Preventing Migraines (and Other Headaches), Part 2

by Nina

Yesterday I wrote about preventing migraines and other headaches through stress reduction (see Preventing Migraines (and Other Headaches), Part 1). Another way you may be able to prevent and/or reduce your headaches, is to practice yoga poses that release muscle tension in your back, shoulders, neck, and head. As Timothy says in the headache chapter of Yoga As Medicine:

“Yoga teaches that releasing the tight muscles improves blood flow to them, and can help relax the mind a well.”

But as Timothy also reminds us in all his writings about yoga therapy, everyone is different and yoga therapy, whether for migraines or any other condition, needs to be individualized. So with that in mind, I’m just going to toss out a lot of ideas for poses you can try to work with your back, shoulders, neck and head; you’ll have to figure out which works best for your body and your yoga experience level. In fact, I have so much to say on this topic, I’m going to—gasp!—use subtitles on this post.

Working with Your Neck

There are two basic ways to release tension in your neck: stretching your neck and relaxing your neck. To stretch your neck, you can do gentle neck stretches, either while standing or sitting. Baxter recommends not doing full head rolls. Instead, he recommends Owl Turns, which involves looking to the right or left as far as you can go with a bit of stretch, and Curious Dog Tips, which involves tipping your head ear to the shoulder to the right or left, as far as you can go with a bit of stretch, ear to shoulder on that side. Another way to stretch your neck (along with your back and chest) is to do seated twisting poses, such as Bharadvajasana, Marichyasana, and Arda Matseyendrasana. As you move into the twist, make sure to turn from your spine first, and then, moving mindfully, let your head follow your spine (so you don’t over-twist your neck).

To relax your neck, try seated forward bends with your head resting on a support. Before bending forward, place a bolster or folded blankets on your straight leg (or a chair over your straight leg if your hamstrings are tight), and rest your head on the support as you come into the pose. Prop yourself high enough so you can stay in the pose for three minutes or so. You can even do the pose seated in a chair, in front of your desk. You can also use gravity to release your neck in a Standing Forward Bend (Uttanasana) or Wide-Legged Standing Forward Bend (Prasarita Padottansana). Instead of having your hands on the floor in this pose, try clasping your elbows so you can just hang. To make the pose more relaxing, try practicing with your buttocks against a wall and your feet about six inches from the wall.

Working with Your Shoulders

To release your shoulders, which helps release tension at the base of your neck, you can try any number of targeted shoulder stretches. See Standing Shoulder Stretches for a good, short sequence that stretches your shoulders within their full range of motion. In general, most of the standing poses also help release tension from your shoulders, because your arms are either overhead, out to sides, or behind your back. So all varied standing pose practices will help both strengthen and relax your shoulders.

Working with Your Back

To release tension from your back, you can practice the seated twisting poses I mentioned above for releasing your neck, or any reclined twist that you prefer. You can also try passive backbends or restorative backbends, such as lying over a bolster with your arms either out to the side or overhead. Just make sure to keep your head supported so that your neck and head is in line with your spine or only in a mild backbend (and not fully extended, that is, in a full backbend position). And, finally, you can try an easy forward bend, such as a Child's pose (Balasana) with your knees together or a Supported Restorative Child's pose, or a Standing Forward Bend (Uttanasana) with your knees bent to release back tension from the extensor muscles of spine.

Working with Your Head

Timothy mentions that poor posture, especially head forward syndrome, is a possible trigger for headaches. So working in Mountain pose, learn to keep your neck aligned with your spine and your spine aligned with your neck. You can also do passive backbends, holding for at least three minutes, to open your chest and active backbends to strengthen your back. These and the shoulder stretches mentioned above will compensate for all the forward bending of your upper body that you do at your desk, car, gardening, etc., and help improve the position of your neck and head relative to your spine.

As far as relaxing your head goes, wow, I have to say, I’ve never thought about how to relax my head before! The main thing that comes to my mind—which is actually very relaxing—is to lie in Savasana with enough support under your head so your neck is in a neutral position and your chin is pointing toward your chest. Then, using the power of your mind, consciously move from one part of your head to another (including, one by one, your sense organs) and intentionally relaxing that area. Be sure to include your forehead—lots of tension there—your scalp and the crown of your head.

About Backbends and Headaches

And, finally, a little warning about backbends: Extreme extension of the neck (the bending you do when you take your head back behind your shoulders) can actually trigger headaches! So if you are doing a backbend where you can control the back-bending in your neck, such as Cobra, Upward Facing Dog, Bow pose, try to work with your head in a more neutral position instead of automatically thrusting it back. If the backbend is one where you can’t really keep your head in a more neutral position (such as Urdva Dhanurasana, called Wheel or Upward Bow), try eliminating the pose from your practice to see if that helps your headaches.

