BACKGROUND: Migraine is a prevalent and debilitating neurological disorder that significantly affects quality of life. While pharmacological treatments exist, they can have limitations such as side effects, contraindications, and incomplete relief, prompting interest in non-pharmacological approaches for better symptom management. OBJECTIVE: This study aimed to assess the effectiveness of alternate nostril breathing (ANB) as a non-pharmacological intervention to reduce the frequency and severity of migraine attacks and associated disability in adult patients. METHODS: A single-center, open-label, two-arm, parallel-group randomized controlled trial was conducted at six Family Health Centers (FHCs) of Dokuz Eylul University, Izmir, Turkey. A total of 86 migraine patients aged 18 to 50 years, diagnosed with migraine based on ICD-10 criteria, were randomized into control (n = 43) and intervention (n = 43) groups. The intervention group practiced ANB three times daily for three months, while the control group continued their usual care. The primary outcomes were changes in migraine frequency and severity. Secondary outcomes included changes in migraine-related disability, both outcomes measured using the Migraine Disability Assessment Scale (MIDAS). RESULTS: The intervention group showed a significant reduction in migraine attack frequency (p = 0.002) and MIDAS scores (p = 0.003) compared to the control group. Both groups experienced a reduction in attack severity (p = 0.001), though no significant difference was observed between the groups (p = 0.074). Within-group comparisons showed significant improvements in attack frequency, severity, and MIDAS scores in the intervention group (p = 0.001 for all). CONCLUSION: ANB significantly reduced migraine frequency and disability, making it a promising non-invasive and accessible treatment option for migraine management. Further research with longer follow-up periods is needed to explore its long-term effects and broader applicability.

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