibility.  Results indicated that serum estrogen levels had significantly [and unexpectedly] increased after 4 months of 2 yoga sessions per week for 1 hour each.

If yoga increases estrogen and/or prevents estrogenic reductions, this may be a notable modality by which it prevents migraines – especially in women.  Regular yoga practice may modulate other hormones such as: aldosterone, cortisol, progesterone, testosterone, etc. – each of which may affect migraine susceptibility.

  • Source: http://www.ncbi.nlm.nih.gov/pubmed/26926324
  • Source: http://www.ncbi.nlm.nih.gov/pubmed/24792340

Pain response: Although yoga is commonly regarded as a migraine prophylactic, it may also lessen the severity of an already-occurring migraine attack.  This isn’t to suggest that someone with a migraine should quickly resort to practicing yoga during an attack and it’ll magically take away the pain.  However, consistent practice of yoga over time (e.g. months) alters neurophysiology in such a way that: psychological ability to cope with pain increases, perceived level of migraine-related pain decreases, and/or migraine severity is reduced (thus resulting in less pain).

Yoga may alter pain responses via a number of highly specific mechanisms, but one general mechanism may be that it modulates regional activation within the brain.  It may be that those practicing yoga experience decreases in migraine-induced pain activation within the contralateral primary somatosensory cortex.  It also could be that yoga increases activity in regions such as the anterior cingulate cortex, anterior insula, and orbitofrontal cortex – similar to mindfulness meditation.

The aforestated areas are implicated in nociception and by increasing their respective activation, it may improve ability to cope with pain.  Reducing production of certain neurochemicals (that exacerbate pain), while simultaneously increasing production of neurochemicals (that attenuate pain) – may be another way in which yoga alleviates migraine pain.

An analysis by Cramer et al. (2013) reviewed the efficacy of yoga for the treatment of chronic low back pain across 967 patients.  Results indicated that yoga was highly effective over the short-term for low back pain and moderately effective over a long-term.  Although migraine and chronic low back pain are far from the same condition, both involve experiencing pain, and perhaps yoga practice modulates nociception in such a way that pain is reduced.

A meta-analysis by Büssing et al. (2012) entitled “Effects of Yoga Interventions on Pain and Pain-Associated Disability” documented that yoga interventions are efficacious for reducing pain-related disability.  Two of the studies included in this meta-analysis were among patients with headache/migraine – suggesting that it is likely helpful in these patients.

Despite some limitations, there is evidence that yoga may be useful for several pain-associated disorders. Moreover, there are hints that even short-term interventions might be effective. Nevertheless, large-scale further studies have to identify which patients may benefit from the respective interventions.  Though the effect of yoga in reducing pain is documented as “moderate” – this should still be considered a useful outcome among migraine sufferers.

  • Source: http://www.ncbi.nlm.nih.gov/pubmed/22178433
  • Source: http://www.ncbi.nlm.nih.gov/pubmed/23246998

Sleep enhancement: A significant number of individuals diagnosed with migraine exhibit abnormal sleep patterns and/or disordered sleep when assessed by sleep experts.  A study by Bigal and Hargreaves (2014) documented the complex relationship between migraine headaches and sleep.  They also mentioned that sleeping during a migraine attack appears to alleviate symptoms in many patients.

There’s likely a bidirectional relationship between sleep and migraines in that poor sleep may increase odds of a migraine, but the occurrence of a migraine may disrupt normative sleep.  A study by Miller et al. (2003) reported that children with migraine experienced high rates of sleep disturbances including: insufficient sleep (42%), teeth-grinding (29%), snoring (23%), etc.  Miller also discovered that the frequency and duration of migraines predicted the specific sleep disturbances experienced – potentially setting stage for a vicious circle.

Interestingly, researchers Duman et al. (2015) found that treatment with a migraine prophylactic affects sleep.  This should lead some to question whether the reduction [or perhaps a percentage of the reduction] in migraine frequency resulting from prophylactic treatment is related to prophylactic-mediated changes in sleep patterns.  That said, certain drugs such as Amitriptyline for migraines may be more efficacious than others in regards to sleep enhancement.

Knowing that sleep abnormalities may cause migraines should lead us to suspect that a possible means by which yoga treats migraines could be via modulation of sleep architecture.  A study by Khalsa (2004) noted that 8 weeks of yoga significantly improved measures of: sleep efficiency (SE), total sleep time (TST), total wake time (TWT), sleep onset latency (SOL), and wake time after sleep onset (WASO) – among individuals with insomnia.  A later study by Halpern et al. (2014) found that yoga improved sleep quality in elderly adults with insomnia.

There are several other studies that show yoga is able to enhance sleep among individuals with sleep abnormalities.  It is possible that some sleep abnormalities are mediated by dysfunction within a myriad of neurophysiological systems (chemical, electrical hormonal, etc.), and since yoga holistically alters these systems – sleep is enhanced.  Enhancement of sleep may not only prevent migraines, but it may correct a vicious circle of migraine-induced sleep problems and abnormal sleep-induced migraine.

  • Source: http://www.ncbi.nlm.nih.gov/pubmed/12656707
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Stress decrease: Another means by which yoga prevents migraine attacks is by decreasing stress levels.  A reduction in stress as a result of consistent yoga practice may increase the threshold necessary to provoke a migraine attack, as well as decrease a significant amount of migraine-related pain (during an attack).  For those questioning the connection between stress and migraine, a paper by Radat (2013) reports that between 50% and 80% of all migraine patients attribute stress as a trigger for migraine attacks.

Other research shows that when annual stress increases, annual migraine frequency predictably increases.  Researchers theorize that exposure to acute stressors alter neurophysiology in such a way, especially among those prone to migraines, that threshold of susceptibility is reduced.  It is also understood that stress exacerbates migraine chronicity, possibly playing a critical role in the transformation of episodic migraine to chronic migraine (i.e. 15+ attacks per month).

Furthermore, elevated stress is associated with increased pain sensitivity, possibly contributing to some of the extreme pain that is often reported by patients during an attack.  Stress management is a commonsense, recommended strategy for migraine patients and often proves clinically helpful.  Randomized controlled trials have shown that relaxation or stress reduction protocols are effective for migraine prophylaxis – especially in children.