Preventing Migraines (and Other Headaches), Part 1

by Nina

Supported Child's Pose

A dear friend of mine, with whom I’ve stayed on many vacations and have traveled with, suffers from terrible migraines; the kind where all you can do is curl up on the fetal position for 24 hours in a dark room. So even though I don’t have migraines myself, I’ve witnessed first hand how awful they can be. Baxter had some good suggestions yesterday (see Yoga for Migraine Headaches) for how to use yoga to get through a migraine headache. But wouldn’t it be nice if you didn’t have to get a migraine in the first place?

Unfortunately, since there are many different triggers for migraines, including different types of food,  it is impossible for us to give you any guaranteed solutions. However, we do have some recommendations for yoga practices you can try. Suffering from a migraine is such a miserable experience and these yoga practices will benefit you in many other ways, so it really seems worth giving them a shot. And everything we’re going to suggest here applies to ordinary tension headaches as well as to migraines, so listen up, everyone!

In his book Yoga As Medicine, Timothy McCall identifies two possible triggers for migraines and other headaches that we can address with yoga: stress and muscle tension in the head, neck and back areas. Today I’m going to talk stress and tomorrow I’ll post something about muscle tension (see Preventing Migraines and Other Headaches, Part 2).

Okay, now to address stress. In his book, Timothy says, “Since stress is a major factor in both tension headaches and in migraines, yoga can certainly play a role in prevention.” And he goes on to say that “There is scientific evidence that relaxation techniques and biofeedback can be effective for both tension and migraine headaches, lessening the duration as well as the frequency of attacks.” That sounds pretty promising to me!

I’ve been ranting about the subject of chronic stress and the importance of stress management since we started the blog (see Chronic Stress: An Introduction  and The Relaxation Response and Yoga), but as a reminder, I’ll simply reiterate that yoga provides a huge selection of possibilities for stress management and you can pick and choose from amongst them according to your experience level, temperament, schedule, and/or personal preference. All of the following yoga techniques reduce your stress levels by switching your nervous system from stress mode (Flight or Fight) to relaxation mode (Rest and Digest). This type of relaxation is something you cannot achieve with a nap or even a full-night’s sleep (see Conscious Relaxation vs. Sleep).

•    Meditation. See How to Meditate for information on how to meditate.

•    Breath practices (pranayama). See Your Key to Your Nervous System for information your nervous system and your breath. For stress reduction and headache prevention, be sure to avoid stimulating and/or overly complex breath practices and focus on simple, calming practices.

•    Restorative poses with a focus for the mind (such as your breath or the relaxation of your muscles).

•    Inverted poses. Studies by Dr. Roger Cole proved that inverted and semi-inverted poses, where your heart is higher than your head, trigger the relaxation response through the mechanisms that control your blood pressure. This is why supported inversions, such Legs Up the Wall pose and Easy Inverted Pose (legs on a chair), are so effective for stress management (See Just in Time for the Holidays: Inverted Poses).

•    Corpse pose (Savasana) with a focus for your mind (such as your breath, the relaxation of your muscles, or peaceful imagery). See Savasana for information.

•    Yoga nidra (yogic sleep), a long, structured form of Savasana. See What is Yoga Nidra? for information about yoga nidra and the Audio Tracks tab at the top of the page for a mini version of yoga nidra that you can stream or download.
 
If you find it difficult to settle in and relax because you’re too restless or anxious when you lie down, first try any active asana practice to burn off steam (although you might want to be careful with backbends—I’ll address that tomorrow) and then move on to relaxation practices.

If you are interested in practicing a combination of inverted and restorative poses, you might like to check the headache sequence in Yoga As Medicine, which includes the following poses:

1. Legs Up the Wall pose
2. Supported Reclined Cobbler’s pose
3. Chair Shoulderstand
4. Half Plow Pose (with chair)
5. One-Legged Forward Bend with head support
6. Full Seated Forward Bend with head support
7. Breath Awareness

Note that this sequence was designed for an experienced practitioner, and if you aren’t familiar yet with or can’t get comfortable in Chair Shoulderstand and Half Plow pose, you may want to skip over those two poses. An easier alternative to those two poses would be to do a Supported Straight Leg Bridge pose (must photograph that for our blog one of these days!). The teacher who designed this sequence also recommended his student use a head wrap (a large bandage that is wrapped around the head to relax the eyes) while practicing, so that may be something you could experiment with. Start wrapping the bandage clockwise at your forehead, go down to your eyes, and then come back up again. Tuck the loose end to secure the bandage.

If the sequence from Yoga As Medicine is too long or complicated for you, any simple restorative sequence could be very effective. Try our Mini Restorative Sequence, which includes three classic restorative poses that almost everyone can enjoy.

So how often should you do these stress reduction practices? I think that if you are chronically stressed out and suffering from debilitating headaches, you should practice six or seven days a week for at least 15 minutes (keep in mind that could be 15 minutes of meditation or 15 minutes in Legs Up the Wall pose). I realize that sounds like a lot. It will take some work—if you can call relaxing “work”—to bring your overall stress levels down. Keep in mind that the payoffs could be huge, as stress management can result in many additional health benefits besides reduced headaches, such as lower blood pressure and a stronger immune system, as well as quality of life benefits, such as increased equanimity and maybe even happiness. And if any of you take up this headache reduction challenge, I’d love to hear back from you about the results.

