BACKGROUND: Chronic migraine is a disabling neurological condition often associated with autonomic dysregulation. Yoga-based interventions, particularly pranayama and relaxation, may provide non-pharmacological benefits; however, few studies have systematically evaluated their physiological and clinical impact. OBJECTIVE: To assess the adjunctive effects of a structured pranayama and relaxation (P plus R) program on clinical outcomes and autonomic function in patients with chronic migraine receiving standard medical treatment. METHODS: In this randomized controlled trial, 90 adults with chronic migraine were assigned to either a P plus R intervention or a control group. The P plus R group received daily guided sessions for 12 weeks alongside standard pharmacological care, while the control group continued standard care alone. The primary outcome was change in monthly headache frequency. Secondary outcomes included headache intensity (VAS), migraine-related disability (HIT-6), quality of life (SF-36), and autonomic function assessed through heart rate variability and standardized autonomic tests. Assessments were conducted at baseline and after 12 weeks. RESULTS: Both groups exhibited significant clinical improvement following the intervention period. However, the intervention group demonstrated a significantly greater reduction in headache frequency (mean reduction -7.1versus -4.6 days/month, p < 0.001), pain intensity (VAS -6.8versus -3.2, p < 0.001), and disability scores (HIT-6 -33.0versus -21.6, p < 0.001) compared to the control group. Quality of life improvements were more pronounced in the intervention arm, especially in physical and vitality domains. Objective autonomic assessment revealed increased HRV indices (higher RMSSD, HF_nu; lower LF/HF ratio) and significant reductions in resting heart rate and blood pressure only in the intervention group, indicating enhanced parasympathetic tone. No adverse events were reported, and adherence rates were high. CONCLUSION: A 12-week pranayama and relaxation program, when added to standard migraine therapy, resulted in significant clinical and autonomic improvements. These findings support the integration of mind-body techniques as effective adjuncts in the multidisciplinary management of chronic migraine.

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