Today's Daily Tip
Help for Headaches
For more than six years, Catherine Slaton, 46, of Seattle, lost several days of each month to migraines. Sometimes the pain behind her right eye was so severe that she "felt like cutting off her head," she says. Curled on the floor in a darkened room, Slaton would lose consciousness and then sleep for several hours. The respite, however, was only temporary: When she awoke, the headache remained, as intense as ever.
"I tried absolutely everything to get rid of them and prevent the next one from happening," Slaton says. Her efforts ranged from chiropractic work, craniosacral therapy, and herbs to hormone therapy and "massive doses of whatever my neurologist prescribed for me, including pills, nasal sprays, and shots," she remembers. Nothing helped.
Then, a year ago, Slaton began taking hatha yoga classes twice weekly at Spectrum Dance Theater, a studio near her home. Initially, she went to ease the pain caused by a bulging disk in her lower back. "Not only did the yoga help with my back condition, but after a few months, my migraines were noticeably less severe," she says. "In the last three months, I've had no trace of a headache." Slaton credits asana and pPranayama with allowing her to feel normal again.
Understanding the Ache
As more than 45 million Americans can attest, chronic headaches that are serious enough to interfere with daily life are complicated and debilitating. But like Slaton, many headache sufferers are discovering that yoga can safely help reduce the severity and frequency of their episodes as well as short-circuit those already in progress. They're also finding that yoga can be used as a complementary therapy to other types of treatment without the risk of dangerous side effects.
While stress or illness is often blamed for headache pain, factors such as family history, food additives, hormonal fluctuations, disrupted sleep patterns, and lack of exercise are also likely to influence outbreaks. And some methods of treatment do more harm than good: Using over-the-counter pain relief medications (and some prescription ones) more than three times a week, for example, can cause "rebound" headaches in certain individuals, according to Todd Troost, M.D., chairman of neurology at the Wake Forest University School of Medicine in Winston-Salem, North Carolina.
Complexities also arise because headaches are often misdiagnosed. "Most people incorrectly assume they have tension-type or sinus headaches, but in reality, more than 90 percent of these people have migraines," says Jan Lewis Brandes, M.D., clinical instructor in the Department of Neurology at the Vanderbilt University School of Medicine in Nashville, Tennessee, and president-elect of the American Council for Headache Education. Although migraines are often equated with nausea, one-sided head pain, and sensitivity to light and sound, many migraine sufferers don't experience all of these symptoms.
In the past, it was thought that migraines were caused by a constriction of arteries in the head, while tension-type headaches were the result of strained muscles in the neck and scalp. Although the entire cascade of events leading up to a headache is not completely understood, many researchers now believe that an imbalance in the brain's neurotransmitters, the chemicals that act as messengers between cells in the brain and the nervous system, lies at the heart of both types. (In fact, the term "tension headache" was recently changed to "tension-type headache," calling attention to the fact that muscle tension may not be the main cause.)
Although no formal scientific studies exist in the West that directly link yoga with headache relief, it has been proven that progressive muscle relaxation, meditation, and focusing on the breath—activities at the heart of most yoga practices—can bring about a state of deep rest in the body that changes the physical and emotional responses to stress. Nearly four decades ago, Herbert Benson, M.D., professor of medicine at Harvard Medical School and the founder, in 1988, of the Mind Body Medical Institute in Chestnut Hill, Massachusetts, correctly surmised that just as stimulating an area of the hypothalamus can cause the stress response, activating other areas of the brain can reduce the stress response, slowing the heart rate and bringing the body back into restorative mode.
This reaction, known as the "relaxation response," has been used effectively in treatment programs for cardiac disease, chronic pain, insomnia, premenstrual syndrome, infertility, the symptoms of cancer, and depression. It is also thought to be at the heart of headache relief. "The problems with neurotransmitters are very important to the onset of headaches," says Richard Usatine, M.D., professor and vice chair of family medicine at the University of Texas Health Science Center in San Antonio and coauthor (with Larry Payne) of Yoga Rx: A Step-by-Step Program to Promote Health, Wellness, and Healing for Common Ailments. "Given that yoga does truly affect the nervous system by increasing the relaxation response," he adds, "it's not a far leap to say that it can affect neurotransmitters in the brain."
Although neurotransmitter imbalance may indeed be a catalyst, some experts believe that muscular tension and postural problems often exacerbate the pain. Simply paying attention to posture can go a long way toward preventing strain in the forehead, temples, shoulders, and back of the head. Indeed, a study (published in the journal Cephalalgia) of 60 women ages 25 to 40 found that those with headaches had a significantly different head posture, plus less strength and endurance in their upper cervical flexors, the muscles that allow the neck to bend.
