Background: There has been a significant increase in the use of complementary and integrative medicine to provide long-term healing solutions in migraine headache patients. Knowing the limitations of conventional medical approach, the present study evaluated the influence of two Indian traditional systems of medicine on migraine-related disability, autonomic variables, perceived stress, and muscle activity in patients with migraine headache without aura. Methods: Thirty subjects recruited to the Ayurveda and Yoga (AY) group underwent traditional Panchakarma (Bio-purification) using therapeutic Purgation followed by yoga therapy, while 30 subjects of control (CT) group continued on symptomatic treatment (non-steroidal anti-inflammatory drugs [NSAID’s]) for 90 days. Migraine disability assessment score, perceived stress, heart rate variability (HRV), and surface electromyography (EMG) of frontalis muscle were measured on day 1, day 30, and day 90 in both groups. Results: Significant reduction in migraine disability and perceived stress scores were observed in the AY group. The low-frequency component of the HRV decreased significantly, the high-frequency component increased and their ratio showed improved sympathovagal balance. The EMG showed decreased activity of the frontalis muscle in the AY group compared to the control group. Conclusion: The integrative approach combining Ayurveda and Yoga therapy reduces migraine-related disability, perceived stress, sympathetic arousal, and muscle tension.

Keywords:
Integrative medicine, Ayurveda, Yoga therapy, Migraine, Pain, Disability, Stress
1.
Dodick DW: Review of comorbidities and risk factors for the development of migraine complications (infarct and chronic migraine). Cephalalgia 2009; 29(suppl 3): 7–14.
2.
Dawn CB, Marcia FT, Rupnow T, Richard BL: Assessing and managing all aspects of migraine: migraine attacks, migraine-related functional impairment, common comorbidities, and quality of life. Mayo Clin Proc 2009; 84: 422–435.
3.
Stewart WF, Lipton RB, Whyte J, Dowson A, Kolodner K, Liberman JN, Sawyer J: An International study to assess reliability of the migraine disability assessment (MIDAS) score. Neurology 1999; 53: 988–994.
4.
Maki K, Vahtera J, Virtanen M, Elovainio M, Keltikangas-Jarvinen L, Kivimaki M: Work stress and new-onset migraine in a female employee population. Cephalalgia 2008; 28: 18–25.
5.
Moon H, Seo JG, Park SP: Perceived stress in patients with migraine: a case-control study. J Headache Pain 2017; 18: 73.
6.
Cortelli P, Pierangeli G, Parchi P, Contin M, Baruzzi A, Lugaresi E: Autonomic nervous system function in migraine without aura. Headache 1991; 31: 457–462.
7.
Jensen R, Fuglsang-Frederiksen A, Olesen J: Quantitative surface EMG of pericranial muscles in headache, a population study. Electroencephalogr Clin Neurophysiol 1994; 93: 335–344.
8.
Leistad RB, Sand T, Westgaard RH, Nilsen KB, Stovner LJ: Stress-induced pain and muscle activity in patients with migraine and tension-type headache. Cephalalgia 2006; 26: 64–73.
9.
Goadsby PJ: Bench to bedside advances in the 21st century for primary headache disorders: migraine treatments for migraine patients. Brain 2016; 139: 2571–2577.
10.
Jaideep SS, Nagaraja D, Pal PK, Sudhakara D, Satyaprabha TN: Modulation of cardiac autonomic dysfunction in ischemic stroke following Ayurveda (Indian System of Medicine) Treatment. Evid Based Complement Alternat Med 2014; 2014: 634695.
11.
Peterson CT, Lucas J, John-William L, Thompson JW, Moseley MA, Patel S, Peterson SN, Porter V, Schadt EE, Mills PJ, Tanzi RE, Doraiswamy PM, Chopra D: Identification of altered metabolomic profiles following a panchakarma-based Ayurvedic Intervention in healthy subjects: The Self-Directed Biological Transformation Initiative (SBTI). Sci Rep 2016; 6: 32609.
12.
Vaidya PB, Vaidya BS, Vaidya SK: Response to Ayurvedic therapy in the treatment of migraine without aura. Int J Ayurveda Res 2010; 1: 30–36.
13.
Mishra K, Singh P, Bunch SJ, Bunch SJ, Zhang R: The therapeutic value of yoga in neurological disorders. Ann Indian Acad Neurol 2012; 15: 247–254.
14.
Sargent J, Solbach P, Coyne L, Spohn H, Segerson J: Results of a controlled, experimental, outcome study of nondrug treatments for the control of migraine headaches. J Behav Med 1986; 9: 291–323.
15.
International Headache Society: International classification of headache disorders. Cephalalgia 2013; 33: 629–808.
16.
Cohen S, Williamson GM: Perceived stress in a probability sample of the United States. Soc Psychol Health 1988: 31–67.
17.
Gada MT: A comparative study of efficacy of EMG bio-feedback and progressive muscular relaxation in tension headache. Indian J Psychiatry 1984; 26: 121–127.
18.
De Luca CJ: The use of surface electromyography in biomechanics. J Appl Biomech 1997; 13: 135–163.
