Study of Additive Effect of Yoga and Physical Therapies to Standard Pharmacologic Treatment in Migraine

Abstract

Objective We aimed to evaluate and compare the effectiveness of physical and yoga therapies as an adjuvant therapy along with standard pharmacologic treatment in patients with migraine. Materials and Methods A total of 61 consenting patients diagnosed to have migraine were randomized into three groups to receive either standard treatment alone, physical therapy along with standard treatment, or yoga therapy along with standard treatment. The respective adjuvant intervention was taught to the respective group of patients and they were advised to perform it daily for 3 months with weekly telephonic reminders and review of their activity logs. Outcome measures assessed were headache frequency, Short-Form McGill Pain Questionnaire (SF-MPQ), and Headache Impact Test-6 (HIT-6) at recruitment and once every month for 3 months. Statistical Analysis Statistical analysis of the study was done by using Stata 14.1 software. All the descriptive statistics, paired t-test was used to compare the difference between pre and postintervention values of headache frequency, SF-MPQ, and HIT-6 score within all the three groups. Analysis of variance test and post hoc test were used to compare the differences between all groups for outcome measures (p < 0.05). Results Headache frequency and the visual analog scale before intervention compared during each month intervals for 3 months in all the three groups were significantly decreased in all the three groups (p < 0.005). Yoga or physical therapy as an adjuvant to standard treatment leads to a higher reduction in headache frequency and severity. Sensory and affective pain ratings of SF-MPQ and HIT-6 also showed a significant improvement at 1 to 3 months of treatment compared with baseline in all the three groups. Conclusion Either physical or yoga therapy as an adjuvant to standard pharmacologic treatment may further improve the quality of life and reduce headache frequency in patients with migraine.

Prescription of therapeutic exercise in migraine, an evidence-based clinical practice guideline

“…No significant differences in duration 1- No adverse effects were reported related to yoga John et al, 2007 [ 51 ] RCT Episodic migraine without aura. IHS 2004 Experimental group : yoga ( n = 36) Control group: self-care ( n = 36) Frequency (headache days/week) Intensity (NRS and VAS) Duration (hours) Post-immediate Experimental group: Significant improvements in frequency, intensity, and duration of attack Control group: Significant increase of symptoms in all outcomes except duration Significant improvements in frequency, intensity and duration of pain favours the experimental group 1- No adverse effects were reported Kisan et al, 2014 [ 52 ] RCT Episodic migraine ICHD-II Experimental group : Yoga and conventional care ( n = 30) Control group: Conventional care ( n = 30) Frequency (Number of headaches/month) Intensity (VAS) Disability (HIT-6) Post-immediate Significant improvements in all outcomes in both groups Significant improvements in all outcomes favour the experimental group in post-immediate follow-up 1- No adverse effects were reported Kumar et al, 2020 [ 54 ] RCT Episodic migraine ICHD-III-beta Experimental group : Yoga and medical therapy (n = 80) Control group: Medical therapy ( n = 80) Frequency (headaches days/month) Intensity (VAS) Disability (HIT-6 and MIDAS) Post-immediate (3 months) Significant improvement in all outcomes in both groups Significant improvements in all outcomes favour experimental group in post-immediate follow-up 1- 1 patient reported weight gain in the intervention group, due to medication Mehta et al, 2021 [ 58 ] RCT ICHD III Episodic migraine, with or without aura …”

“…( n = 30) Control group : Amitriptyline alone. ( n = 30) Frequency (days/month) Intensity: 1 (mild), 2 (moderate) and 3 (disabling) Duration of headache (hours/day) Post-immediate - Significant improvements-favour the experimental group in frequency, moderate pain intensity and duration 1- 6 persons withdrew for non-adherence to the proposed physical treatment Köseoglu et al, 2003 [ 53 ] q-RCT IHS Episodic migraine without aura Aerobic exercise ( n = 40) Frequency (attacks/month) Intensity (a four-degree scale) Duration (hours of attack/month) Post-immediate Significant improvements in all outcomes - 1- No adverse effects were reported EXERCISE AND RELAXATION TECHNIQUES GRADE OF RECOMMENDATION: C in favour of intervention Dittrich et al, 2008 [ 48 ] RCT Episodic migraine with and without aura ICHD-I Experimental group: Aerobic exercise group and relaxation (n = 15) Control group: information about Physical activity (n = 15) Frequency (attacks/month) Pain intensity (slight, moderate, intense, very intense, intolerable) Quality of life (PLC) There were no significant differences in any outcome except in pain intensity in favour of the exercise group at post-immediate There were no significant differences in any outcome at post-immediate 1- No adverse effects were reported Mehta et al, 2021 [ 58 ] RCT ICHD III Episodic migraine, with or without aura Group 1: Physical therapy: PMR exercise, stretching, isometric exercise of neck muscles, and cardiorespiratory endurance training. (n = 20) Group 2: Yoga.…”

“…RCT ( n = 6): Kumar 2020 [ 54 ], Kisan 2014 [ 52 ], Boroujeni 2015 [ 45 ], John 2007 [ 51 ], Mehta 2021 [ 58 ], Wells 2021 [ 68 ]…”

Prescription of Therapeutic Exercise in Migraine. An Evidence-Based Clinical Practice Guideline of the Professional College of Physiotherapists of the Community of Madrid

“…It obtained a B grade of recommendation based on the results of 2 systematic reviews with meta-analysis [35,38], and 6 randomized controlled trials [41,42,44,48,59,61] (Table 8). A total of 467 patients with episodic migraine were included in these studies.…”

“…This modality consists of the combination of exercise and relaxation techniques, previously defined. This combination of techniques reached a C grade of recommendation based on the results of 2 randomized controlled trials [48,64], and 1 quasi-randomized trial [62] (Table 8). A total of 119 patients with migraine were included in these studies, of whom 91 were patients with episodic migraine and 28 had no clear differential diagnosis between episodic or chronic migraine.…”