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Original Article
6 (
1
); 41-51
doi:
10.25259/SRJHS_6_2026

Effect of select yoga practices on clinical, biochemical, and quality of life outcomes in patients with migraine: A randomized controlled trial

,
1Scientific Research Department, Kaivalyadhama Shriman Madhava Yoga Mandir Samiti (Kaivalyadhama Yoga Institute), Lonavala, Maharashtra, India.

*Corresponding author: Pratibha Hemant Rajbhoj, Scientific Research Department, Kaivalyadhama Shriman Madhava Yoga Mandir Samiti (Kaivalyadhama Yoga Institute), Lonavala, Maharashtra, India. pratibha@kdham.com

Received: , Accepted: ,
© 2026 Published by Scientific Scholar on behalf of Sri Ramachandra Journal of Health Sciences
Licence
This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, transform, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

How to cite this article: Rajbhoj PH, Bhogal RS. Effect of select yoga practices on clinical, biochemical, and quality of life outcomes in patients with migraine: A randomized controlled trial. Sri Ramachandra J Health Sci. 2026;6:41-51. doi: 10.25259/SRJHS_6_2026

Abstract

Objectives:

Migraine, a neurological disorder, is not only painful but also disabling and affects the daily life activities of the sufferer. According to the 2023 Global Burden of Disease Study, migraine remains a leading cause of headache-related years lived with disability worldwide, highlighting its significant global health burden. The objective of the study is to evaluate the effect of selected yoga practices on migraine-related disability, headache impact and intensity, cortisol, homocysteine, Vitamin B-12 (Vit B-12) levels, and overall well-being in migraine patients.

Material and Methods:

The current pilot study follows a randomized controlled trial design. A total of 32 migraine patients were randomly assigned, in equal numbers, into the Standard Care Group (G roup I) and the Standard Care and Yoga Group (G roup II). Assessments were conducted twice, once at baseline and again at post-intervention. Caregivers and outcome assessors were blinded. The data analysis was performed using descriptive statistics, paired, and independent t-tests.

Results:

Group II showed a significant reduction in Migraine Disability Assessment questionnaire (p = 0.001), headache impact test-6 (p < 0.0001), headache frequency (p = 0.001), pain intensity (P < 0.0001), and perceived stress (p < 0.0001). Significant improvement was observed in multiple domains of 36-item short-form, including physical functioning, emotional well-being, social functioning, and energy levels (all p < 0.05). Serum cortisol levels decreased significantly in Group II (p = 0.011). Homocysteine showed a decreasing trend, while Vit B-12 showed a non-significant increase.

Conclusion:

The findings suggest yoga can be an effective adjunct therapy for migraine management, contributing to a reduction in migraine-related disability, headache impact, frequency, and intensity. It also enhanced the physiological and psychological health of the patients. Further research, with larger sample sizes and long-term follow-up, is recommended.

Keywords

Homocysteine
Migraine
Migraine-related disability
Pranayama
Shuddhi Kriya

INTRODUCTION

Migraine is a chronic neurological disorder characterized by recurrent episodes of moderate to severe headache, often accompanied by nausea, vomiting, and sensitivity to light and sound. It significantly affects the quality of life, productivity, and overall well-being of suffering individuals. On a global basis, it is responsible for more disability than any other neurological problem. Recent global estimates indicate that migraine affects approximately 14–15% of the population worldwide, with a substantially higher prevalence in women than in men, consistently demonstrating a female-to-male ratio of nearly 3:1.[1,2] The prevalence varies by age, increasing to about 40 years and declining thereafter, in both men and women. The gender ratio also appears to vary by age, increasing from menarche to about age 42 years and declining thereafter.

Standard treatment strategies primarily focus on pharmacological interventions, which, while effective in symptom management, are often associated with side effects and limited long-term relief. As a result, there is a growing interest in complementary and alternative therapies, including yoga, to manage migraine symptoms more holistically. In recent times, migraine is treated with the help of pharmacological, non-pharmacological, and neurostimulation. Pharmacological management of migraine includes both acute and preventive therapies; however, frequent use of acute medications may increase the risk of medication overuse headache, and several preventive agents are associated with adverse effects and variable long-term adherence.[3-5] The non-pharmacological treatments are the most popular therapies that encompass stress management training and have been found to have good results, as compared to the pharmacological treatment, and are also found efficacious for comorbidities such as depression, anxiety, etc. Having no side effects, there is a growing interest in these complementary and alternative therapies, including yoga, towards managing migraine symptoms more holistically.[6]

