Freedom from Migraines: How Yoga May Help
Imagine a heated rod placed on your head, moving back and forth. Imagine, now, a tight container surrounding your head becoming smaller and smaller, squishing your brain. You may also be losing vision or feeling nauseous. It is difficult to even imagine the panic and suffering caused by such an experience, yet these are some of the ways in which people have described suffering from migraines.
Migraines are relatively common. A recent study (Burch et al., 2018) that analyzed data from the National Health Interview Survey showed that migraine and headache prevalence is around 15.3% for the U.S. population. Migraine episodes often leave people drained and dissuaded from being productive, thus contributing to a lower quality of life. Still, it doesn’t end there. People suffering from chronic migraines are also at a higher risk for other conditions, such as ischemic cerebrovascular diseases (Bigal, 2011). In short, migraines are a pain.
Despite the prevalence and burden of migraines, our understanding of migraine disorders leaves much to be desired. We don’t understand the causes of migraines well, but suspect the condition may be related to an imbalance of neurotransmitters — tiny chemicals that our nerve cells fire to communicate amongst each other. Furthermore, overuse of medications can lead to adverse effects, rebound headaches for instance, which then require a cascade of other medications (see here).
Yoga may play a role in addressing this situation, as per the recent study by Kumar et al. (2020). In it, the researchers studied the efficacy of yoga in relieving episodic migraine symptoms by randomly assigning individuals into two groups: yoga and medication. The yoga group received migraine medication and practiced a predetermined yoga routine, while the medication group only received the medication. The yoga group, which practiced a mix of breath regulation (pranayama), yogic postures (asanas) and sitting meditation had a greater decrease in headache frequency (4.41 fewer days with headaches per month vs. 0.89 fewer headache days per month) and intensity (a score 2.61 points lower vs. a score 1.31 points lower on a 10 point headache intensity scale). It was also determined that the yoga group had a greater proportion of people who were headache-free (12.28%) as opposed to the medication-only group (0%) at the end of the three-month study.
There is much to learn about the mechanisms underlying this potentially therapeutic effect of yoga practice. One thing that is known, however, is that yoga can activate the parasympathetic nervous system and reduce potentially harmful stress responses associated with the sympathetic nervous system (for a simple explanation, see here).
Hatha yoga may even be better than strenuous gym workouts in regulating migraine episodes. The authors note that exercise can paradoxically have both therapeutic and negative effects on individuals suffering from migraines. Strenuous exercise leads to the release of opioids and beta-endorphin, which may ease symptoms, while also raising lactate and calcitonin gene-related peptide (CGRP) levels, which may act as triggers (Amin et al., 2019). Hatha yoga, on the other hand, is considered light exercise (Clay et al., 2015) and has been associated with lower blood lactate increase after aerobic exercise (Raju et al., 1986). So, yoga practice may not be associated with the possibly detrimental effects of strenuous exercise.
Work is not yet complete, however, as these results come from subjective self-reporting, not objective biophysical markers. Similarly, it is unclear which aspects of the yoga routine may have a therapeutic effect- is it just the postures or breathing patterns? Ideally, future studies should include measurements of nitric oxide or other molecules that may be involved in the pathogenesis of the disease. Still, as we continue our struggle in understanding and treating ailments, it may be time to look more closely at systems of mind-body discipline such as yoga and elucidate their mechanisms of action.
References:
Amin, F.M., Aristeidou, S., Baraldi, C., Czapinska-Ciepiela, E.K., Ariadni, D.D., Di Lenola, D., Fenech, C., Kampouris, K., Karagiorgis, G., Braschinsky, M., et al. (2018). The association between migraine and physical exercise. J Headache Pain 19.
Bigal, M.E. (2011). Migraine and cardiovascular disease. Arq Neuropsiquiatr 69, 122–129.
Burch, R., Rizzoli, P., and Loder, E. (2018). The Prevalence and Impact of Migraine and Severe Headache in the United States: Figures and Trends From Government Health Studies. Headache 58, 496–505.
Clay, C.C., Lloyd, L.K., Walker, J.L., Sharp, K.R., and Pankey, R.B. (2005). The metabolic cost of hatha yoga. J Strength Cond Res 19, 604–610.
Kumar, A., Bhatia, R., Sharma, G., Dhanlika, D., Vishnubhatla, S., Singh, R.K., Dash, D., Tripathi, M., and Srivastava, M.V.P. (2020). Effect of yoga as add-on therapy in migraine (CONTAIN): A randomized clinical trial. Neurology 94, e2203–e2212.
Raju, P.S., Kumar K.A., Reddy S.S., Madhavi S., Gnanakumari K. Bhaskaracharyulu C., Reddy M.V., Annapurna N., Reddy M.E., Girijakumari D., et al. (1986). Effect of yoga on exercise tolerance in normal healthy volunteers. Indian J Physiol Pharmacol 30, 121–132.