19.
Yadunandan U (ed): Ashtanga Hrudayam of Vagbhata with Vidyotini Hindi commentary, ed 12. Varanasi, Chaukhambha Sanskrit Sansthan, 1997, pp 380–474.
20.
Rais A, Bhatted S: Clinical study to evaluate the effect of Virechana karma on serum electrolytes. Ayu 2013; 34: 379–382.
21.
Shastri P (ed): Sharangadhara Samhita, Madhyama Khanda. Varanasi, Oriental Publishers and Distributors, 1985, vol. 2, pp 145–147.
22.
Niteshwar K, Vidayanath R: Sahasra Yoga Churnaprakarana 62. Varanasi, Chaukhambha Bharati Academy, 2007.
23.
Wells RE, Burch R, Paulsen RH, Wayne PM, Houle TT, Loder E: Meditation for migraines: a pilot randomized controlled trial. Headache 2014; 54: 1484–1495.
24.
Michalsen A, Grossman P, Acil A, Langhorst J, Ludtke R, Esch T, Stefano GB, Dobos GJ: Rapid stress reduction and anxiolysis among distressed women as a consequence of a three-month intensive yoga program. Med Sci Monit 2005; 11: 555–561.
25.
Basler AJ: Pilot study investigating the effects of Ayurvedic Abhyanga massage on subjective stress experience. J Altern Complement Med 2011; 17: 435–440.
26.
Salahuddin L, Cho J, Jeong MG, Kim D: Ultrashort term analysis of heart rate variability for monitoring mental stress in mobile settings. Conf Proc IEEE Eng Med Biol Soc 2007; 4656–4659.
27.
Bhimani NT, Kulkarni NB, Kowale A, Salvi S: Effect of pranayama on stress and cardiovascular autonomic function. Indian J Physiol Pharmacol 2011; 55: 370–377.
28.
Mason H, Vandoni M, deBarbieri G, Codrons E, Ugargol V, Bernardi L: Cardiovascular and respiratory effect of Yogic slow breathing in the Yoga beginner: what is the best approach? Evid Based Complement Alternat Med 2013; 2013: 743504.
29.
Brown RP, Gerbarg PL: Yoga breathing, meditation, and longevity. Ann N Y Acad Sci 2009; 1172: 54–62.
30.
Thirthalli J, Naveen GH, Rao MG, Varambally S, Christopher R, Gangadhar BN: Cortisol and antidepressant effects of yoga. Indian J Psychiatry 2013; 55: 405–408.
31.
deCharms RC, Maeda F, Glover GH, Ludlow D, John MP, Soneji D, John DE, Gabrieli JD, Mackey SC: Control over brain activation and pain learned by using real-time functional MRI. Proc Natl Acad Sci USA 2005; 102: 18626–18631.
32.
Grant JA, Courtemanche J, Duerden EG, Duncan GH, Rainville P: Cortical thickness and pain sensitivity in Zen meditators. Emotion 2010; 10: 43–53.
33.
Grossman P, Niemann L, Schmidt S, Walach H: Mindfulness-based stress reduction and health benefits. A meta-analysis. J Psychosomat Res 2004; 57: 35–43.
34.
Streeter CC, Gerbarg PL, Saper RB, Ciraulo DA, Brown RP: Effects of yoga on the autonomic nervous system, gamma-aminobutyric-acid, and allostasis in epilepsy, depression, and post-traumatic stress disorder. Med Hypotheses 2012; 78: 571–579.
35.
Larsson SE, Larsson R, Zhang Q, Cai H, Oberg PA: Effects of psychophysiological stress on trapezius muscles blood flow and electromyography during static load. Eur J Appl Physiol 1995; 71: 493–498.
36.
Bhatia R, Dureja GP, Tripathi M, Bhattacharjee M, Bijlani RL, Mathur R: Role of temporalis muscle over activity in chronic tension type headache: effect of yoga based management. Indian J Physiol Pharmacol 2007; 51: 333–344.
37.
Natsume Y, Neeraj K, Tripathi SM, Nose M, Bhutani KK: Kalyanaka ghrita: an example of intertextuality among the Bower manuscript, Charak samhita, Susruta samhita, Astangahrdayam samhita and Ayurvedic Formulary of India (AFI). Ind J Trad Knowl 2015; 14: 519–524.
38.
Peterson CT, Denniston K, Chopra D: Therapeutic uses of Triphala in Ayurvedic Medicine. J Altern Complement Med 2017; 23: 607–614.
39.
Gupta SC, Patchva S, Aggarwal B: Therapeutic roles of curcumin: lessons learned from clinical trials. AAPS J 2013; 15: 195–218.
40.
Subramanian M, Chintalwar GJ, Chattopadhyay S: Antioxidant properties of a Tinospora cordifolia polysaccharide against iron-mediated lipid damage and gamma-ray induced protein damage. Redox Rep 2002; 7: 137–143.
41.
Chua LS: Review on liver inflammation and anti inflammatory activity of Andrographis paniculata for hepatoprotection. Phytother Res 2014; 28: 1589–1598.
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