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Migraine is a common and debilitating disease. This meta-analysis examined the efficacy of yoga therapy in patients with migraine. The authors found a significant decrease in migraine pain intensity in patients who received yoga therapy versus controls (standard mean difference [SMD], −1.21; P = .01). Headache frequency (SMD, −1.43), headache duration (SMD, −1.03), headache impact test scores (SMD, –2.28), and migraine disability assessment scores (SMD, −0.52) also decreased with yoga therapy (P < .05 for all), although significant heterogeneity in the included studies was present.
Yoga therapy may be an effective and low-risk treatment option for patients with migraine; however, additional studies on its efficacy are warranted.
Yoga therapy may have some potential in treating migraine, and thus this meta-analysis aims to explore the efficacy of yoga therapy for patients with migraine.
PubMed, EMbase, Web of science, EBSCO and Cochrane library databases have been systematically searched and we included the randomized controlled trials (RCTs) reporting the efficacy of yoga therapy for migraine patients. The outcomes included.
This meta-analysis included six RCTs. The results revealed that compared with control group for migraine, yoga therapy was associated with remarkably decreased pain intensity (SMD = -1.21; 95% CI = -2.17 to -0.25; P = 0.01), headache frequency (SMD = -1.43; 95% CI = -2.23 to -0.64; P = 0.0004), headache duration (SMD = -1.03; 95% CI = -1.85 to -0.21; P = 0.01), HIT-6 score (SMD = -2.28; 95% CI = -3.81 to -0.75; P = 0.003) and MIDAS score (SMD = -0.52; 95% CI = -0.77 to -0.27; P < 0.0001).
Yoga therapy may be effective to treat migraine patients, but it should be recommended with caution because of heterogeneity.
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.
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.
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
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.