Yoga, coupling Shuddhi-Kriya, Yogasana, Pranayama, and relaxation, is a popular alternative form of mind–body therapy. As per the yogic literature, Pranayama and Shatkriya/Shatkarma cleanse 72000 plus nadis, i.e., the energy channels in the human body. With the help of Shatkarmas, the yoga practitioners get rid of the waste materials from the body, resulting in cleaning the internal pranic pathways, thereby resulting in proper functioning of the related organ systems. The yogic way of life and regular practice of Pranayama and Shatkarma may help in restoring healthy neurological responses in migraine patients.[7,8]

Yoga, an ancient mind–body practice, has been shown to enhance overall well-being by reducing stress, improving autonomic balance, and promoting relaxation. Emerging evidences suggest yoga-based interventions may help alleviate migraine symptoms by modulating stress responses, improving blood circulation, and enhancing neurovascular functions.[9] The current research has systematically evaluated the impact of selected yoga practices on migraine-related disability, headache impact and intensity, cortisol, homocysteine, Vitamin B-12 (Vit B-12), and on overall well-being, in patients with migraine by employing a randomized controlled trial design. This study seeks to provide scientific evidence on the efficacy of yoga as an adjunct therapy for migraine management.

MATERIAL AND METHODS

Ethics

This study was approved by the Institute’s Independent Ethics Committee (IEC) of Kaivalyadhama Yoga Institute, Lonavala, India (IEC Approval No.: Kdham/SRD/IIEC-07/2021/02; Date of Approval: July 17, 2021) and was conducted in accordance with the ethical principles outlined in the Declaration of Helsinki (1975, revised 2000). Informed consent was obtained from all study participants before their enrollment. The study is registered with Clinical Trial Registry, India, having CTRI Number: CTRI/2021/11/038100.

Study design and participants

This is a randomized, controlled pilot study on 32 migraine patients of age ranging from 20 to 50 years. Age and gender matched participants were divided into two groups [Table 1] namely Group I (n1 = 16) and Group II (n2 = 16). Group I was the Standard Care Group (SCG) and Group II was the Standard Care and Yoga Group (SCYG). Group II underwent selected yoga practices for 5 days a week for 12 weeks. However, SCG was not given any intervention other than the standard care treatment.

Table 1: Migraine patients profile expressed in Mean±SD and percentage.
S. No. Profile Group I Group II Total
Mean ± SD/No. (%) Mean ± SD/No. % Mean ± SD/No. %
1. Age 34.63±8.35 36.00±11.14 35.31±9.71
2. Height 1.62±0.09 1.60±0.085 1.61±0.086
3. Weight 64.26±14.28 62.57±8.77 63.41±11.69
4. BMI 24.43±3.95 24.33±2.34 24.38±3.19
5. Gender
  Male 5 31.25 5 31.25 10 31.25
  Female 11 68.75 11 68.75 22 68.75
6. Socio economic status
  Below ₹17000 or not applicable 0 0 3 18.75 3 12
  ₹17,000/–₹40,000/- 4 25 4 25 8 32
  ₹41,000/–₹85,000/- 7 43.75 4 25 11 36
  ₹85,000/- and above 5 31.25 5 31.25 10 20
7. Marital status
  Married 13 75 11 68.75 24 68
  Unmarried 3 25 4 25 7 28
  Divorced 0 0 1 6.25 1 4
8. Diet
  Veg 6 41.7 5 31.25 11 34.4
  Veg and non-veg 10 58.3 11 68.75 21 65.6
9. Education
  High School 3 16.7 3 18.75 6 20
  Graduation 9 50 8 50 17 44
  Post-graduation 4 33.3 5 31.25 9 36
10. Migraine associated symptoms
Migraine headache
  With Aura 2 12.5 3 18.75 5 15.63
  Without Aura 14 87.5 13 81.25 27 84.37
11. Nausea
  Yes 13 81.25 12 18.75 5 15.63
  No 3 18.75 4 81.25 27 84.37
12. Headache severity reduces after vomiting
  Yes 7 43.75 10 62.5 17 53.13
  No 9 56.25 6 37.5 15 46.87
13. Photophobia
  Yes 15 93.75 15 93.75 30 93.75
  No 1 6.25 1 6.25 2 6.25
14. Phonophobia
  Yes 14 87.5 14 87.5 28 87.5
  No 2 12.5 2 12.5 4 12.5
15. Family history
  Yes 10 62.5 7 43.75 17 53.13
  No 6 37.5 9 56.25 15 46.87
Medication
16. Paracetamol 6 50 7 53.8 13 52
17. Ibuprofen 4 33.33 3 23.08 7 28
18. Acetylsalicylic acid 2 16.7 1 7.69 3 12
19. Pizotifen 2 16.7 3 23.08 5 20
20. Propranolol 1 8.33 2 15.38 3 12
21. Naproxen 1 8.33 1 7.69 2 8
22. Nimesulide 0 0 3 23.08 3 12
23. Sumatriptan 1 8.33 0 0 1 4
24. No medicines 1 8.33 0 0 1 4
Study compliance
25. Dropouts 4 25 3 18.75 7 21.88
26. Completed study 12 75 13 81.25 25 78.12
27. Total participants 16 100 16 100 32 100

