Downward dog for migraine?

Effectiveness of yoga therapy for migraine treatment: A meta-analysis of randomized controlled studies.

When I saw the title of this research article, I was immediately intrigued. I’ve been doing yoga for years, sporadically. I’d been told I should do yoga every day for migraine but I’ve never been able to find the time or the money for a daily in-person class, which are usually 45-60 minutes long and might cost $20 or more a session.

But when the pandemic happened and we went into lockdown, I started an earnest investigation of online yoga classes. There were so many options. I could pick the type of class that suited my mood and energy level. I could opt for a short or a long class, and I could even pause the class to check on dinner or put out the washing. I could do it at whatever time I wanted. I know some people like the social contact of an in-person class, but I was perfectly happy not being able to see how other people’s warrior poses were so much better than mine. And it was free!

Yoga feels wonderful to me, and I love the connection between moving the body and calming the mind, but it also feels like my migraine attacks have been less severe since I started a regular practice. By regular, I mean ‘daily but with regular omissions’, and maybe 20-30 minutes on average.

The research article confirmed my hunch about the benefit of yoga, to some extent. It found that yoga therapy was consistently associated with decreased pain intensity, headache frequency, headache duration and impact of headache/disability. This was based on six randomised controlled trials (RCTs), five of which had been conducted in Asia and one in the US.

RCTs are considered the strongest type of research evidence, because study participants are randomly assigned to the treatment group or a control group (that doesn’t receive the treatment). The random assignment means that these studies are much less likely to be affected by bias than studies that observe what people do. For example, a study that looked at rates of migraine in people who do yoga compared to people who don’t would not give conclusive evidence about the influence of yoga on migraine. This is because people who do yoga are almost certainly different from people who don’t, and these differences may be the actual causes of different rates of migraine in each group.

The research had some limitations, however. Not all of the RCTs reported on the same outcomes, which made it difficult to compare the results. The studies were relatively small, ranging from 15-80 people in each of the treatment and control groups. The best type of RCTs are ‘blinded’ so that participants do not know whether they are receiving the treatment or not, and ‘placebo-controlled’ but this wasn’t possible for trials of yoga, as no sham or placebo yoga practice exists. The yoga treatments in these studies lasted between 6 weeks to 3 months and there was no ‘standard’ treatment. The duration and frequency of yoga sessions in each trial weren’t documented, but were noted to be diverse.

What can we take from this? Regular exercise is known to be helpful for managing migraine, and yoga may have additional value through the use of breathing to dampen down the body’s stress responses and elevate the systems in control of rest and relaxation. Not everyone enjoys yoga, but other activities may have similar benefits. In the words of my favourite online yoga instructor, Adriene Mishler, “Find what feels good.”

Fiona Imlach, Co-founder of Migraine Foundation Aotearoa New Zealand

  1. Wu Q, Liu P, Liao C, Tan L. Effectiveness of yoga therapy for migraine: A meta-a10.1016/j.jocn.2022.01.018.nalysis of randomized controlled studies. J Clin Neurosci. 2022 May;99:147-151.
  2. Wells, R.E., Beuthin, J. & Granetzke, L. Complementary and Integrative Medicine for Episodic Migraine: an Update of Evidence from the Last 3 Years. Curr Pain Headache Rep 23, 10 (2019).