Although there’s likely a bidirectional relationship between stress and migraine, meaning that high stress can trigger migraine AND migraine can increase stress – lowering stress generally yields significant therapeutic benefit for migraine patients.  Since yoga is a highly effective intervention for stress reduction, it makes sense that the reduction in stress that it facilitates would be useful for migraine patients.  A review by Li and Goldsmith (2012) analyzed 35 trials documenting the effect of yoga on anxiety and stress.

Of the 35 trials analyzed, a total of 25 documented significant reductions in stress and anxiety symptoms as a result of a yoga regimen.  However, authors also reported notable limitations with the research, and rightfully, that results should be interpreted with caution.  Nonetheless, there is substantial body of preliminary evidence suggesting that adherence to a yoga regimen is capable of significantly reducing stress.

As was already mentioned, this stress reduction may act as a migraine prophylactic via preventing stress-induced neurophysiological changes that trigger migraine attacks.  What’s more, even if some don’t find the stress reduction associated with yoga useful for the prevention of migraine attacks, the stress reduction may make it easier to cope with migraine-related pain.  Overall, it is necessary to consider that the stress decrease resulting from yoga practice is valuable in migraine management.

  • Source: http://www.ncbi.nlm.nih.gov/pubmed/23608071
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Vagal tone: It is apparent that reduced vagal tone is associated with stress (and excessive sympathetic nervous system activation) – which is linked to migraine.  Increasing vagal tone has been noted as effective for the prevention of migraine attacks, as well as abortion of already-occurring attacks.  A study by Khattab et al. (2007) assessed vagal modulation during yoga and discovered that yoga training significantly altered vagal function.

Streeter et al. (2010) noted that yoga increases parasympathetic tone via stimulation of vagal afferents.  Vagal stimulation elicits a host of neurophysiological alterations including increases in the neurotransmission of GABA – possibly a mechanism by which heightened vagal tone attenuates migraine.  Kisan et al. (2014) confirmed that yoga significantly decreases sympathetic activity and enhances vagal tone and decreases sympathetic activity – a likely mechanism by which it improves migraine.

Research by Goadsby et al. (2014) suggests that migraine attacks can be treated by vagus nerve stimulation.  A report by Yuan and Silberstein (2015) underscores the fact that vagus nerve stimulation is a promising intervention for migraine.  What’s more, long-term usage of vagus nerve stimulators appear to prevent migraines and alter nociceptive pathways in the brain.

It is unknown as to whether enhancement of vagal tone from yoga is as significant and/or therapeutic as that resulting from vagal nerve stimulator devices, making it difficult to determine whether vagal modulation via yoga is a prominent mechanism by which it reduces migraine.  That said, since vagal tone can alleviate migraines, and yoga enhances vagal tone – it is logical to assume that migraines may be reduced among those practicing yoga [in part] via vagal mechanisms.

  • Source: http://www.ncbi.nlm.nih.gov/pubmed/20722471
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The aforestated mechanisms by which yoga treats migraines may be weighted in terms of therapeutic value.  In other words, the antioxidant effect provided by yoga to reduce oxidative stress may be more important than its ability to enhance sleep quality (and vice versa).  Currently it would be impossible to decipher the most important antimigraine mechanisms of yoga.

The primary effect of yoga is upon the autonomic nervous system (ANS), which in turn affects systems throughout the entire body – possibly some which haven’t even been investigated or discovered.  That said, it may also be that similarly practiced yoga (e.g. Hatha yoga) for the same duration elicits the similar neurophysiological effects among users, but the weighted therapeutic value of specific mechanisms may subject to interindividual variation.  For example, one migraine patient may derive more antimigraine benefit from yoga’s modulation of neurotransmission whereas another may derive greater antimigraine benefit from yoga-induced neuroelectrical alterations.

Since not all migraine patients exhibit the same pathoetiological underpinnings and/or neurophysiological footprints associated with the disorder, this may explain why some patients may benefit more from yoga than others.  This would also explain why thee may be variations among patients regarding the mechanisms of yoga that are most therapeutic.  Moreover, there may be general trends regarding the therapeutic mechanisms of yoga in relationship to specific migraine subtypes (e.g. common vs. classic migraine).

In summary, most would speculate that a synergistic blend of neurophysiological alterations contributes to yoga’s antimigraine effect.  Therefore, it would be somewhat myopic to assume that one mechanism (e.g. increased GABA) from yoga account for the totality of its therapeutic efficacy among migrainers.  It is more likely that a culmination of numerous aspects of neurophysiological modulation elicited by yoga act as a non-pharmacological migraine prophylactic.

Benefits of Yoga for Migraines (Possibilities)

There are numerous possible benefits associated with practicing yoga for the management of migraines.  As an antimigraine intervention, yoga is perhaps most appealing due to its non-pharmacological status.  In other words, those practicing yoga won’t be paying for, nor popping prophylactic pills on a daily basis in hopes that migraines are reduced.  Moreover, yoga is typically: devoid of adverse effects, an effective adjunct to pharmaceuticals, and may inhibit migraine chronification.