SD: Standard deviation

Trial settings

Participants were enrolled from the outpatient department (OPD) section of the institute, local clinics, and through advertising the project enrollment on social media. Patients were then screened with the help of a neurologist and an ophthalmologist. Those fulfilling the International Classification of Headache Disorders-III criteria were only recruited for the study. A clinical trial was conducted at the research department of the host institute.

Eligibility criteria

Patients of age ranging from 20 to 50 years, satisfying the International Headache Society, ICHD-III criteria for migraine with or without aura and having a history of migraine for at least 2 years, with headache frequency of 5–15 attacks per month, and the individuals, ready to participate on their own will and ready to give written consent for participation in the study, were only included in the study. Patients with other medical and/or neurological illnesses, those with recent head or neck traumas within the preceding 2 years, and female patients who were pregnant or lactating, as well as those practicing yoga, were not recruited in the study.

Study groups

Group I: SCG

Migraine patients in this group were on standard care for the entire study period. Patients received guidance on maintaining a migraine-friendly diet, sleep hygiene, hydration, and stress management. Patients maintained a headache diary for this period. Confirmation of maintaining a daily diary was done by telephonic conversation or personal contact. All the assessments were done at the baseline and at the end of 12-week study period. Headache diaries of all the study participants were collected for review.

Group II: SCYG

The patients in this group continued the same standard care and attended the educational session, similar to that of Group I (SCG). The only difference was that they received additional intervention of Yoga therapy.

Participants in both the groups continued with routine standard care for migraine, guided by their physician. This included medications for both immediate relief (such as nonsteroidal anti-inflammatory drugs or triptans) and also when needed, daily preventive medicines. They also attended regular follow-ups to adjust treatment whenever needed. No additional yoga or complementary practices were introduced to the Group I participants during the study, for its clear comparison with the intervention group.

Each migraine patients in Group II were provided with a Neti pot to perform Jala Neti Kriya. They were requested to bring their own water bottle for Jala Dhauti (Vamana) Kriya. The entire yoga protocol [Table 2] was conducted at the research center for the 1st week only. Patients were instructed to come on an empty stomach so as to perform the selected yoga module under the supervision of a yoga therapist. After the 1st week of on-site yoga intervention, the yoga module was conducted online using the Skype/Zoom application, while keeping the video on. Patients were provided with a daily diary to maintain headache records for the entire duration of the study, which was verified at the end of the yoga session by the Yoga Therapist and the study investigators. At the end of 12 weeks of post-intervention, the assessment was conducted, and daily diaries were collected.

Table 2: Yoga intervention.
S. No. Name of the practice Round Time Frequency of practice
1. Jala Neti Kriya 1 10 min 2 days a week
2. Jala Dhauti (Vamana) Kriya 1 10 min Twice in 15 days, then once in 15 days, lastly once a month
3. Kapalabhati Kriya 3 5 min 5 days a week
4. Shavasana 1 5 min 5 days a week
5. Anuloma- Viloma Pranayama 10 5 min 5 days a week
6. Bhramari Pranayama 10 5 min 5 days a week
7. Ujjayi Pranayama 10 5 min 5 days a week
8. Simple meditation 1 10 min 5 days a week
Total time 35–55 min 60 sessions (3 months)

The patients in Group I were also provided with the same yoga intervention post-research study period, and were also provided with a separate Neti-pot to perform Neti Kriya.

