Meditation and Yoga May Ease Migraine Symptoms, Study Shows

Struggling with migraines? This specific yoga routine can help, study says

Meditation and Yoga May Ease Migraine Symptoms, Study Shows

(CNN)Waking up with a slight headache that becomes painful enough to hinder daily life is the experience of many who suffer from migraines.

But for those on a medication plan, adding a yoga practice to their treatment repertoire may help to reduce the intensity and frequency of those troublesomemigraines, and how many pills they need to take to ease the pain, found a study published Wednesday in the journal Neurology.

A migraine is an intense pulsing or throbbing pain in one area of the head that can last for up to three days, with additional symptoms of nausea, vomiting and sensitivity to light and sound, according to the National Institute of Neurological Disorders and Stroke.

The most common trigger for migraines is stress. Because yoga is a gentle exercise that influences both body and mind, it's been found to be effective in managing symptoms of this oftendebilitating condition.

Migraine is one of the most common headache disorders, affecting more than 10% of people worldwide. Despite its prevalence, the condition remainsinsufficientlytreated, the study said, and many people end up having to take time off from workor school, resulting in declining job orschool performance and suffering a lower quality of life.

Though medications are the first resort for treatment, only about half of migraine patients find luck with them, the study reported.

For some people, medications cause negative side effects or don't completely take away the pain, said Andrew Russo, who holds two professorships at the University of Iowa — one in molecular physiology and biophysics and another in neurology. He was not involved in the study.

Trials of previous studies lasted only about a month, or didn't specify the yoga type, duration or timing, the report said. Given these circumstances, authors at the All India Institute of Medical Sciences (AIIMS) in New Delhi, India, studied the effectiveness of yoga in tandem with medications for people with migraines.

After a three-month yoga intervention, the participants who practiced a specific yoga module in addition to taking medications had more success in reducing migraine intensity, frequency and the amount of medication they had to take in comparison to the medication-only group.

«Yoga brings down stress, and stress is a precipitant for migraine,» said coauthor Dr. Gautam Sharma, a cardiology professor and head of the Centre for Integrative Medicine and Research (part of AIIMS). «It's improving the mood, decreasing depression. It's acting one of the anti-anxiety medicines, and all of these medicines are used for migraine.»

Holistic intervention

At AIIMS, participants were counseled for 10 minutes on lifestyle changes including sleep, meals, mental relaxation and an exercise schedule.

All patients were given a headache log book and asked to make daily entries about how long their headaches lasted, pain score, any associated sickness, area of the headache, any triggering activities or events and medications and their effects.

A total of 114 people were split between two groups; one took medication only while the other added a standardized yoga module to their treatment plan. In the yoga group, participants followed the regimen for three days per week for one month at AIIMS, led by a qualified yoga therapist under the supervision of doctors who integrate yoga into medical practice.

For the next two months, they followed the program five days a week at home with the help of a guidebook of the yoga module. Whether they kept up with the program was tracked by a twice-monthly phone call from the yoga center and a daily log the participants were asked to maintain.

Though the yoga group had more headaches at the beginning of the intervention, after three months their headache frequency, intensity, pill intake and scores on the Headache Impact Test and Migraine Disability Assessment questionnaire all had higher rates and speed of improvement in comparison to the medication-only group. Both tests evaluate how people's migraines impact their daily lives.

More than 12% of the people in the yoga group became headache-freeat the end of the intervention, in comparison to none in the medication-only group. By the same time, they reduced their average pill intake by more than 47%.

«I thought it was a very clever design to do [the study]with the medication because all too often we see Western versus Eastern or holistic medicine, and it shouldn't be viewed as such,» Russo said.

«[It]showed that they're complementary.

It's a fallacy to think Eastern or yoga-type therapies, mindfulness-type therapies that are more holistic and pill versions don't involve the same nervous system.»

And their MIDAS scores, the test assessing how migraine influences a person's everyday life, fell by more than 37%.

Yoga for stress relief

Causes of migraine include depression, anxiety, exhaustion, muscle tension and sensory overload. But the most consistent trigger shown to be occurring with the conditionis stress, Russo said.

The researchers think yoga could work for alleviating migraine for a number of reasons connected to physical, biochemical, psychological and neurological health.

Yoga reduces activity of the sympathetic nervous system, which controls the body's involuntary response to stressful situations, increasing heart rate and alertness and sending extra blood to the muscles, Sharma said. Less sympathetic nervous system drive equals less stress, while more parasympathetic activity leads to a state of calm, which is central to yoga practice.

Practicing yoga may reduce migraine attacks by also improving nitric oxide levels, which the body produces to relax the blood vessels, increasing blood flow and lowering blood pressure, according to a 2015 study the researchers cited.

Yoga may help people with migraine by lessening the tension in the area of pain or where the pain stems from — such as the head, neck and shoulders — and loosening stiff muscles. Tight muscles hold stress, which can trigger migraines.