  • All ages: Not all pharmaceuticals for migraine have been proven safe and effective in pediatric patients. Young children and adolescents may want to avoid prophylactic agents and/or abortive therapies due to the fact that their brains’ aren’t fully developed and these agents may modify (perhaps deleteriously) neural development.  When practiced properly, yoga is considered safe for individuals of all ages (pediatrics and adults).
  • Adjunct: Due to pharmacokinetic and pharmacodynamic interactions, not all antimigraine agents can be administered as adjuncts. Since yoga is non-pharmacological, it can be practiced while taking a prophylactic or using an abortive medication – without posing risk of interaction.  Though the lack of an interaction may be appealing, the neurophysiological effects of yoga appear to legitimately augment antimigraine agents.  Studies comparing the efficacy of an antimigraine pharmaceutical with the same antimigraine pharmaceutical plus yoga – discovered that while both therapies were effective, the addition of yoga resulted in significantly greater benefit.  This indicates that yoga is a highly effective adjunct.
  • Chronicity buffer: Some researchers speculate that regularly practiced yoga may inhibit migraine chronification. Migraine may transform from episodic (infrequent) to chronic (frequent) over time, possibly as a result of suboptimal treatment.  Since yoga can reduce the frequency of migraine attacks, it may buffer against migraines becoming more chronic.  The buffering effect may be mediated in part via yoga-induced changes in autonomic activation.
  • Comorbid conditions: Migraines often co-occur with other medical conditions, possibly linked through shared neuromechanisms. Since yoga is effective for the management of migraines, it may ameliorate symptoms of concurrent conditions with shared underlying neurophysiological causes.  For example, consider someone suffering from migraines and generalized anxiety disorder.  Although the specific nuanced causative mechanisms of each condition may differ, yoga practice may simultaneously improve both conditions by decreasing activation of the sympathetic nervous system.  Should you have another health issue (in addition to migraine), there’s a possibility that yoga may decrease its symptomatic severity.  A few examples of other conditions that yoga may help include: addiction, chronic pain, depression, fatigue, headaches, insomnia, and stress.
  • Coping enhancement: Repeated yoga practice changes neural activity in the brain, possibly increasing activation of regions that enhance innate ability to cope with migraine and migraine-related symptoms (e.g. pain, light sensitivity, nausea, etc.). Even though pain of migraines may remain severe after practicing yoga, coping ability may improve.  It could be that holding the body in (often uncomfortable) poses trains the brain and nervous system to remain calm – and that the pain will eventually pass.
  • Cost: Another advantage associated with using yoga to manage migraines is that it’s completely free – you won’t be forking over your hard-earned cash for a medication. Some people have a tough time affording pharmaceutical migraine medication, and for these individuals, implementation of a yoga routine may be highly beneficial.  Although formalized yoga classes may cost some money, these classes are not a necessity.  Free yoga lessons are available online via platforms such as YouTube.  Moreover, even if it costs you a bit of upfront money to learn yoga, once various poses are learned, you won’t need to continue paying for lessons.
  • Efficacy: Most research suggests that yoga is a highly effective prophylactic and may even help reduce migraine attack severity. Though research of yoga for migraine is not conclusive (due to various limitations), most evidence suggests benefit.  It appears very effective as an adjunct migraine prophylactic (when used with a pharmaceutical), but may also be effective as a standalone antimigraine intervention.
  • Lack of side effects: Most migraine patients will not experience any unwanted side effects as a result of yoga. Significant side effects and/or adverse events from practicing yoga haven’t been reported in the literature.  As of current, side effects should be considered nearly non-existent – making yoga much easier to tolerate than medications.  Yoga modulates neurophysiology to facilitate endogenous antimigraine relief – rather than relying on an external (sometimes neurophysiologically incompatible) pharmaceutical.
  • Non-pharmacological: Some migraine patients may perceive yoga as advantageous over other therapies due to the fact that it’s non-pharmacological. In other words, you aren’t ingesting any exogenous chemical to prevent or abort migraines.  Though pharmaceutical options can be helpful for some, others struggle to tolerate them and/or find them problematic when used over a long-term.  Since yoga is non-pharmacological, doctor’s appointments aren’t required for medication refills.
  • Long-term effects: Consistently practicing yoga shouldn’t provoke unwanted long-term reactions in most migraine patients. Many people take antimigraine medications that haven’t been studied long enough to know whether they increase likelihood of adverse long-term events.  Though most approved by the FDA are relatively safe, administration of an exogenous chemical for a prolonged period could be unsafe – especially when considering interindividual differences in neurophysiology, genetics, etc.  Yoga probably won’t cause any adverse long-term events, but may improve long-term health in numerous ways.
  • Pain reduction: An aspect of migraine attacks that patients really struggle with is the intense migraine-induced pain. Research suggests that yoga may reduce migraine-related pain, as well as help with other pain conditions (e.g. chronic lower back pain).  It may do this by altering function of the nervous system, neural activation, and/or concentrations of neuromodulators.  Some migraine patients may find that, with consistent yoga practice, their migraine pain is reduced.
  • Quality of life: Reports suggest that migraine diagnoses (especially if “chronic”) take a toll on quality of life. Yoga has potential not only to prevent migraines (which in and of itself could improve quality of life), but also has been shown to improve quality of life among those without migraines.  The improvement in quality of life is often a result of reductions in anxiety, improvements in mood, and increased energy.
  • Safety: When practiced properly, yoga is extremely safe and risk of injury is low. Yoga doesn’t require significant athleticism and most poses (asanas) can be modified based on individual capabilities.  Many would agree with the statement that yoga is safer than many other forms of exercise.  Those practicing yoga tend to do so to recover from injuries, suggestive of the fact that it is healing rather than injurious.
  • Sleep improvements: As was discussed, one of the ways yoga may treat migraines is by enhancing sleep. Several studies have noted that yoga is able to significantly improve sleep-related variables such as: efficiency, total time, onset latency, etc.  The sleep improvements could be considered an added benefit of using yoga for migraines – especially among migraine patients with sleep problems (e.g. insomnia).
  • Stress reduction: Many migraine patients are anxious, stressed, and looking for ways to help them remain calm. Staying calm helps decrease likelihood of a migraine attack, and can also improve ability to cope with a migraine attack.  Moreover, the stress reduction may have positive implications for health – possibly preventing future diseased states.

Drawbacks of Yoga for Migraines (Possibilities)

There aren’t many drawbacks associated with practicing yoga for the management of migraines.  The biggest drawback may be that yoga is ineffective (or suboptimally effective) for preventing migraine attacks.  Other possible drawbacks of yoga for migraines include: disliking yoga practice (for unspecified reasons), time-consuming (it may take up too much time), and the fact that benefit is not immediate.