Study measures

The following tests, corresponding to selected parameters, were administered:

Primary outcome

  1. Migraine disability assessment questionnaire (MIDAS): It is a five-item scale whereby the responses to these items are in number form. It assesses the impact of migraine on a person’s daily life by measuring migraine-related disability over the preceding 3 months. MIDAS measures migraine-related disability in three key areas, namely work/school productivity, household responsibilities, and social and leisure activities. The reliability coefficient (Cronbach’s α) for the MIDAS is >0.90.[10]

  2. Headache impact test-6 (HIT-6): This questionnaire helps assess headache severity, frequency, and the level of disability they cause. In each case, respondents are asked how often they felt a certain way. It consists of 6 items, and the responses to these items are on a 5-point Likert scale, ranging from “Never” to “Very Often”. The reliability coefficient (Cronbach’s α) for the HIT-6 ranges from 0.67 to 0.79.[10]

  3. Headache frequency: Migraine headache frequency was defined as the number of days a person experiences headache over the preceding 3 months. This was assessed using the MIDAS questionnaire.

  4. Migraine headache intensity: Migraine headache intensity was evaluated using the visual analog scale (VAS), a validated and widely used numbered scale showing 1–10 numbers for measuring subjective pain levels. It consists of a 10-cm horizontal line, anchored by two verbal descriptors at each end: “0” representing “no pain” and “10” representing “the worst pain imaginable.” Participants were instructed to indicate their headache intensity by placing a mark on the scale that best represented their pain during migraine attacks. Using this scale, pain intensity is further categorized as Mild pain: 0–3, Moderate pain: 3–6, Severe pain: 6–10.

Secondary outcomes

  1. Perceived stress scale (PSS): It measures the perception of stress. The questions in the PSS ask about feelings and thoughts during the preceding month. In each case, respondents were asked how often they felt a certain way. It consists of 10 items, and the responses to these items are on a 5-point Likert scale ranging from “Never” to “Very Often.” The reliability coefficient (Cronbach’s α) for the PSS is 0.715.[11]

  2. 36-Item short-form (SF-36) health survey: The SF-36 health survey is designed to assess a person’s overall health-related quality of life. It measures health status across eight domains, categorized into physical and mental health components. It is a 36-item scale, and the responses to these items are on different scales namely Likert scale and frequency scale.

  3. Serum cortisol, homocysteine, and Vit B-12 were assessed to explore potential biological correlates of migraine and to examine whether the yoga intervention influenced stress-related and metabolic pathways. Cortisol is a key biomarker of hypothalamic–pituitary– adrenal axis activity and is frequently elevated in chronic stress states, which are known migraine triggers. Homocysteine has been implicated in endothelial dysfunction and vascular dysregulation–mechanisms relevant to migraine pathophysiology. Vit B-12 plays an essential role in homocysteine metabolism, and deficiency may contribute to elevated homocysteine levels and vascular instability.

Biochemical tests: Serum cortisol, homocysteine, and Vit B-12 were measured on an enzyme-linked immunosorbent assay plate reader (Architect i1000 Fully Automated Immunoassay Analyser, Abbott USA) using Abbott Diagnostics (USA) enzyme immunoassay kit, where the sensitivity limit was 1.0 µg/dL, 1.00 µmoL/L and ≤30 pg/mL, respectively. The intra-assay coefficient of variation for serum cortisol was ≤5%; for homocysteine, it varies depending on the concentration of homocysteine in the sample, at a concentration of 11.00 µmoL/L, at 16.80 µmoL/L and at 24.30 µmoL/L it was approximately 2.7%, 2.4%, and 2.8% respectively and for Vit B 12 it varies depending on the concentration of Vit B-12 in the sample typically, for low concentration samples (~200 pg/mL), medium concentration samples (~500 pg/mL) and for high concentration samples, the intra-assay coefficient was approximately 3.5%, 2.5% and 2%, respectively.

Randomization and allocation

41 patients were screened. Of these 32 were found to be eligible for the study. Patients were randomized into Group I (Standard Care) and Group II (Conventional Care and Yoga), using the permuted block randomization method. Baseline data were collected 1 day before the beginning of the intervention. Post-intervention data were collected on the subsequent day following the completion of the 3-month intervention period [Figure 1]. Participants were instructed to come fasting early in the morning for blood collection at both time points.