Another study found mindfulness-based stress-reduction techniques, which are similar to yoga, had positive results among people with migraine. The participants of that study also lowered their MIDAS and HIT scores and had similar results for headache intensity and frequency.

The authors of the current study also cited evidence that meditations and yoga postures influence regions of the brain.

Exercise has been observed to have therapeutic effects on migraine, but it also triggers the pain of them by releasing proteins and other substances that cause intense inflammation in the brain or compensate for insufficient oxygen.

«Yoga may differ in this regard from other forms of physical activity as yogic postures are performed slowly and gently along with breathing exercises, relaxation exercises and pranayama,» which may prevent an increase in those levels, the current study said.

«I think migraine occurs when there's a departure from homeostasis or, in other words, when there's an imbalance in the body,» Russo said. «What we think the medications are doing, such as blocking [that protein]; apparently with yoga you're restoring that balance by reducing stress.»

A strategic yoga routine

Yoga can bea cost-free, practical option for migraine treatment. But yoga is more than just exercise, Sharma said — it's «exercise plus.»

The breathing, relaxation and mindfulness techniques in the module helped participants go beyond the exercise component, into a «deep meditation [that] can be viewed as a spiritual practice as well,» Sharma said.

«The yoga that we know of is just the tip of the iceberg,» Sharma added, «and the more you practice, the deeper you go, the more benefit that you derive from yoga.»

People with migraine who want to try this yoga method should talk with their doctor about using it to supplement their treatment. They should also ask whether there are any reasons the practice could be harmful for them, Sharma said. Learning with a yoga therapist is ideal before venturing out on your own, but the module is for beginners.

The study's module started with prayer and breathing and meditation exercises. Next on the list were instant relaxation techniques. Then, sukshma vyayama, physical exercises to warm up the body. Quick relaxation techniques followed, in which patients observe their abdominal muscles while breathing. Next, a series of asanas, or physical techniques.

The meditation practice yoga nidra in savasana pose, or deep relaxation techniques, helped to relax the body toward the end of the practice.

The module concluded with pranayama exercises and poses, to control the breath and cool down. Pranayama means to extend vital energy beyond one's normal limitations, as the root word, «prana,» means life force, while «ayama» denotes expansion.

Further studies with follow-ups, different locations and yoga practice without medication are needed to determine the long-term benefits of yoga for migraine relief. But integrating yoga into treatment would help patients and their doctors move toward overall wellness rather than just curing the pain, Sharma said.

«My job as chief of integrative medicine at AIIMS is to explore how integrative, traditional medicine systems — especially yoga — can be used as an adjuvant to modern therapy,» Sharma said. The authors saw the study as evidence that, for migraines, a «wholesome, integrative medicine approach» can work.

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What Is Migraine? Symptoms, Causes, Diagnosis, Treatment, and Prevention

Meditation and Yoga May Ease Migraine Symptoms, Study Shows

There’s no cure for migraine, but there have been recent advances in treatment.

Medications to Treat and Prevent Migraine Attacks

Medical treatment options for migraine are twofold: drugs that work to alleviate symptoms once an attack has started and medications that prevent attacks from happening or reduce their frequency and severity.

Abortive Medications Acute, or abortive, treatments include over-the-counter pain relievers and prescription medications called triptans.

A newer category of abortive migraine treatments is the calcitonin gene-related peptide (CGRP) receptor antagonists, which include the oral medicines Ubrelvy (ubrogepant), approved by the Food and Drug Administration (FDA) in 2019,and Nurtec ODT (rimegepant), approved by the FDA in 2020.(In June 2021, Nurtec ODT was additionally approved to prevent episodic migraine.)

CGRP is a protein in the brain and nervous system involved in the transmission of pain and the reaction of tissues and blood vessels to that pain. It has long been implicated in the process by which migraine occurs. It is hoped that the arrival of anti-CGRP therapies will open a new era in the acute and preventive treatment of primary headache disorders, including migraine disease.

A newer abortive migraine treatment is Reyvow (lasmiditan), which is taken as an oral tablet and is the only approved drug in the 5-HT1F receptor agonist class.

Preventive Medications Most of the medications that have a preventive, or prophylactic, effect on migraine weren’t developed specifically for migraine; they’re primarily used for treating cardiovascular conditions, seizures, and depression. (Some research has shown a link between migraine and a greater risk for each of these, so treating migraine may also have protective or beneficial effects with respect to these conditions.)

Four newer drugs that were developed specifically to lower the frequency of migraine include Aimovig (erenumab),Ajovy (fremanezumab), Emgality (galcanezumab-gnlm), and Vyepti (eptinezumab). All four are CGRP antibodies, which block the action of CGRP, and all have been shown to reduce migraine days in both episodic and chronic migraine. Aimovig and Emgality are injected subcutaneously monthly, Ajovy is injected subcutaneously either monthly or every three months, and Vyepti is administered intravenously every three months.

Injections of Botox (onabotulinumtoxina) every 12 weeks may also help prevent migraine in some people with chronic migraine.