  • Adverse experiences: In rare cases, some individuals may report adverse outcomes resulting from yoga practice. Theoretically, a person may injure themselves if attempting to perform a pose that requires advanced-level skill.  Additionally, migraine patients with comorbid psychiatric conditions may run risk of exacerbating certain symptoms.  For example, a subset of individuals may experience “brain fog” or a disconcerting reaction known as relaxation-induced anxiety.
  • Consistent practice required: The prevention of migraines as a result of yoga is unlikely to occur after a single session or sporadic practice (e.g. yoga once per month). The best designed study of yoga for migraines discovered that patients experienced significant benefit by practicing at least 5 days per week – for a duration of 3 months.  Irregular yoga practice may not provide any antimigraine benefit due to the fact that neurophysiology will likely revert back to pre-yoga homeostasis (as a result of large intervals between sessions).  Those looking for a quick-fix may dislike the fact that consistent effort is required for results.
  • Dislike of yoga: There’s always a chance that a person may try yoga and end up disliking it. Not only can certain positions get uncomfortable, but some individuals may find practitioners that seem more like New Age extremists, cult leaders, or portray themselves as some sort of mystical guru – rather than yoga teachers.  Obviously anyone disliking certain aspects of yoga could find a non-spiritual teacher and/or test another type of yoga practice.  Nevertheless, some migraine patients may not enjoy themselves during the practice and won’t want to continue.
  • Ineffective: Although some individuals may find yoga effective for the prevention of migraine attacks, others may find it totally ineffective. In other words, it is possible that a migraine patient may practice yoga consistently (and properly) for months – only to experience no reduction in the frequency of migraine attacks or symptomatic severity.  Compared to FDA-approved interventions – there is a scarcity of randomized controlled trials documenting the efficacy of yoga for migraine prophylaxis.  Some may argue that yoga should be currently considered ineffective than other, proven migraine prophylactic interventions.
  • Lack of immediate effect: Like most migraine prophylactics, patience is often required before the therapeutic effects of yoga emerge. Some individuals may find that it takes a minimum of 3 months before they notice any reduction in migraine attack frequency resulting from yoga practice.  Others may report that it takes substantially longer (e.g. 6 months to 1 year) before they noticed a legitimate antimigraine effect resulting from yoga practice.  The lack of immediate effect is predicated on the fact that significant neurophysiological alterations require time – they will not usually occur after a single session.  That said, some individuals may simply give up and jump to the conclusion that yoga is ineffective for migraine, when the reality is that it could’ve been effective if they had given it a bit more time.
  • Time consuming: It requires nearly zero time to swallow a migraine prophylactic, whereas yoga practice may require 30-90 minutes per session. Assuming you’re practicing yoga several times per week for 30 minutes a session – that’s 1 hour 30 minutes of your time.  If you drive to-and-from a yoga class, take time to throw on special workout gear, socialize after, shower, etc. – this may consume more time than expected.  While yoga doesn’t need to be as time consuming as some people make it, the best designed study (thus far) showing its efficacy had participants practice for 60 minutes per session. Since yoga requires more time than popping a prophylactic pill – some may view it as an inconvenient option.

Yoga for Migraines (Review of Research)

Included below is a summary of most studies investigating the efficacy of yoga as a migraine prophylactic.  The first paper evaluating yoga for the management of migraine were published in the early 1980s by Indian researchers.  As a result of its preliminary therapeutic efficacy, additional larger-scale, follow up studies have been conducted – from the 1980s to present day.  Upon assessing these studies, it appears as though yoga is a safe, viable, non-pharmacological intervention for prophylaxis of migraine.

2015: Effects of yoga exercises for headaches: a systematic review of randomized controlled trials.

A systematic review conducted by Kim (2015) analyzed the effect of yoga exercises for the management of headaches.  The goal of this systematic review was to determine the strength of evidence supporting yoga as an effective headache management strategy.  Although the term “headache” is usually distinguished from the term “migraine” in literature, many migraine patients suffer from concurrent non-migrainous headaches – making this a review worthy of mention.

To conduct the systematic review, Kim compiled trials that investigated the effects of yoga in headache management.  To be included in Kim’s review, data must have been extracted from randomized controlled trials (RCTs) published prior to January 2015.  Thereafter, quality of the compiled trials was assessed with the Cochrane risk of bias tool.

Only 1 trial fit inclusion criteria for the systematic review, and the Cochrane risk of bias tool suggested that there may have been moderate bias risk.  This meant that nearly all trials up to 2015 investigating yoga for the management of headache were: suboptimally designed (non-RCTs) and/or potentially biased.  Nevertheless, Kim documented the findings of this lone trial in her systematic review to serve as a narrative rather than robust clinically-relevant evidence.

Results of the standalone randomized controlled trial (RCT) suggested that yoga was therapeutically valuable among those with headaches.  In particular, practicing yoga resulted in: reduced headache frequency / intensity, fewer psychiatric symptoms (anxiety / depression), and decreased headache medication usage – compared to a control group.  Based on this review we can conclude that yoga may be helpful in headache management, but further research (from higher-quality trials) is warranted.

  • Source: http://www.ncbi.nlm.nih.gov/pubmed/26311986

2015: Yoga intervention on blood NO in female migraineurs.

A study conducted by Boroujeni et al. (2015) sought to determine how yoga would affect blood nitric oxide concentrations among female migraine patients.  For those unaware, it is necessary to underscore the potential role of nitric oxide in the pathogenesis of migraine.  Nitric oxide is a molecule that influences cerebral blood flow, arterial diameter, and nociception – all of which are implicated in migraine.

Studies have shown that increasing nitric oxide concentrations tends to provoke migraine without aura in sufferers.  Conversely, administration of a nitric oxide synthase inhibitor [to reduce concentrations of nitric oxide] attenuates migraine attacks.  For this reason, researchers sought to determine whether yoga may yield therapeutic benefit among migraine patients, and if so, whether the benefit was mediated in part by a decrease in circulating nitric oxide.

A total of 32 female migraine patients participated in this trial and were assigned at random to receive either: medication (14 patients) OR yoga training with medication (18 patients) – for a 3-month duration.  To determine efficacy of the yoga training as an intervention for migraine, the following measures were collected: headache severity (Visual Analogue Scale), nitric oxide metabolites (Greiss reaction), and headache impact on life (Headache Impact Test).

Results indicated that after 3 months, the 18 patients receiving yoga training plus medication experienced significant improvements in: the impact of headache on patient’s life, headache frequency, and headache severity.  There was also a trend of reduced headache duration among those receiving yoga training compared to the control group – but this was not of statistical significance.  Interestingly, there were no differences in plasma concentrations of nitric oxide among the control group and yoga groups.

Reflecting upon the results, we can conclude that yoga appears effective for the management of migraines when utilized as an adjunct to pharmaceutical medication.  Furthermore, yoga may facilitate its antimigraine effect via mechanisms other than nitric oxide modulation.  Additional [larger scale] trials should attempt to confirm the results from this study, as well as decipher the specific mechanisms by which yoga provides benefit to migraine patients.

  • Source: http://www.ncbi.nlm.nih.gov/pubmed/26918241

2014: Effect of Yoga on migraine: A comprehensive study using clinical profile and cardiac autonomic functions.