Flow diagram of the progress through the phases of a randomized trial of two groups (i.e., enrollment, intervention allocation, follow-up and data analysis).
Figure 1:
Flow diagram of the progress through the phases of a randomized trial of two groups (i.e., enrollment, intervention allocation, follow-up and data analysis).

Blinding

To ensure confidentiality and minimize bias, each participant was assigned a unique identification code, and all study-related data were recorded using these codes. Caregivers and laboratory personnel involved in sample collection and clinical monitoring were blinded to the participants’ group assignments. For statistical analysis, datasets were anonymized, and intervention arms were labeled as Group I and Group II. The statistician, conducting the analysis, was blinded to group allocation to maintain objectivity.

Statistical analysis

Data analysis was performed using R software version 4.4.2. Demographic and anthropometric data were analyzed using descriptive statistics in the form of Mean ± standard deviation for continuous variables, and in the form of frequency (%) for categorical variables. The paired samples t-test was used to assess changes in outcome measures before and after the intervention within each group. For between-group comparisons, the independent samples t-test was employed. A p < 0.05 was considered statistically significant for all analyses.

RESULTS

A total of 32 participants were equally allocated to Group I and Group II. Of these, 25 adhered to the study protocol, while 7 dropped out 4 from Group I and 3 from Group II, resulting in 12 participants in Group I and 13 in Group II [Figure 1].

Migraine patients’ detailed profile

The mean age of the study participants was 35.31 ± 9.71 years, and the mean body weight was 63.41 ± 11.69 kg. A higher proportion of participants were female (69%), compared to males (31%). The majority of participants (36%) belonged to the middle socio-economic class.

With respect to dietary habits, the population included both pure vegetarians and mixed (vegetarian and non-vegetarian) diet followers, with the latter comprising a greater proportion (66%). All participants were formally educated, with graduates constituting the largest population (50%).

Clinically, the majority of patients were diagnosed with migraine without aura (84%). Most did not report persistent nausea (84%), though several reported symptomatic relief following vomiting (53.13%). Photophobia (94%) and phonophobia (88%) were common features among participants, and a positive family history of migraine was frequently noted (53%).

At baseline, the majority of the participants were already receiving standard pharmacological treatment for migraine under the supervision of their personal healthcare providers [Table 1].

Study parameters data

Within-group comparison [Table 3] highlights significant differences between Group I and Group II from baseline (T0) to post-intervention (T1). In Group I, there were no significant changes in migraine disability, migraine headache impact, headache intensity, physical functioning, role limitations due to physical health, role limitations due to emotional problems, emotional well-being, and social functioning, while perceived stress and pain levels increased. Group II showed a significant reduction in migraine-related disability (p = 0.001), headache impact (p < 0.0001), headache intensity (p < 0.0001), and perceived stress (p < 0.0001), alongside notable improvements observed in physical functioning (p = 0.027), emotional well-being (p < 0.0001), and social functioning (p < 0.0001). In addition, role limitations due to both physical and emotional problems were alleviated significantly in Group II, while energy levels (p < 0.0001) and general health (p = 0.001) also showed significant positive changes. In terms of biochemical markers, homocysteine levels significantly decreased (p = 0.007), and Vit B-12 levels showed a rising trend, though not significant, suggesting a potential metabolic benefit from the intervention. Meanwhile, cortisol levels remained stable in Group II while slightly increased in Group I. In Group I, headache frequency showed a trend of reduction with the help of standard care, but the difference was nearly significant (p = 0.06), whereas Group II showed a significant reduction (p < 0.0001) in it. Overall, the findings indicate the intervention had a strong positive effect on migraine-related disability, headache impact, intensity and frequency, stress, pain, and overall quality of life, whereas Group I experienced only minimal or negative changes over the study period.