Some pharmacological treatments that help with chronic migraine are not effective when it comes to episodic migraine. Treatment will depend on what type of migraine you have.

Nerve Stimulation Devices for Migraine Relief

When medications aren’t providing adequate migraine relief, it may be worth trying a nerve stimulation device. These devices, of which there are several types, reduce pain or help prevent migraine episodes by delivering electrical or magnetic pulses to selected nerves.

They are unly to replace medications in a person’s migraine management plan, but they may help control pain when used alongside meds.

The available external devices target, respectively, the upper branch of the trigeminal nerve, on the forehead; the vagus nerve, via the neck; the occipital nerve, on the back of the head; and the peripheral nerves in the upper arm. An implanted device also targets the occipital nerve.

Side effects from nerve stimulation tend to be mild and mainly include redness, irritation, or muscle twitching at the site of the stimulation.

The main drawback of nerve stimulation devices may be that they’re expensive and not always covered by health insurance plans.

Learn More About Nerve Stimulation Devices for Migraine Treatment

Alternative and Complementary Therapies

In addition to medications, lifestyle changes (such as getting enough sleep, eating right, and managing stress) can help you avoid certain triggers, potentially preventing some migraine attacks. Practicing relaxation exercises, such as yoga and meditation, may ease migraine pain.

While the evidence isn’t definitive, some people with migraine have found that home remedies and alternative therapies such as acupuncture and biofeedback are effective. Consult with your healthcare provider to find an approach that works for you.

According to MedlinePlus, you should see your doctor if there are changes in your headache pattern, if treatments you’ve been using stop working, if your headaches are more severe when you’re lying down, or if you have bothersome side effects from your medication.

You should call 911 if you have problems with speech, vision, movement, paralysis, or loss of balance, particularly if you’ve never had these symptoms before with a migraine. If your headache starts suddenly, it may be an emergency.

Learn More About Treatment for Migraine: Medication, Alternative and Complementary Therapies, and More

Prevention of Migraine

While there’s no way to completely prevent migraine, some people are able to control their exposure to certain triggers that can prompt an episode. Often you need several triggers to lead to a migraine attack, not just one.

Common triggers for migraine attacks include the following:

Changes in the Weather

Many people report that changes in the weather, particularly changes in barometric pressure, trigger migraine attacks. Other weather-related migraine triggers include heat, humidity, wind, and reduced light exposure.

Poor air quality, from wildfires or other sources of air pollution, can also be a trigger for some people.

Lights, Sounds, or Smells

Bright lights — whether natural, such as sun glare, or the flickering of a fluorescent bulb — are known to trigger migraine in many people with the condition.

Loud noises and strong smells (from perfume, cleaning products, or secondhand smoke) are also associated with migraine onset.

In some cases, however, heightened sensitivity to light, sound, and smell are the early signs of an oncoming attack — rather than light, sound, or smell triggering the attack.


According to the American Migraine Foundation, about one-third of people cite dehydration as a migraine trigger. Make sure you’re drinking enough water throughout the day.

Disrupted Sleep

Getting too little or too much sleep can trigger migraine in some people, as can changes in your sleep-wake pattern, such as jet lag.

Foods and Food Additives

Certain foods and beverages, particularly alcoholic beverages, can be triggers. The flavor enhancer monosodium glutamate can also be a trigger, as can caffeine.

Foods containing the amino acid tyramine have been associated with migraine onset. Examples include aged cheese, smoked fish, chicken livers, figs, certain beans, and red wine.

The nitrates in cured meats such as bacon, hot dogs, salami, and other lunch meats are a trigger for some.

Research has also suggested that the artificial sweeteners aspartame and sucralose can be triggers.

And for some people, fruits such as avocados, bananas, and citrus as well as some nuts and seeds can trigger migraine.

Missing or skipping meals can trigger attacks, too.

One approach to discovering migraine food triggers is to try an elimination diet, in which certain foods are eliminated from the diet for a few weeks, then reintroduced one at a time to see whether a migraine attack occurs.

However, a given food does not always trigger a migraine attack; sometimes another trigger, such as a change in the weather, also has to be present for an attack to take place. Or a certain amount of food has to be consumed before it has an effect, according to an article published in June 2020 in the journal Nutrients.

Elimination diets can deprive you of whole-food groups for an extended period, potentially leading to nutrient shortfalls, and they can be difficult and stressful to follow. What’s more, undernutrition itself can be a migraine trigger, as noted in an article in Cephalagia.

For that reason, most experts recommend consulting your physician before trying an elimination diet for migraine and, if you do decide to try it, working with a registered dietitian to maintain good nutrition.

Stress or Relief From Stress

Everyday stress can trigger a migraine attack, as can the relaxation that may occur following stress. The American Migraine Foundation reports that stress is a trigger for 70 percent of individuals with migraine.In turn, the chronic pain of migraine can cause stress. It’s important to find healthy ways to reduce or avoid stressors, at work and at home, when possible.


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