A study by Kisan et al. (2014) sought to determine the adjunct efficacy of yoga for the treatment of migraine.  Prior to the study, researchers noted that migraine often requires long-term management and mentioned that yoga therapy may be a practical intervention.  Yoga therapy isn’t associated with high-costs (like medication), can enhance quality of life, and appears to reduce the occurrence of headaches – as well as abortive medication usage.

Researchers recruited 60 individuals with migraine to participate in the study.  The 60 participants were assigned at random to receive either: conventional care (30 patients) OR yoga therapy plus conventional care (30 patients) – for a total of 6 weeks.  It should be noted that patients assigned to the yoga therapy group received yoga sessions for 5 days per week.

The efficacy of yoga as an adjunct intervention for migraine was determined based on changes in migraine (frequency, intensity, impact of the attacks on the patient’s lives) from pre-treatment baseline to post-treatment (after 6 weeks).  In addition, autonomic function tests were administered at baseline and changes were assessed after 6-weeks.  Results indicated that both groups (conventional care AND yoga plus conventional care) experienced significant improvement on clinical migraine evaluations.

However, the individuals receiving yoga therapy along with conventional care experienced greater clinical improvement than the standalone conventional care (control) group.  Specifically, variables such as headache frequency and intensity decreased more significantly among those receiving adjunct yoga.  What’s more, the autonomic function tests revealed that patients receiving yoga therapy (as an adjunct) exhibited improved vagal tone and decreased sympathetic activation.

Based on these results, it appears as though yoga therapy as an adjunct to conventional care significantly reduces headache frequency and severity.  Furthermore, since autonomic function tests indicate significantly favorable changes in vagal tone and sympathetic activation after 6 weeks of yoga therapy, we can speculate that autonomic modulation could be a critical mechanism by which yoga facilitates its adjuvant antimigraine effect.

  • Source: http://www.ncbi.nlm.nih.gov/pubmed/25035622

2014: Preventive Effects of a Three-month Yoga Intervention on Endothelial Function in Patients with Migraine.

A study by Naji-Esfahani et al. (2014) assessed the effect of yoga therapy among individuals with migraine, specifically investigating whether it was capable of improving endothelial function.  It is understood that migraine patients commonly exhibit chronic endothelial dysfunction, ultimately increasing their risk for deleterious health conditions such as ischemic attacks.  Preliminary evidence suggested that yoga may be useful for migraine management, but whether it was able to reduce risk of migraine-related adverse health events via the endothelium remained unclear.

In this study, researchers recruited 42 female migraine patients and assigned them at random to receive either: medication (14 patients) OR yoga exercise plus medication (18 patients) – for a duration of 12 weeks.  To track endothelial function, blood tests were administered to patients prior to each intervention at baseline (pre-treatment) and after the 12 weeks (post-treatment).  The blood tests documented two biomarkers: intercellular adhesion molecule (ICAM) and vascular cell adhesion molecule (VCAM).

Analysis of the results revealed that there were significant reductions in plasma VCAM (vascular cell adhesion molecule) among patients receiving yoga therapy plus medication – compared to those receiving standalone medication.  The group receiving yoga therapy exhibited an average VCAM of 15.29, whereas the controls exhibited an average VCAM of 21.70.  No significant changes in concentrations of ICAM (intercellular adhesion molecule) were noted after the 12 weeks.

It was concluded that yoga exercises seem to effectively augment conventional pharmacology for the treatment of migraines.  As evidenced by changes in VCAM scores, consistent yoga therapy may reduce severity of endothelial dysfunction and may also minimize likelihood of endothelial-implicated adverse events (e.g. ischemic attacks).  Though it remains unclear as to how yoga modulates endothelial biomarkers, its ability to do so may reflect its efficacy in migraine prophylaxis and health-conductive effects.

  • Source: http://www.ncbi.nlm.nih.gov/pubmed/24829729

2014: Effect of rajyoga meditation on chronic tension headache.

A study by Kiran et al. (2014) assessed the effect of rajyoga meditation among individuals with chronic tension type headache (CTTH).  It is important to note that rajyoga refers to “Raja yoga” which loosely translates to “best of its kind” yoga.  The meditation component of the practice is what was investigated as a potential therapeutic intervention for chronic tension type headache.

Those diagnosed with chronic tension type headache are said to experience at least 15 days per month with tension headaches characterized by pain, tightness, and pressure around the forehead, back of the head, and/or neck.  Although chronic tension type headaches are distinct from migraine, some patients experience both.  Furthermore, some treatments that are effective for chronic tension type headache are also useful as migraine treatment (and vice versa).

This specific study documented whether Raja yoga meditation would enhance the effectiveness of a pharmacological treatment among 50 patients (18-58 years old) diagnosed with CTTH.  Patients were assigned to one of the two following groups: 8 lessons of Rajyoga meditation (a spiritual-based practice) for relaxation plus medication OR standalone medication (analgesics / muscle relaxants) twice per day – for a duration of 8 weeks.  To gauge the efficacy of the meditation adjunct, researchers measured CTTH severity, frequency, duration, and headache index.

Results indicated that both groups (meditation plus medication vs. standalone medication) exhibited significant reduction in the aforestated CTTH measures (severity, frequency, duration, index) – after 8 weeks.  That said, patients receiving the combination of Rajyoga meditation plus medication experienced more significant reductions in headache severity (94%), duration (91%), and frequency (97%) – compared to those receiving standalone medication (36%, 36%, 49% – respectively).  Improvement on the headache index score measure was significantly greater among the combined treatment group (99%) compared to the standalone medication group (51%).

In summary, it appears as though Rajyoga meditation is an effective adjuvant to medication for the management of chronic tension type headache.  It is unknown as to whether other types of meditation would be equally as efficacious as the Rajyoga type in management of chronic tension type headache.  Moreover, one could speculate that a similar intervention (medication plus yogic meditation) would be useful among migraine patients – particularly those with insufficient therapeutic responses to standalone medication.

  • Source: http://www.ncbi.nlm.nih.gov/pubmed/25509967

2014: Meditation for migraines: a pilot randomized controlled trial.

A randomized controlled trial (RCT) conducted by Wells et al. (2014) evaluated the usefulness of meditation as a treatment for migraines.  Researchers specifically sought to document the safety and efficacy of the practice known as Mindfulness-Based Stress Reduction (MBSR).  The impetus for this investigation was based on an understanding that: stress can trigger migraines, mindfulness-based stress reduction can mitigate stress, and mind/body interventions already appear useful for migraine management.

