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Pilot study of Laughter Yoga therapy in treatment of chronic migraine
Soma Sahai-Srivastava, M.D, Andrew Joyce, B.A. , Ceren Ugurlu, M.D, Carroll Christie, M.D, Christina Manh, B.A. , Hilary Kimblin, University of Southern California, Los Angeles, California
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Results
Objectives
Results
To study effects of laughter yoga in chronic migraine patients in addition to usual treatment.
19 total cases and controls enrolled and 14 completed the study.
12 Patients serves as cases alone, 5 patients were controls only, and 2 served as their own cross over control. Patients who were randomized as controls were offered positions as cases after completing control trial
They were all female with an average age of years.
No difference in demographics between case and control group
The LY group had average headaches (13.875/month) at baseline which did not decrease significantly (13.5/month) at week 8.
Quality of life scores at 8 weeks improved in in the LY group (MSQLv2 Role Function Restrictive (RFR) 42 to 65, Role Function Preventive (RFP) 55 to 78, Emotional Function (EF) 49 to 70) compared to usual care (MSQLv2 RFR 31 to 32, RFP 51 to 40.8, EF 31 to 28) .
HIT-6 scores for LY group showed a mild improvement at 8 weeks (65 to 60), compared to usual care group (67 to 68).
Fatigue scores showed a trend towards improvement in both groups with greater improvement in the LY group; LY group (47 to 41), usual care (54 and 49).
No major side effects except 2 patients had co-morbid TMJ disorder which may have been aggravated by LY therapy.
Introduction
Chronic migraine is a disabling headache disorder that affects 1.4–2.2% of the US population.
Traditional yoga postures and exercises have been shown to decrease migraine frequency and severity.
Laughter yoga is a less well known technique that includes mimicking facial movements of laughter to induce a state of mirthfulness.
Laughter is natural human emotion which may improve stress levels and muscle relaxation by decreasing levels of cortisol, dopamine, epinephrine, and growth hormone.
The effects of laughter yoga without the use of traditional postures have not been formally studied for chronic migraine.
Figure 1. Improvement and decline of controls and subjects by survey scores. Reported as a percent. Positive scores are improvement and negative scores show decline.
Conclusion
Addition of Laughter Yoga therapy to usual medical therapy is feasible low risk treatment that may improve quality of life and depression in chronic migraineurs while also decreasing headache impact on daily life. Laughter Yoga therapy may also cause a mild decrease in headache frequency.
Survey Score, mean
Control
Baseline
8 weeks
Change pt. (%) ↑ / ↓
Subject
MSQLv2.1 scale best-worst [ 100-0]
MSQLv2.1 RFR
31.0
32.9
1.9(1.9) ↑
42.1
65.0
22.9 (22.9) ↑
MSQLv2.1 RFP
51.4
40.8
-10.6 (-10.6) ↓
55.0
78.1
23.1(23.1) ↑
MSQLv2.1 EF
31.4
28.9
-2.5 (-2.5) ↓
48.9 70
21.1 (21.1) ↑
HIT-6 scale best-worst [36-78]
HIT-6
67.0
68.3
2.5 (3.0) ↓
65.5
59.5
-6.0(-14.3) ↑
FSS scale best-worst [9-63]
FSS
53.7
49.0
-4.7 (-8.4) ↑
46.9
41.4
-5.5(-9.8) ↑
PHQ-9 scale best-worst [ 0-27]
PHQ-9
15.9
14.5
-1.4 (-5.2) ↑
11.5
6.75
-4.75 (-17.6) ↑
Methods
Randomized case-control study of 19 chronic migraineurs
Patients were randomized to usual care including medical treatment or usual care in addition to Laughter Yoga therapy once a week for an hour with a live instructor in group sessions, followed by daily practice at home (LY group).
We collected data that included;
Demographics
Vital signs
And validated survey instruments; the Migraine Specific Quality of Life Questionaire (MSQLv2.1), HeadacheImpace Test (HIT-6), Fatigue Severity Scale (FSS), and Patient Health Questionaire (PHQ-9)
Data was collected at baseline, at week 4 and 8
References
Lipton RB, Stewart WF, Diamond S, et al. Prevalence and burden of migraine in the United States: data from the American Migraine Study II. Headache. 2001;41(7):
John, P. J., Neha Sharma, Chandra M. Sharma, and Arvind Kankane. "Effectiveness of yoga therapy in the treatment of migraine without aura: a randomized controlled trial." Headache: The Journal of Head and Face Pain 47, no. 5 (2007): Berk, L. S., et al. (1989)
Neuroendocrine and stress hormone changes during mirthful laughter. American Journal of the Medical Sciences, 298,
Streeter CC, et al. Effects of yoga versus walking on mood, anxiety, and brain GABA levels: a randomized controlled MRS study. Journal of Alternative and Complementary Medicine. Vol. 16,
Natoli, J. L., et al. "Global prevalence of chronic migraine: a systematic review." Cephalalgia (2009).
Table 1. Mean survey scores for controls and subjects
↑ indicates improvement for the specified survey ↓ indicates a decline for the specified survey.