CC BY-NC-ND 4.0 · J Neurosci Rural Pract 2016; 7(01): 109-113
DOI: 10.4103/0976-3147.165389
Original Article
Journal of Neurosciences in Rural Practice

Influence of hydrotherapy on clinical and cardiac autonomic function in migraine patients

M. U. Sujan
Department of Neurophysiology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
M. Raghavendra Rao
2   Department of Complementary and Alternative Medicine, Health Care Global Enterprises Private Ltd., Bengaluru, Karnataka, India
Ravikiran Kisan
Department of Neurophysiology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
Hulegar A. Abhishekh
Department of Neurophysiology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
Atchayaram Nalini
1   Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
Trichur R. Raju
Department of Neurophysiology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
T. N. Sathyaprabha
Department of Neurophysiology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
› Author Affiliations
Further Information

Publication History

Publication Date:
25 September 2019 (online)


Background: Migraine is associated with autonomic symptoms. The growing body of literature suggests that the dysfunctional autonomic nervous system might play a pivotal role in the pathogenesis of migraine. Thermal therapies have been hypothesized to modulate these changes and alleviate pain. However, data regarding the efficacy of hydrotherapy in migraine remain scant. We evaluated the effect of add on hydrotherapy procedure (a hot arm and foot bath with ice massage to head) in migraine patients. Methods: Forty chronic migraine patients fulfilling the International Classification of Headache Disorders II criteria were recruited from the neurology outpatient clinic. Patients were randomized to receive either hydrotherapy plus conventional pharmacological care (n = 20) or conventional medication only (n = 20). Hydrotherapy group received treatment with hot arm and foot bath (103°F to 110°F) and ice massage to head daily for 20 min for 45 days. Patients were assessed using headache impact test (HIT), visual analog scale for pain and cardiac autonomic function by heart rate variability (HRV) before and after intervention period. Results: There was a significant decrease in HIT score, frequency, and intensity of headaches following treatment in both the groups. However, it was more evident in add on hydrotherapy group compared to pharmacological treatment alone group. There was also significant improvement in the HRV parameters. In particular, there was a significant decrease in heart rate (P = 0.017), increase in high frequency (HF) (P = 0.014) and decrease in low frequency/HF ratio (P = 0.004) in add on hydrotherapy group. Conclusion: Our study shows that add on hydrotherapy enhanced the vagal tone in addition to reducing the frequency and intensity of headaches in migraine patients.