Additionally, researchers noted that MBSR may be useful for reducing chronic pain or pain tolerance – each of which may also be useful in cases of migraine.  For those unfamiliar with MBSR, it is a practice that aims to enhance mindfulness (conscious, present awareness) while simultaneously decreasing stress.  In this pilot trial, a total of 19 individuals diagnosed with episodic migraines were assigned at random to receive either: standard medical care (9 patients) OR mindfulness-based stress reduction (MBSR) therapy.  Efficacy of MBSR was evaluated based on change in migraine frequency from pre-treatment (baseline) to follow-up.

A set of secondary outcomes were also documented with measures of: headache (severity and duration), self-efficacy, stress level, migraine-related disability, mood (anxiety and depression), quality of life, and mindfulness.  Assessment of results indicated that MBSR was well-tolerated (with no reported side effects) and resulted in approximately 1.4 fewer migraines per month than usual.  Despite the average 1.4 fewer migraines per month, this was not a statistically significant reduction.

Secondary outcomes indicated that MBSR minimized migraine severity, but not to a greater extent than standard medical care.  Measures of migraine length, migraine-related disability, self-efficacy, and mindfulness improved significantly in the MBSR group compared to the controls.  It was concluded that MBSR is a safe and practical intervention for adult migraine patients.

However, it should be emphasized that it failed to improve the primary outcome measure of migraine attack frequency.  Researchers hypothesize that a lack of statistical significance associated with MBSR for migraine reduction [compared to controls] may be a consequence of an underpowered study – associated with the small sample size.  For this reason, it may be necessary to reevaluate the therapeutic antimigraine efficacy of MBSR in a future large-scale trial.

Although MBSR significantly improved a subset of secondary measures (e.g. migraine-related disability scores) compared to the controls, these results must be interpreted with skepticism as a result of the possible inaccurate results (from the underpowered data).  Nonetheless, MBSR appears to be well-tolerated with a high degree of patient adherence.  Future research should help us get a better understanding of its prophylactic efficacy for migraine, as well as the potential mechanisms by which it may prevent migraine attacks.

Keep in mind that MBSR is a protocol that may yield different neurophysiological changes than various types of yogic meditation.  It is unknown as to whether, by comparison to MBSR, certain types of yoga would’ve been more/less useful [in this study] for migraine prophylaxis.  That said, some may generalize these findings as a lack of usefulness for meditative and/or yogic stress reduction in migraine management.

  • Source: http://www.ncbi.nlm.nih.gov/pubmed/25041058

2007: Effectiveness of yoga therapy in the treatment of migraine without aura: a randomized controlled trial.

Researchers John et al. (2007) published a study in the journal “Headache” assessing the efficacy of yoga therapy for the treatment of common migraine (devoid of aura).  Prior to their trial, researchers noted that many studies had suggested benefits of complementary and/or alternative medicines for the management of migraine.  Despite the suggested benefits, none of the already-published research had thoroughly investigated the efficacy of yoga therapy in migraine management.

For this reason, they recruited 72 patients diagnosed with common migraine (implying no aura) and assigned them at random to receive either: yoga therapy OR self-care – for a 3-month span.  To determine the efficacy of yoga therapy, researchers documented: headache frequency (with a headache diary), migraine severity (with a 0-10 scale), and migraine-related pain (with the McGill pain questionnaire).  Additionally, they analyzed psychiatric symptoms of anxiety and depression (with the Hospital Anxiety-Depression scale) plus medication usage.

Results indicated that the individuals receiving yoga therapy experienced significant reductions in: headache frequency, migraine severity, migraine-related pain, anxiety/depression, and medication usage – compared to the self-care group.  What’s more, most of the reductions were significant with P-values < 0.001 – suggesting the benefits were unlikely do to chance.  Based on the results of this study, it appears as though yoga therapy (over 3-month duration) can assist in the management of migraine, as well as migraine-related symptoms.

  • Source: http://www.ncbi.nlm.nih.gov/pubmed/17501846

2007: Role of temporalis muscle over activity in chronic tension type headache: effect of yoga based management.

A study by Bhatia et al. (2007) investigated the therapeutic value of yoga for management of chronic tension type headache (CTTH).  Chronic tension type headache refers to at least 15 episodes per month of mild-to-moderate pressure, tightness, or band-like pain – usually around the forehead, head, and/or neck.  It should be noted that CTTH is a distinct diagnosis from that of migraine, however, both diagnoses share similar features.

In any regard, the first part of this study sought to elucidate the role of muscle spasm in CTTH using EMG (electromyography).  Researchers recorded m. temporalis EMG for 1 minute during rest, mental activity, and maximal voluntary contractions.  Additionally, subjective pain of CTTH was measured with a visual analogue scale.

After collection of the EMG data, it was apparent that patients with CTTH exhibited overactivation of the m. temporalis (both right and left sides) – compared to the non-CTTH controls.  Thereafter, researchers tested various interventions including: botulinum toxin injections, NSAIDs, and yoga – to determine which would most effectively offset the abnormal m. temporalis overactivation.  Of the aforestated interventions, yoga was significantly more effective than others in reducing EMG amplitude (during rest and metal activity).

What’s more, yoga therapy also reduced scores of subjective pain from approximately 7.00 to 2.00.  Researchers concluded that non-invasive therapies appear therapeutically useful for the management of chronic tension type headache.  Although this was a very small-scale study, and further research is warranted to validate existing results, it highlights the potential benefit of yoga therapy among patients with CTTH.

Although the results of this study do not pertain to migraine patients, some interventions for CTTH are also effective for migraine management.  Knowing this, we could speculate that yoga therapy may be as effective (or perhaps more so) for migraine management than CTTH – especially for the reduction of pain.  Moreover, certain mechanisms by which yoga therapy appears to ameliorate CTTH may be similar to those by which it treats migraines.

  • Source: http://www.ncbi.nlm.nih.gov/pubmed/18476387

1994: Acute and prophylactic treatment of migraine.

A report by Reilly (1994) outlined some acute and prophylactic interventions for migraine.  Reilly mentioned that approximately 10% of all adults have experienced migraine and that migraine is regarded as a disabling health condition.  Various symptoms, possible causes, as well as triggers of migraine attacks are discussed.

In addition, some alternative treatments such as yoga and acupuncture are discussed.  Although in the mid-1990s yoga hadn’t received significant scientific support as an antimigraine intervention, it was discussed as a possibility.  Yoga may be a valuable intervention among patients who cannot tolerate and/or wish to avoid traditional pharmacology.

