Today in the chart

When your patients ask how to manage their migraines as outpatients, you probably discuss food triggers, getting enough sleep, and avoiding alcohol. Now there’s new evidence that adding yoga to their regularly prescribed migraine treatment may be better than medication alone, according to a study published in Neurology, the medical journal of the American Academy of Neurology. The research suggests yoga may help people with migraines have episodes that happen less often, don’t last as long, and are less painful.

The study involved 114 people between 18 and 50 who had episodic migraines. Participants experienced four to 14 headaches per month and were randomly assigned to two groups: medication-only or yoga plus medication. The people in the yoga group were taught a one-hour yoga practice that included breathing and relaxation exercises and postures. People were supervised by a yoga instructor three days a week for one month. Then they practiced independently at home five days a week over the next two months. Both groups received the appropriate medications and counseling about lifestyle changes that may help with migraines, such as getting adequate sleep, eating regular meals, and exercising.

The study showed people self-reported that they improved in both the medication-only group and the yoga group. Still, the benefit was higher in the yoga group in all areas, including headache frequency, pain intensity, use of medications, and how many migraines interfered with daily life.

For headache frequency, the yoga group started with an average of 9.1 headaches per month and ended the study reporting just 4.7 headaches per month, a 48% reduction. The medication-only group reported an average of 7.7 headaches per month at the start of the study and 6.8 at the end of the three months, a 12% decrease.

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

Why does yoga seem to be beneficial? Regular exercise is frequently recommended for migraines because it modifies pain, which could be a factor. However, around 22% of migraine patients complain as exercise was a trigger, and hence some patients avoid exercise and are physically less active. Yoga requires slower or even static movements that are more beneficial than aerobic or other types of exercise. In addition, studies have shown that gentle, mindful exercise, including walking and qigong, may alleviate stress and other types of pain.

Nothing can replace treatment prescribed by a healthcare professional for migraines. But yoga as an add-on therapy for migraines may be superior to medical therapy alone. In addition, integrating a cost-effective and safe intervention like yoga into managing migraines may be useful.