title: Influence of hydrotherapy on clinical and cardiac autonomic function in migraine patients.
abstract: 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.
  
  
  CONCLUSIONS
  Our study shows that add on hydrotherapy enhanced the vagal tone in addition to reducing the frequency and intensity of headaches in migraine patients.
authors.affiliation: Department of Neurophysiology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India.
authors.forename: M U
authors.initials: MU
authors.lastname: Sujan
authors.affiliation: Department of Complementary and Alternative Medicine, Health Care Global Enterprises Private Ltd., Bengaluru, Karnataka, India.
authors.forename: M Raghavendra
authors.initials: MR
authors.lastname: Rao
authors.affiliation: Department of Neurophysiology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India.
authors.forename: Ravikiran
authors.initials: R
authors.lastname: Kisan
authors.affiliation: Department of Neurophysiology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India.
authors.forename: Hulegar A
authors.initials: HA
authors.lastname: Abhishekh
authors.affiliation: Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India.
authors.forename: Atchayaram
authors.initials: A
authors.lastname: Nalini
authors.affiliation: Department of Neurophysiology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India.
authors.forename: Trichur R
authors.initials: TR
authors.lastname: Raju
authors.affiliation: Department of Neurophysiology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India.
authors.forename: T N
authors.initials: TN
authors.lastname: Sathyaprabha
keywords: Headache; heart rate variability; hydrotherapy; migraine