Effect of yoga as add-on therapy in migraine (CONTAIN)
Anand Kumar, Rohit Bhatia, Gautam Sharma, Dhanlika Dhanlika, Sreenivas Vishnubhatla, Rajesh Kumar Singh, Deepa Dash, Manjari Tripathi, M.V. Padma Srivastava
Abstract
<h3>Objective</h3> To evaluate the effectiveness of yoga as an adjuvant to conventional medical management on clinical outcomes in patients with migraine. <h3>Methods</h3> CONTAIN was a prospective, randomized, open-label superiority trial with blinded endpoint assessment carried out at a single tertiary care academic hospital in New Delhi, India. Patients enrolled were aged 18–50 years with a diagnosis of episodic migraine and were randomized into medical and yoga groups (1:1). Randomization was computer-generated with a variable block size and concealed. A predesigned yoga intervention was given for 3 months. Outcomes were recorded by a blinded assessor. The primary endpoint was a decrease in headache frequency, headache intensity, and Headache Impact Test (HIT)–6 score. Secondary outcomes included change in Migraine Disability Assessment (MIDAS) score, pill count, and proportion of headache free patients. <h3>Results</h3> Between April 2017 and August 2018, 160 patients with episodic migraine were randomly assigned to medical and yoga groups. A total of 114 patients completed the trial. Baseline measures were comparable except for a higher mean headache frequency in the yoga group. Compared to medical therapy, the yoga group showed a significant mean delta value reduction in headache frequency (delta difference 3.53 [95% confidence interval 2.52–4.54]; <i>p</i> < 0.0001), headache intensity (1.31 [0.60–2.01]; <i>p</i> = 0.0004), HIT score (8.0 [4.78–11.22]; <i>p</i> < 0.0001), MIDAS score (7.85 [4.98–10.97]; <i>p</i> < 0.0001), and pill count (2.28 [1.06–3.51]; <i>p</i> < 0.0003). <h3>Conclusion</h3> Yoga as an add-on therapy in migraine is superior to medical therapy alone. It may be useful to integrate a cost-effective and safe intervention like yoga into the management of migraine. <h3>Clinicaltrials.gov identifier</h3> CTRI/2017/03/008041. <h3>Classification of evidence</h3> This study provides Class III evidence that for patients with episodic migraine, yoga as adjuvant to medical therapy improves headache frequency, intensity, impact, and disability.