  • References

  • 1 D’Amico D, Grazzi L, Usai S, Leonardi M, Raggi A. Disability and quality of life in headache: Where we are now and where we are heading. Neurol Sci 2013; 34 Suppl (Suppl. 01) S1-5
  • 2 Pryse-Phillips W, Findlay H, Tugwell P, Edmeads J, Murray TJ, Nelson RF. A Canadian population survey on the clinical, epidemiologic and societal impact of migraine and tension-type headache. Can J Neurol Sci 1992; 19: 333-9
  • 3 Steiner TJ, Scher AI, Stewart WF, Kolodner K, Liberman J, Lipton RB. The prevalence and disability burden of adult migraine in England and their relationships to age, gender and ethnicity. Cephalalgia 2003; 23: 519-27
  • 4 Avnon Y, Nitzan M, Sprecher E, Rogowski Z, Yarnitsky D. Different patterns of parasympathetic activation in uni- and bilateral migraineurs. Brain 2003; 126: 1660-70
  • 5 Bugdayci G, Yildiz S, Altunrende B, Yildiz N, Alkoy S. Salivary alpha amylase activity in migraine patients. Auton Neurosci 2010; 155: 121-4
  • 6 Ekici B, Unal-Cevik I, Akgul-Ercan E, Morkavuk G, Yakut Y, Erkan AF. Duration of migraine is associated with cardiac diastolic dysfunction. Pain Med 2013; 14: 988-93
  • 7 Nilsen KB, Tronvik E, Sand T, Gravdahl GB, Stovner LJ. Increased baroreflex sensitivity and heart rate variability in migraine patients. Acta Neurol Scand 2009; 120: 418-23
  • 8 Alstadhaug KB. Migraine and the hypothalamus. Cephalalgia 2009; 29: 809-17
  • 9 Leone M, Proietti Cecchini A, Mea E, Curone M, Tullo V, Casucci G. et al. Functional neuroimaging and headache pathophysiology: New findings and new prospects. Neurol Sci 2007; 28 Suppl (Suppl. 02) S108-13
  • 10 Peroutka SJ. Migraine: A chronic sympathetic nervous system disorder. Headache 2004; 44: 53-64
  • 11 Law S, Derry S, Moore RA. Sumatriptan plus naproxen for acute migraine attacks in adults. Cochrane Database Syst Rev 2013; 10: CD008541
  • 12 Büssing A, Ostermann T, Lüdtke R, Michalsen A. Effects of yoga interventions on pain and pain-associated disability: A meta-analysis. J Pain 2012; 13: 1-9
  • 13 John PJ, Sharma N, Sharma CM, Kankane A. Effectiveness of yoga therapy in the treatment of migraine without aura: A randomized controlled trial. Headache 2007; 47: 654-61
  • 14 Kisan R, Sujan M, Adoor M, Rao R, Nalini A, Kutty BM. et al. Effect of Yoga on migraine: A comprehensive study using clinical profile and cardiac autonomic functions. Int J Yoga 2014; 7: 126-32
  • 15 Waller B, Lambeck J, Daly D. Therapeutic aquatic exercise in the treatment of low back pain: A systematic review. Clin Rehabil 2009; 23: 3-14
  • 16 Bender T, Karagülle Z, Bálint GP, Gutenbrunner C, Bálint PV, Sukenik S. Hydrotherapy, balneotherapy, and spa treatment in pain management. Rheumatol Int 2005; 25: 220-4
  • 17 Langhorst J, Musial F, Klose P, Häuser W. Efficacy of hydrotherapy in fibromyalgia syndrome – A meta-analysis of randomized controlled clinical trials. Rheumatology (Oxford) 2009; 48: 1155-9
  • 18 Mooventhan A, Nivethitha L. Scientific evidence-based effects of hydrotherapy on various systems of the body. N Am J Med Sci 2014; 6: 199-209
  • 19 Mortimer R, Privopoulos M, Kumar S. The effectiveness of hydrotherapy in the treatment of social and behavioral aspects of children with autism spectrum disorders: A systematic review. J Multidiscip Healthc 2014; 7: 93-104
  • 20 Plecash AR, Leavitt BR. Aquatherapy for neurodegenerative disorders. J Huntingtons Dis 2014; 3: 5-11
  • 21 Yang M, Rendas-Baum R, Varon SF, Kosinski M. Validation of the Headache Impact Test (HIT-6™) across episodic and chronic migraine. Cephalalgia 2011; 31: 357-67
  • 22 Heart rate variability: Standards of measurement, physiological interpretation and clinical use. Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology. Circulation 1996; 93: 1043-65
  • 23 Abhishekh HA, Kumar NC, Thirthalli J, Chandrashekar H, Gangadhar BN, Sathyaprabha TN. Prolonged reaction to mental arithmetic stress in first-degree relatives of schizophrenia patients. Clin Schizophr Relat Psychoses 2014; 8: 137-42
  • 24 Abhishekh HA, Nisarga P, Kisan R, Meghana A, Chandran S, Trichur R. et al. Influence of age and gender on autonomic regulation of heart. J Clin Monit Comput 2013; 27: 259-64
  • 25 Dhargave P, Nalini A, Abhishekh HA, Meghana A, Nagarathna R, Raju TR. et al. Assessment of cardiac autonomic function in patients with Duchenne muscular dystrophy using short term heart rate variability measures. Eur J Paediatr Neurol 2014; 18: 317-20
  • 26 Gass JJ, Glaros AG. Autonomic dysregulation in headache patients. Appl Psychophysiol Biofeedback 2013; 38: 257-63
  • 27 Perciaccante A, Fiorentini A, Valente R, Granata M, Tubani L. Migraine and heart rate variability. Arch Intern Med 2007; 167: 2264
  • 28 Bäcker M, Grossman P, Schneider J, Michalsen A, Knoblauch N, Tan L. et al. Acupuncture in migraine: Investigation of autonomic effects. Clin J Pain 2008; 24: 106-15
  • 29 Perini R, Veicsteinas A. Heart rate variability and autonomic activity at rest and during exercise in various physiological conditions. Eur J Appl Physiol 2003; 90: 317-25
  • 30 Nishimura M, Onodera S. Effects of water temperature on cardiac autonomic nervous system modulation during supine floating. J Gravit Physiol 2001; 8: P65-6