Table 3: Within group comparison of results (paired samples t-test).
Parameters Time points Group I (n=12) Group II (n=13)
Mean±SD P-value Mean±SD p-value
MIDAS T0 39.50±18.99 0.987 24.85±18.69 0.001
T1 39.58±23.36 7.38±5.25
HIT-6 T0 64.58±6.93 0.211 64.62±6.87 <0.0001
T1 67.08±6.50 46.31±3.15
Headache frequency T0 23.17±6.35 0.006 21.08±4.05 <0.0001
T1 15.33±5.7 7.46±4.41
Headache intensity (VAS) T0 8.50±1.09 0.120 8.62±1.12 <0.0001
T1 7.83±1.19 5.15±0.80
Perceived stress scale T0 20.75±5.69 0.030 18.54±4.56 <0.0001
T1 24.25±3.25 10.31±2.81
Physical functioning T0 68.33±20.49 0.302 71.15±17.93 0.027
T1 59.17±27.46 82.31±14.38
Role limitations due to physical health T0 25.00±28.20 0.339 32.69±35.92 <0.0001
T1 18.75±24.13 96.15±9.39
Role limitations due to emotional problems T0 19.44±30.01 1.00 48.71±44.33 0.002
T1 19.44±26.43 94.87±12.52
Energy/fatigue T0 52.92±23.98 0.01 54.62±13.14 <0.0001
T1 44.17±22.95 78.85±5.06
Emotional well being T0 58.89±20.72 0.152 65.85±14.39 <0.0001
T1 53.67±18.72 86.15±4.79
Social functioning T0 47.17±21.29 0.163 62.50±16.93 <0.0001
T1 40.00±15.30 87.50±7.22
Pain T0 41.67±23.58 0.008 38.08±23.59 <0.0001
T1 23.09±13.88 78.27±10.07
General health T0 41.67±23.58 0.05 39.62±23.93 0.001
T1 41.25±17.98 66.92±9.69
Homocysteine (umoL/L) T0 20.79±13.21 0.242 17.39±12.33 0.007
T1 16.47±8.90 14.20±9.72
Vitamin B-12 (pg/mL) T0 179.83±79.38 0.391 172.00±78.70 0.199
T1 188.75±73.83 243.54±190.52
Cortisol (µg/dL) T0 10.36±6.10 0.064 8.40±2.23 0.960
T1 14.59±6.44 8.35±3.01

Group I-Standard Care Group, Group II-standard care+yoga group, T0: Baseline, T1: Post intervention/control period. VAS: Visual analogue scale. Results are shown as mean±SD, SD=Standard deviation, HIT-6: Headache impact test-6, MIDAS: Migraine disability assessment questionnaire, p < 0.05 considered statistically significant.

The between-group results [Table 4] of the study indicate that Group II experienced significant improvements across multiple health parameters. For migraine disability (MIDAS), there was no significant difference at baseline between the Group I and Group II both the groups showed severe disability related to migraine headache (Grade IV) at the baseline. Group II showed a significant reduction in it (p = 0.001), showing mild disability (Grade II) at the end of the intervention, whereas Group I showed no significant change in it.

Table 4: Between group comparison of results (independent samples t-test).
Parameters Time points Mean±SD p-value
Group I (n=12) Group II (n=12)
MIDAS T0 39.50±18.99 25.00±19.51 0.060
T1 39.58±23.36 7.83±5.22 0.001
HIT-6 T0 64.58±6.93 64.42±7.14 0.948
T1 67.08±6.50 46.17±3.24 <0.0001
Headache frequency T0 23.17±6.35 21.58±3.78 0.466
T1 15.33±5.7 7.75±4.48 0.001
Headache intensity (VAS) T0 8.50±1.09 8.50±1.08 1.000
T1 7.83±1.19 5.17±0.84 <0.0001
Perceived stress scale T0 20.75±5.69 18.25±4.63 0.255
T1 24.25±3.25 10.25±2.93 <0.0001
Physical functioning T0 68.33±20.49 71.67±18.63 0.687
T1 59.17±27.46 81.25±14.48 0.027
Role limitations due to physical health T0 25.00±28.20 35.42±36.08 0.435
T1 18.75±24.13 95.83±9.73 <0.0001
Role limitations due to emotional problems T0 19.44±30.01 52.77±43.71 0.011
T1 19.44±26.43 97.22±9.62 <0.0001
Energy/fatigue T0 52.92±23.98 55.83±12.94 0.644
T1 44.17±22.95 78.75±5.28 <0.0001
Emotional well being T0 58.89±20.72 66.67±14.71 0.093
T1 53.67±18.72 85.67±4.66 <0.0001
Social functioning T0 47.17±21.29 65.63±13.19 0.017
T1 40.00±15.30 87.50±7.54 <0.0001
Pain T0 41.67±23.58 41.25±21.55 0.958
T1 23.09±13.88 78.33±10.52 <0.0001
General health T0 53.75±24.69 41.25±24.23 0.187
T1 41.25±17.98 67.92±9.40 0.001
Homocysteine T0 20.79±13.21 17.92±12.72 0.623
T1 16.47±8.90 14.57±10.06 0.626
Vitamin B-12 T0 179.83±79.38 174.67±81.58 0.881
T1 188.75±73.83 245.42±198.87 0.398
Cortisol T0 10.36±6.10 8.50±2.29 0.303
T1 14.59±6.44 8.26±3.12 0.011