  • Source: http://www.ncbi.nlm.nih.gov/pubmed/8058492/

1992: Efficacy of yoga therapy in the management of headaches.

Researchers Latha and Kaliappan (1992) published a study in the Journal of Indian Psychology (Volume 10, 1992) evaluating the efficacy of yoga for the management of migraine and tension headaches.  A total of 20 migraine/headache patients were recruited to participate and assigned at random to receive: yoga therapy OR no treatment – for a duration of 4 months.  To determine the efficacy of yoga therapy for migraine/headache management, researchers assessed: headache activity (frequency, duration, intensity), medication usage, stress level, coping abilities, and somatic symptoms.

Assessments of the aforestated variables were conducted once at pre-treatment (baseline) and again after 4-months (post-treatment).  Results indicated that, after 4 months, there were significant decreases in: headache activity, medication usage, and perceived stress among those that received yoga therapy – compared to the “no treatment” group.  Yoga therapy also significantly improved coping abilities among the headache patients.

Although some may interpret the results of this study as yoga therapy being highly effective for headaches and/or migraines – others may not.  Not only was this study extremely small-scale, but it wasn’t controlled (with a placebo).  In this study, the yoga therapy was compared to “no treatment” – not even a sham-yoga (placebo) was utilized.

Moreover, the sample included both migraine and tension headache patients – despite differences in the neurophysiological underpinnings (and symptoms) of each condition.  Ultimately, it is difficult to regard this study as yielding credible evidence that yoga is effective for headache (migraine and tension).  That said, since a randomized controlled trial did find yoga beneficial for migraine management – the findings of these researchers may have been accurate.

  • Source: http://psycnet.apa.org/psycinfo/1993-42561-001

1981: A Comparative Study of Relative Effectiveness of Biofeedback and Shavasana (Yoga) in Tension Headache

A study published in the Indian Journal of Psychiatry by Sethi et al. (1981) was among the first to investigate the efficacy of multiple non-pharmacological interventions for the management of tension headache.  Some patients were assigned to receive EMG Biofeedback whereas the others were assigned to engage in Shavasana yoga.  Each of these techniques were understood to enhance relaxation, alter ANS activation, and were hypothesized to improve headache.

Those in the EMG Biofeedback group were observed at baseline for headache frequency and severity.  Patients receiving EMG Biofeedback were guided with auditory feedback to consciously modify their EMG levels.  After 4 preliminary training sessions to familiarize the patients with EMG Biofeedback, they were slated to receive bi-weekly 30 minute sessions for a duration of 10 weeks.

Individuals in the Shavasana yoga group were trained by a skilled yoga practitioner for 4 preliminary sessions to familiarize them with the practice.  Like the EMG Biofeedback group, baseline measures of headache frequency and severity were observed.  The Shavasana yoga was continued for an additional 10 weeks with 2 sessions per week for 30 minutes each.

In each group, progress of treatments was documented with a 5-point rating scale for headache and social adjustment; the lower the score – the better their symptoms.  By the end of the 12-week trial, 3 of the 16 patients had dropped out – meaning the only data to be assessed was from 13 patients.  Of the 13 patients, results indicated that: 6 individuals experienced significant headache improvement, 4 individuals experienced modest headache improvement, and 2 patients zero headache improvement.

Researchers suggested that, based on the aforestated results, EMG Biofeedback and Shavasana yoga were equally efficacious for the management of tension headache, but neither intervention was of greater efficacy than the other.  Results were somewhat similar to previous research in the 1970s in which progressive muscular relaxation and EMG biofeedback were of equal therapeutic efficacy for headache reduction.  There was a trend for quicker symptomatic remission among the yoga group (~13 sessions) compared to the biofeedback group (~16 sessions).

It should be noted that the extremely small sample size and design of the study may have yielded inaccurate results.  Additionally, there are differences between tension headaches and migraines, making it difficult to generalize the results of this study to migraine patients (as well as other types of headaches).  That said, this was among the first studies to investigate the effect of yoga on headache, and noted symptomatic benefit.

  • Source: http://www.ncbi.nlm.nih.gov/pubmed/22058528

Limitations associated with the research of yoga for migraines

Due to an array of limitations associated with the research of yoga for migraines, its efficacy as a migraine prophylactic remains unclear.  Examples of notable limitations include: suboptimal study designs and lack of incentive to publish further research.  Unless these limitations are addressed in the future, it will be difficult to recommend (or rule out) yoga as an efficacious non-pharmacological migraine prophylactic.

  • Practice parameters: In the available research investigating yoga for migraines, the practice parameters differed between the studies. Specific parameters associated with yoga such as: session length, number of sessions per week, and/or cumulative term of practice (e.g. 3 months) – may affect its efficacy.  It may be beneficial to pinpoint the minimal effective dose – or shortest sessions, fewest number of sessions, and/or shortest cumulative term of practice – necessary to significantly prevent migraines.
  • Migraine subtype: While it is important to confirm that yoga effectively prevents migraines, it may be necessary to investigate its efficacy in migraine patients based on subtype. Theoretically, certain interventions (including yoga) may be more efficacious among those with common migraine (no aura) compared to those with classic migraine (with aura); vice-versa also applies.  Migraine chronicity may also be an important factor to consider when attempting to determine which patients are most likely to benefit from yoga as a prophylactic.
  • Sample sizes: In a perfect world, every intervention with therapeutic potential would be tested in large sample sizes. The larger the samples (assuming robust designs are implemented), the more relevant the results to the general population.  Many of the studies investigating the migraine prophylactic effect of yoga utilized small-to-moderate sized samples.  Moreover, sample diversity (in regards to incorporation of both males and females) may also be helpful – most trials consist of significantly fewer men than women.
  • Study designs: The biggest problem with the current research of yoga for migraines is that designs are poor [by scientific standards]. Most published trials either fail to implement a placebo control and/or lack randomization.  To gather more substantial evidence regarding the effect of yoga on migraines, it is important to utilize a robust design – preferably randomized, placebo-controlled, and double-blinded.
  • Research bias: Another problem that may be more prevalent than suspected is research bias. Although there probably won’t be a financial incentive (such as provided by a pharmaceutical company) to prove that yoga is effective for migraines, this doesn’t automatically rule out the potential for bias.  Some researchers may strategically organize a study in such a way that outcomes (even of randomized controlled trials) may be biased.  In the single RCT assessing yoga for migraines, risk of bias was noted as “moderate.”
  • Type of yoga: There are many different types of yoga, some of which may be more effective than others for the management of migraines. Just as mindfulness meditation is considered effective as an adjunct intervention for certain medical conditions and transcendental meditation is not, one type of yoga (e.g. Hatha) may be more effective for migraine patients than another type (e.g. Raj).  As of current, it is unclear as to whether all types of yoga are of similar efficacy for migraine prophylaxis.
  • Unincentivized: Since yoga is a non-pharmacological intervention for migraine prophylaxis and cannot be patented by pharmaceutical companies, there’s no incentive to carry out additional research. Pharmaceutical companies cannot profit from yoga as a migraine prophylactic and neither can researchers.  For this reason, research dollars will be allocated to other avenues with greater profit potential.  Additionally, some may note that FDA-approved prophylactics (in the form of pills) are already available – implying that since proven interventions exist, researching the migraine prophylactic potential of yoga is unnecessary.