Check back tomorrow for tips about how to use yoga poses to release neck, shoulder and back tension that can trigger headaches.

Yoga and Migraine Headaches

by Baxter

We’ve had a few different requests over the past months to talk about the condition of migraine headaches and how yoga might be helpful in addressing them. So Nina and I are splitting up the topic into two focuses. Tomorrow Nina will share with you some ideas around yoga as a possible preventative strategy for migraine headaches (see Preventing Migraines and Other Headaches, Part 1 and Part 2, and today I will tackle the use of yoga during a migraine attack. And we might even get Brad to weigh in on the topic, as he lectures to the pharmacology students at UCSF on medications used to treat migraines. As we talked about the subject during a recent meal, he shared an opinion about treating acute headache attacks with yoga. “F#*k the yoga,” he joked, “Take the drugs!” As he may go into in more detail here later this week, he feels the modern abortive migraine meds are so effective that it might be foolish to not take them, as migraines can take the sufferer out of circulation for a day or more if a severe headache takes hold (see Brad's Perspective on Migraine Headaches). However, yoga has some effective solutions to offer, too, and there is no reason you can’t combine medication and yoga.

Let’s back up for minute and talk about what a migraine headache is. It is actually important to distinguish this from other forms of headache. In my medical practice, I used to get patients coming in with reported “migraines,” who were actually having more common musculoskeletal headaches that were very strong. They were under the impression that any “bad” headache was a migraine. To clarify the distinction, according to MayoClinic.com:

“A migraine headache can cause intense throbbing or pulsing in one area of the head and is commonly accompanied by nausea, vomiting, and extreme sensitivity to light and sound. Migraine attacks can cause significant pain for hours to days and be so severe that all you can think about is finding a dark, quiet place to lie down.

Some migraines are preceded or accompanied by sensory warning symptoms (aura), such as flashes of light, blind spots or tingling in your arm or leg. Migraines may progress through four stages — prodrome, aura, attack and postdrome — though you may not experience all the stages.”  

Since the physiology of the stages of the headache is quite complex, for now I’d like to suggest that the “acute” attack really starts with the “prodrome,” which can be a period of time a day or two prior to the actual onset of the headache symptoms, and can include any of the following signs or symptoms: constipation or diarrhea, depression, food cravings, hyperactivity, irritability or neck stiffness. As you can see from this list, these symptoms could also be associated with other things going on in your life, but the person with migraines begins to notice patterns that can help them predict the coming of headache over time.  So, if you are migraine sufferer who has identified these prodrome warnings, this could be the time to pull out some yoga tools best suited to this phase of things. I will get to more specific recommendations shortly.

The second stage mentioned is the “aura,” which, interestingly, the majority of migraine sufferers do not get before the headache shows up. But some do, and it can give them another opportunity to intervene, either with their meds or some yoga or both. The aura usually lasts from 10-30 minutes, and can be in the form of some visual phenomena, like flashing lights, or loss of vision, or pins and needle sensations in an extremity, or speech or language problems. There are even some people, like Brad himself, who typically only have the aura and do not go on to experience the full-blown headache.

If things progress to a full blown headache, it is typically a pulsating, throbbing pain on one side of the head, and can be accompanied by nausea, vomiting, fatigue, light, sound, and even smell sensitivity, and can last from 4 to 72 hours.  Once the headache subsides, the postdrome period that follows can often leave you feeling fatigued for a day or two. Migraines occur with differing frequencies for different people, and at least one of my students reports a distinct connection with her migraines and her monthly menstrual cycles.

When considering how to use yoga to attempt to short circuit the start of a full blown migraine or to mitigate the severity of the symptoms if you are already at the aura phase, there will be different approaches. In the one to two day prodrome period, taking some time to do a balanced, yet generally gentle asana practice, could possibly stop things from progressing further. The exact practice might be modified if GI symptoms predominate (doing Legs up the Wall, for example, if diarrhea predominates), or if neck pain is your early clue of a possible impending headache (doing gentle neck stretches, for example). In general, I’d recommend milder versions of all of your more active poses, with more focus on a calming connection to your breath than trying to work hard from a musculoskeletal view. And save time for a few restorative poses and perhaps a guided meditation with a stress-reducing focus.

Once you are at the aura stage or onward, the possibility of yoga halting a headache is much less likely, and certain kinds of yoga practices actually could aggravate the headache.  Inversions, for instance, are one of the biggest aggravators that my student reported to me, and even lying down flat in Savasana could be too much at times. However, supported poses, where the head is elevated a bit, like Reclined Cobbler’s pose can be quite helpful.

Since many headache sufferers head to a quite dark room anyway, setting up in Reclined Cobbler’s pose, using an eye pillow while in there, could potentially speed up recovery times.

I hope you've found this helpful, and if you have any recommendations from your own experience, please let us know!