Group I-standard care group, Group II-standard care+yoga group, T0: Baseline, T1: Post intervention/control period. VAS: Visual analogue scale. Results are shown as mean±SD, SD=Standard deviation, HIT-6: Headache impact test-6, MIDAS: Migraine disability assessment questionnaire, p < 0.05 considered statistically significant.

At baseline, both groups demonstrated a severe impact of migraine on daily functioning, with comparable HIT-6 scores and no statistically significant difference. Post-intervention, Group II exhibited a significantly greater reduction (p < 0.0001) in HIT-6 scores compared to Group I, indicating minimal to no impact of migraine on daily life.

At baseline, both groups demonstrated comparable frequency of migraine headache with no statistical difference. At the end of the intervention, Group II showed a significant reduction (p = 0.001) in the frequency of migraine headache attacks compared to Group I.

At baseline, both groups showed comparable severe migraine headaches according to self-reported VAS scores, with no statistical difference. At the end of the intervention, Group II showed a significant reduction (p < 0.0001) in the scores of headache intensity compared to Group I with mild headache attacks.

Perceived stress levels also followed this trend, with no initial differences but a significant reduction in Group II after yoga (p <0.0001). Physical functioning remained similar between groups at baseline, yet after yoga intervention, Group II demonstrated a significant improvement (p = 0.027). Both physical and emotional role limitations showed remarkable enhancements in Group II, with p < 0.001 for both, indicating a substantial positive impact of yoga. Energy/fatigue levels improved significantly (p < 0.0001), and emotional well-being also showed a marked enhancement post-intervention (p < 0.0001) in Group II. Social functioning was significantly different at baseline but showed an even greater improvement after yoga (p < 0.0001), underlining the role of yoga in enhancing interpersonal interactions.

Pain levels, initially similar in both the groups, showed a significant reduction in Group II following yoga (p < 0.0001). General health also improved notably (p = 0.001) in Group II. In Group II, homocysteine showed a trend of reduction post-intervention, but the reduction is not significant. Similarly, for Vit B-12, it showed an increasing trend but not a significant post-intervention (p = 0.626 and p = 0.398, respectively). Interestingly, cortisol levels, a key indicator of stress, significantly decreased in Group II (p = 0.011), suggesting that yoga might have helped regulate stress responses.

DISCUSSION

In the current study, Group II showed a significant reduction in headache-related disability, functional impairment, impact on daily life, and severity of headache. Similarly, the stress levels and pain were reduced significantly. There was improvement in emotional and physical functioning and overall well-being. Furthermore, there was a substantial improvement in quality-of-life measures. These results are in line with the previous studies and reinforce the potential of yoga as a beneficial intervention for migraine.[6,9]

A few of the cross-sectional studies have shown that migraine patients experience migraine attacks when homocysteine levels are elevated.[12] So also, it is believed that elevated levels of homocysteine and below normal levels of Vit B-12 may damage the endothelial cells, leading to migraine attacks.[13]The most common reasons for high levels of homocysteine are genetic make-up, aging, lifestyle, medical conditions, and deficiency of Vit B-12, B-6, folate, and certain enzymes.[12]Migraine patients usually show Vit B-12 deficiency[14] and it is evident that there is a negative correlation between migraine attacks and Vit B-12.[13] Dietary Vit B-12 absorption relies on adequate stomach acidity.[15] In the stomach, dietary Vit B-12 is bound to proteins and requires gastric acid to release it. The optimum gastric acid pH levels are usually in the range 6.2– 12.[15] Once freed, Vit B-12 binds to intrinsic factor, a protein essential for its absorption in the small intestine. Disruptions in stomach acidity can impede this process, leading to Vit B-12 deficiency. Since one of the reasons for migraine is high levels of acidity[16] leading to overuse of acid suppressive treatment[17,18] that, in turn, may impede the absorption of Vit B-12 in migraine patients and thus may enter into a vicious cycle. In the current study, the yoga module was designed so as to help reduce stomach acidity. It might have helped the absorption of Vit B-12 in Group II participants. It is evident that there was a significant reduction in the homocysteine levels, and there was a trend of increase in Vit B-12 levels, although not significant. These results are compatible with the previous studies.[19,20]