Is yoga an effective treatment for migraines?

Although numerous studies report that regularly-practiced yoga appears to reduce migraine attack frequency, its efficacy as a prophylactic should be considered “unknown.”  Surely most published trials conclude that yoga appears efficacious in reducing various parameters of migraine, including frequency.  However, of the entire body of literature investigating yoga as an antimigraine intervention, only a single trial can be analyzed as a potential source of legitimate evidence.

Most trials investigating yoga for the prevention of migraines are suboptimally designed, often lacking elements of randomization, placebo-control, and/or double-blinding.  What’s more, many trials utilize small sample sizes and/or assess the efficacy yoga as an adjunct prophylactic (rather than a standalone treatment).  While results of these trials shouldn’t be completely dismissed as useless drivel, most lack features necessary for clinical relevance.

A systematic review conducted by Kim (2015) found just one trial of sufficient quality to be further evaluated.  This standalone randomized controlled trial (RCT) was published by John et al. (2007) from a university in India.  A sample of 72 migraine patients participated in this trial, involving 60-minute yoga sessions, 5 days per week, over a span of 3 months – all under guidance of a yoga instructor.

Results revealed that patients practicing yoga had significantly fewer migraines than the control.  The intensity of migraines, anxiety/depression levels, and medication use – were all significantly reduced in the yoga group when compared to the control.  Although this was a well-designed study, a risk of bias tool suggested that there was “moderate” risk of bias in this study.

As a result of this moderate risk, it is difficult to make any definitive conclusions regarding the efficacy of yoga for migraine.  Still, it is important to highlight that preliminary evidence suggests that consistently-practiced yoga is able to reduce migraine frequency and symptomatic severity.  Since investigating yoga for migraine prophylaxis is underfunded (likely due to the fact that it cannot be patented and sold), it may take awhile for researchers to endorse or reject its therapeutic efficacy [as both a standalone and adjunct].

Will yoga exercises prevent migraines?

Due to lack of robust scientific evidence, cynics may be quick to dismiss yoga as a therapeutic migraine prophylactic.  However, absence of high-quality evidence does not indicate that yoga is automatically an ineffective prophylactic – nor does it mean that you should avoid testing it.  If every migraine patient waits 10-20 years for scientists to gather more evidence and publish more reviews before giving it a try, they may potentially miss out on years of prophylactic benefit (in the event that it turns out to be effective).

Even in the worst case scenario that yoga is scientifically ineffective as a migraine prophylactic, you may find it useful for improving other aspects of health – or your ability to psychologically cope with migraines.  Another point should be made that various non-evidence-based interventions for migraine (e.g. Fioricet for migraines) end up subjectively effective for certain users; the same may be true with yoga.  Since there are no risks of major adverse effects nor contraindications associated with yoga, migraine patients have little to lose by giving it a try.

How long should migraine patients practice yoga for a prophylactic effect?

Since there’s only a single RCT (randomized controlled trial) of decent quality, migraine patients seeking a prophylactic effect from yoga may wish to closely follow the parameters implemented in that particular trial.  In the trial, migraine patients participated in 5 yoga sessions per week for 60 minutes each – over a total duration of 3 months.  It should also be noted that patients were instructed and monitored by a yoga therapist.

Assuming you want to give yoga a legitimate chance to work as a migraine prophylactic, it may be best to follow the guidelines of 5 sessions per week at 60 minutes each – for at least 3 months.  You may also want to find a qualified yoga instructor to ensure that your form is proper.  This protocol appeared to reduce: migraine frequency, pain scores, and migraine medication usage.

It is possible that some individuals may require less frequent practice (e.g. 2 sessions per week) and/or sessions of shorter duration (e.g. 30 minutes) for therapeutic benefit.  There may also be interindividual variation in regards to the therapeutic efficacy of various parameters; one person may find that 2 sessions per week reduces migraines, while another may need at least 5 sessions for migraine reduction.  In other words, you may need to experiment for yourself to determine the most efficient frequency and/or duration of yoga necessary for migraine prophylaxis.

Have you tried yoga for migraine prevention?

If you suffer from migraines, share a comment whether you’ve tested yoga as an antimigraine intervention.  For those that have found yoga to be therapeutic for the management of migraines, provide some details such as the: type of yoga you practice (e.g. Bikram), duration of each yoga session (e.g. 45 minutes), and frequency of your yoga practice (e.g. 3 days per week).  If you’ve tested multiple styles/types of yoga, do you believe that a certain style was more effective than another for migraine prophylaxis?

To help others get a better understanding of your situation, mention the type of migraine you suffer from (e.g. episodic common migraine) – as well as whether you use yoga as a standalone or adjunct prophylactic.  After starting yoga, how long did it take before you noticed a significant reduction in the frequency and/or severity of your migraines?  In terms of antimigraine efficacy, what would you rate yoga on a scale from 1 to 10?

For individuals with migraine that would rather avoid pharmaceutical options (for a myriad of reasons: ineffectiveness, side effects, long-term effects, contraindications), yoga is a safe – possibly effective – alternative.  It’s efficacy as a migraine prophylactic may be contingent upon an interplay between: individualized neurophysiological and/or genetic causes of migraine, as well as yoga parameters (type, technique, session length, frequency of practice, and cumulative duration of practice).

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