Something as simple as practicing Tadasana (Mountain Pose) can help eliminate bad habits and serve as a reminder to lift the head up and away from the shoulders rather than crunching it into the neck. If the head is thrust forward, gently sliding the chin toward the throat until the ears and shoulders line up will bring it into a more neutral position.
Stretching and strengthening the muscles in the upper torso can also help relieve tension in the neck and head. Adho Mukha Svanasana (Downward-Facing Dog Pose), the mainstay of hatha yoga practices, accomplishes this balance most efficiently. But although some instructors and texts (including B.K.S. Iyengar's Light on Yoga) suggest inverted asanas as part of a headache sequence, many headache-prone people find an inversion even as simple as Downward Dog uncomfortable, due to the increased sense of pressure in the head. Ardha Adho Mukha Svanasana (Half Downward-Facing Dog or Right Angle Pose) provides many of the same benefits without allowing the head to fall below the heart.
Shoulder shrugs and circles can also help release the space between the shoulder blades, as can slow, soft neck movements, says Nischala Joy Devi, a yoga teacher in Fairfax, California, and the author of The Healing Path of Yoga. "Move your head gently from side to side and forward to back," she says. "But be careful not to rotate your head in circles. The top vertebra in your spine, which supports your skull, moves in only a few directions. Rolling your neck goes against the natural motion of this vertebra and can actually cause damage."
Relax into the Pain
While specific asanas, like the ones that Baxter Bell, M.D., chose for this story, can help with headaches, the trickle-down effects resulting from an ongoing yoga practice may be the best preventative medicine of all: Headache-prone people who take up yoga often report that they eat more healthily and sleep better, two of many factors that can reduce the frequency and severity of headaches. Of course, even the best precautionary measures are no guarantee that a headache won't crop up occasionally. If it does, yoga offers plenty of ways to help make the body and mind comfortable during even the most painful episodes.
When a headache is at its worst, even dedicated yogis may find an intensely active practice excruciating. Relaxing, restorative postures are preferable during those times. Most important, if something creates strain, don't do it.
Keep noise to a minimum and dim the lights or turn them off completely. Darkness helps move the body's focus from the sympathetic nervous system (which increases the heart rate and blood pressure) to the parasympathetic nervous system (which eases the body back into restorative mode). "This environment essentially re-creates what people do naturally to break a pain cycle, which is to go into a dark, quiet room and fall asleep," says Bell, who teaches yoga and workshops on the therapeutic applications of hatha yoga in the San Francisco Bay Area. He suggests spending at least 10 minutes in each restorative pose, even if the headache has gone, explaining that "this is really the minimum amount of time needed to truly achieve the relaxation response."
For many restorative poses, Bell recommends placing a weighted sandbag (between five and 10 pounds) on the feet to shift the energy of the pain away from the head. "During a headache, people feel trapped in their head. The sandbag can bring the focus down the body to the feet," he says. "Visualize the downward movement as you exhale to facilitate this sense of grounding."
Some yogis, like Kathy Livingston, 43, who lives in Brownsville, Tennessee, find the restorative inversion Viparita Karani (Legs-up-the-Wall Pose) particularly soothing. Livingston, who has suffered from migraines since age 14, began practicing hatha yoga just months ago at Your Yoga Source, her local studio. She's always known that a headache is coming on when she gets a loud roaring in her ears followed by tunnel vision. Now, at the first sign of a symptom, Livingston puts her legs up the wall, even if she's at the busy law office where she works. "I find that the tunnel vision goes away," she says. "When I get up, the headache is gone."
In the midst of a headache, it's easy to become overwhelmed by the pain and rally against the ache, taking a defensive tack that often makes things worse. "When someone is in pain, they feel anxious and out of control," says Peter Van Houten, M.D., medical director of the Sierra Family Medical Clinic in Nevada City, California, and coauthor (with Rich McCord) of Yoga Therapy for Headache Relief. "That, in turn, makes them feel even more pain."
To combat this phenomenon, yoga teacher Devi suggests this approach: "Instead of gripping the pain, imagine it as a block of ice melting away. That way, the pain is slowly dissipated throughout the body," she says. "It's the exact opposite of holding on; it's letting go and releasing the pain."
Gentle forward bends, such as a supported version of Balasana (Child's Pose), can also be useful for unraveling the knot of pain. Sit on the heels or cross-legged in front of a chair that has a padded seat (or place a folded towel or blanket on an unpadded chair), then gently rest your forehead on the seat. Or place a folded blanket beneath a bolster, fold your arms atop the bolster, and rest the forehead on the bolster between the arms.
