Yoga enhances conventional medical therapy in patients with episodic migraine

Reference

Kumar A, Bhatia R, Sharma G, et al. Effect of yoga as add-on therapy in migraine (CONTAIN): A randomized clinical trial. Neurology 2020;94(21):e2203-e2212.

Synopsis

This study took place in a single center in India where they randomized patients with "episodic migraine" to receive undefined conventional medical therapy (n = 80) or yoga combined with conventional therapy (n = 80). Although this was an open-label study, the authors report that the outcomes were recorded by an assessor masked to treatment allocation. Since the outcomes included things such as headache frequency, headache intensity, and migraine disability, all of which seem heavily dependent on patient report, it is unclear what this step really added other than the illusion of objectivity. Having said that, it is difficult to imagine what sham yoga looks like. Anyway, the patients allocated to conventional therapy alone continued whatever it was they had been taking and those assigned to yoga continued their medical therapy but also attended supervised sessions 3 times weekly for 1 month, followed by 2 more months of home yoga sessions 5 times weekly. After 3 months, 46 (28.8%) patients did not continue. This is a worrisome degree of drop-out that makes the outcome data potentially suspect. With the data at hand, patients in each group had statistically significant improvements over baseline in headache frequency, headache intensity, headache impact, migraine-related disability, and pill counts. However, the patients who also performed yoga had greater net improvements. For example, the yoga patients had a net 2.2 fewer headaches. It is unclear if the improvements in the other measures, such as disability ratings and pill count, were clinically important. Three control patients reported adverse events: 2 reported weight gain, 1 reported dry mouth. Only 1 yoga patient reported an adverse effect: weight gain.