Group II also showed a significant reduction in PSS levels and also a reduction in cortisol levels, which is considered the stress hormone. Both the outcome of the self-report questionnaire by the patients, as well as the biochemical markers of stress, showed complementarity, confirming the significant stress reduction. These results are in line with the previous studies.[21-23] In relation to acidity, as stress also plays a vital role, it is evident that stress leads to an increase in acidity.[24,25] Yoga practices, in the current study, may have helped to break this vicious cycle of increase in stress, increase in acidity, reduced absorption of dietary Vit B-12, increased levels of homocysteine. This may have helped reduce the severity and frequency of migraine attacks, which is very well evident in Group II, which also showed a reduction in pain and related disability[26] and their severity, as shown in the VAS, MIDAS, and HIT-6 scores post-intervention. These results are also compatible with the previous studies.[23,27-30]

Beyond headache relief, the study also highlights the holistic benefits of yoga on physiological and psychological well-being. Physiologically, yoga has shown a reduction in stress-related biomarkers such as cortisol[31,32] and homocysteine,[33-35] thus, improving vascular function that may have helped enhance overall neurological resilience.[8,36]Psychologically, participants reported a reduced perceived stress, improved emotional stability, reduced fatigue, and an enhanced general well-being; demonstrating yoga’s potential to address both the physical and mental burdens of migraine.

Limitations of this study

The number of participants in the present study is very small, as the study is a pilot trial. Due to COVID-19 pandemic, we were not able to get a sufficient number of patients from the neurology OPD, as against our intention of undertaking a full-fledged study with a larger sample. The present study does not involve the assessment of detraining post-intervention, which would have enabled us to see the long-term sustained effect of the treatment.

Suggestions for future research

Future research should explore the long-term sustainability of yoga’s benefits, its potential for migraine prevention, and its comparative effectiveness with standard treatment. In addition, investigating the underlying mechanisms through neuroimaging and biochemical analysis could provide deeper insights into how yoga promises its therapeutic effects in migraine patients.

CONCLUSION

The findings of this study indicate that yoga, including Shuddhi Kriyas and pranayama, and meditation, of only 35– 50 min of practice, can serve as an effective adjunct therapy in the management of migraine. Participants who were engaged in regular yoga practice demonstrated a significant reduction in headache intensity, reduced levels of homocysteine, suggesting that yoga may help alleviate the severity and also prevent the occurrence of migraine episodes. This could be attributed to yoga’s role in modulating the autonomic nervous system, reducing stress, and promoting neuroendocrine balance.

Acknowledgment:

The authors gratefully acknowledge the support of CCRYN, Government of India. They also thank Dr. O.P. Tiwari and Shri Subodh Tiwari for their continued support and encouragement. Sincere thanks are extended to Dr. Satish D. Pathak, Dr. Charudutt Apte, Dr. Aradhana Gaherwar, Dr. Paranjape, and Dr. Manasi Godbole for their clinical support; Dr. Amol Raut for his expert guidance; and Messrs. Godbole Laboratory for biochemical analyses. The authors also thank Ms. Priya Chaudhary and Mr. Deval Chauhan for diligently conducting the yoga sessions.

Ethical approval:

The research/study was approved by the Institutional Review Board at Independent Ethics Committee of Kaivalyadhama Yoga Institute, number Kdham/SRD/IEC-07/2021/02, dated 17th July 2021.

CTRI Number: CTRI/2021/11/038100.

Declaration of patient consent:

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given consent for clinical information to be reported in the journal. The patient understands that the patient’s names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Conflicts of interest:

There are no conflicts of interest.

Use of artificial intelligence (AI)-assisted technology for manuscript preparation:

The authors confirm that there was no use of artificial intelligence (AI)-assisted technology for assisting in the writing or editing of the manuscript, and no images were manipulated using AI.

Financial support and sponsorship: Nil.

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