Wrapping the head with an Ace bandage while in restorative postures can also be helpful. While the idea of wrapping your head can take some getting used to, the sensation it creates can be immensely comforting. The bandage simulates darkness, which migraine sufferers often crave, while the gentle pressure on the eyes stimulates the relaxation response.
Use the Breath
Deep breathing can foster the relaxation response and help at the onset of a headache or in the midst of a full-blown episode. Plus, breathwork can be done in public places, where doing postures might not seem appropriate.
When we're in pain, it's common to take shallow, rapid breaths that raise the heart rate and make the body tense. In contrast, breathing more deeply into the diaphragm, the dome-shaped muscle that contracts to draw air into the lungs, invites the body to relax. Bell suggests doing a simple test to see if you're using the diaphragm correctly. "Lie with the back on the floor, then place the hands on the belly," he says. "Notice if the hands are rising and falling when the breath moves in and out." The hands should rise as you inhale and fall as you exhale.
For Skye Livingston (no relation to Kathy), this type of deep, rhythmic breathing is key to easing her headaches. Livingston, 33, of Oakland, California, started getting headaches daily around three years ago, about the same time she started an office job that demanded lots of computer work. She's since quit the office position and now leads cycling vacations, yet the headaches persist. "They start in the back of my neck, then the tightness comes up through my head," she says. "They can last all day, and sometimes I get them five days a week."
Livingston, who has practiced Iyengar Yoga for 10 years, believes her headaches are complicated by prescription medication she takes, plus a mild curvature of the spine she's had since childhood. Asanas help greatly, particularly twists, which help the blood flow up and down through the body. While practicing, she also finds that pushing air into the back of her lungs encourages her body to relax. "I avoid any posture that compresses or constricts the diaphragm area, such as Halasana [Plow Pose] and Salamba Sarvangasana [Supported Shoulderstand]," she says. "When I can't fully breathe, my headaches often get worse."
Beyond general deep breathing, specific pranayama techniques can be useful in easing headache pain and reducing the anxiety that often accompanies it. Catherine Slaton uses Nadi Shodhana (alternate-nostril breathing) to calm her, inhaling and exhaling alternately through the left and right nostrils and using the fingers to gently block the air flow.
Kathy Livingston uses deep and lightly audible Ujjayi Pranayama (Victorious Breath) to take her mind off the pain. And Bell recommends Sitali Pranayama (Cooling Breath), which features an inhalation with curled tongue, followed by a warming Ujjayi exhalation. (See All Fired Up?, for instructions.) "This technique works because it forces the body to slow down on the exhalation," Bell says. "This has a very meditative, quieting quality."
In the end, all the methods described in this article should be viewed as tools in an ongoing headache prevention plan. If one of them doesn't work, try another—and another—until you find the right mix. Above all, be willing to experiment, and trust yourself to discover an approach that works for you.
While yoga can be a useful part of any treatment program, it's important to consider all the possible contributors to headaches. Some factors are unalterable, such as genetics—people with a family history of headaches are likely to suffer from them, according to Stephen Silberstein, M.D., professor of neurology and director of the Jefferson Headache Center at Thomas Jefferson University in Philadelphia. Gender is another factor: 75 percent of adult migraine sufferers are female. Fluctuations in estrogen levels are partly to blame, says Christine Lay, M.D., director of the Women's Comprehensive Headache Center at Roosevelt Hospital in New York. Women are hit hardest two or three days before their menstrual cycle, when estrogen levels drop; those using birth control pills may also be more vulnerable.
Other factors, however, are changeable. Consider the 10 to 15 percent of the headache population who react to substances in certain foods. Nitrate and sodium nitrite, two preservatives often found in luncheon meats, hot dogs, pepperoni, and salami, can be triggers, as can monosodium glutamate (MSG). Artificial sweeteners, such as aspartame—an ingredient found in certain chewing gums, diet sodas, and weight-loss powders—bother some people; others react badly to tyramine, a substance found in aged cheeses, sour cream, pickled herring, yeast extracts, Chianti, and yogurt.
Other catalysts include disrupted sleep, skipped meals, dehydration, and lack of exercise. To find out which may affect you, keep a headache diary for several weeks and share the results with your doctor. Note the severity of the headaches, the dates of your menstrual cycles, your sleep schedule, what you eat and drink, and any medications (both prescription and over-the-counter), alternative remedies, and dietary supplements you use, along with anything else you feel relevant.