For years Carol woke up in the middle of the night with a shooting pain in her neck that soon became a throbbing headache. Most nights she was unable to go back to sleep, and in the morning she felt exhausted and depressed. Seeking relief, Carol consulted numerous medical doctors, including two neurologists. Though every specialist Carol saw concurred that her problem was muscle tension, no one offered an effective means to treat it. They prescribed muscle relaxants, antidepressants, prescription pain-killers, and even an oxygen tank, but these measures failed to bring Carol any lasting relief. They did, however, make her so drowsy she couldn't drive and push her further into depression.
Ultimately, Carol consulted Tomas Brofeldt, M.D., at the University of California's Davis Medical Center in Sacramento. Brofeldt is a doctor of emergency medicine with a special interest in headaches. Trained in structural engineering as well as medicine, Brofeldt treats head pain using yoga to correct posture. He believes 75 percent of all headaches arise from muscle tension in the back of the neck, specifically the semispinalis capitis muscles, due to problems in posture.
The first problem Brofeldt noticed when he examined Carol was that her shoulders were rounded, and her thoracic spine and head were slumping forward, creating tension in her neck muscles. Because the muscles of the neck and upper back connect to the head, tension in the neck can be referred to the forehead and behind the eyes, causing headaches. Brofeldt prescribed simple exercises for Carol to do throughout the day. He also advised her to do aerobic exercise, such as walking uphill, lightweight resistance exercise to build strength in her upper body, and yoga for alignment awareness and stretching. He suggested that she meditate 10 minutes a day in an attempt to calm her busy mind. Brofeldt kept in touch with Carol in the following months to encourage her to stay with the program.
Even though Carol was not inclined to do yoga, she followed Brofeldt's advice and came to me for private yoga classes. I had just returned from the Iyengar Teacher's Exchange in Estes Park, Colorado, with a long list of therapeutic sequences developed by the Iyengars at their clinic in India, including some for headaches. I modified the sequences to suit Carol's particular needs, and she began to practice them before she went to bed.
Carol has come to understand that her headaches have a psychosomatic quality and has acknowledged the difficulty she has relaxing and letting go in both passive yoga poses and meditation. She is now able to observe herself with humor, and her headaches have diminished in frequency. Although she still gets headaches a couple of times a month, Carol now "has a handle on it" and knows that if she doesn't follow her daily physical routine, the headaches recur.
Muscle Tension and Headaches
Brofeldt believes that headaches are unique to the human race, originating from our need to constantly hold the head upright. We hold the mouth closed and the head upright by contracting the temporalis and the semispinalis capitis muscles. What we perceive as headaches are actually symptoms of muscle fatigue from these "headache muscles," according to Brofeldt. Often, pain from these stressed postural muscles is referred to other sites, for example, from the neck to behind the eyes. Stressed postural muscles may also cause nausea, generalized fatigue, lack of concentration, and visual disturbances.
In people who have rounded shoulders, a strong curve in the upper back, and a tendency to hold the head forward, like Carol, the "headache muscles" are held in a chronically foreshortened state. The more forward the head position, the more the muscles have to hold. Chronically overworked, the muscles become fatigued and go into spasm. Brofeldt compares this to a "charley horse" and says that just as we would stretch a calf muscle in spasm, we need to stretch the "headache muscles" to bring relief. We should retrain the upper back to extend, the chest to open, the shoulders to roll back and down, and the head to rest on the midline. A yoga practice which focuses on alignment and somatic awareness provides the tools for this retraining.
Being aware of our bodies can help us to perceive the onset of a headache and stop it early in its course. The first sign of a headache is often a tightening of the shoulders and neck (trapezius and semispinalis capitis). This fatiguing contraction of the "headache muscles" causes a reduction in blood flow to the vessels of the head. As the muscles contract, a reflex increase in sympathetic tone (the part of the nervous system activated during stress) shunts blood to the muscles, causing blood vessels to constrict in neighboring tissue. If the muscle is not relieved and is forced to further contract, the increase in intramuscular pressure may prevent blood and nutrients from reaching the starving muscle cells. If the cycle isn't broken, chemical mediators are released that forcefully dilate vessels, sharply augmenting the pain, and the headache becomes a migraine. Brofeldt believes that most migraines are due to this protective reflex against end-stage muscle ischemia, or muscles starved of blood.
Severe head pain, nausea, and sensitivity to light force the migraine victim to retreat into a state of complete rest. He or she must stop, lie down, and cease all stimulation and activity. The sufferer must fall into a deep, delta sleep, the kind that leads to complete relaxation, so that the painfully exhausted "headache muscles" can revitalize. In the delta stage of sleep, the muscles are totally relaxed and can be restocked with glycogen and nutrients. People who have interrupted sleep patterns or who do not get enough sleep will not have time to replenish.
Check Your Posture
Margaret Holiday, D.C., a chiropractor in Marin County, California, agrees with Brofeldt's observation that the most common cause of headaches is the forward head position, with rounded shoulders, a curved upper back, and the accompanying muscular tension. "Anything that distorts the spinal curves has the potential to cause headaches," she says. Holiday often sees alignment problems in the feet reiterate throughout the spine and result in tension in the neck and head.
Holiday notes that how we stand, sit, and work can affect headaches. A desk worker, for example, who sits in front of a computer screen much or all of the day, is at great risk for muscle tension. Often the computer screen is set too high, creating neck strain as the head is held forward and the upper back rounds. Placing the computer screen lower than the eyes, or angling it down, may help relieve strain. Also, the abdominal muscles lose tone with hours of sitting, which contributes to the inability to keep the spine in an upright, neutral position.
Holiday concurs with Brofeldt that sleeping well is important. She suggests finding a pillow of a size and shape that supports the neck during the night. Do not sleep on your arm or hand as a pillow, and if possible, avoid lying on the stomach with the head turned.
Although the overwhelming majority of headaches are caused by muscular tension, Holiday feels it is important to get a diagnosis from a medical doctor to rule out serious medical conditions. Tumors, or more common conditions such as food allergies or sinus infections, may be the source of recurrent headaches. Headaches can also stem from trauma, such as whiplash or childhood falls, and resultant injury to the cervical spine.
In addition to postural and structural factors, Holiday believes that dysfunctional breathing patterns contribute to headaches. She teaches deep, diaphragmatic breathing to release contracted muscles in the upper body and belly. She notes that headache sufferers often "live in their heads; they don't breathe fully. They need time to be in the body and develop the balance between the mental and physical parts of themselves."
Breathe Away Head Pain
Richard Miller, Ph.D., a practicing clinical psychotherapist who has published widely on the subjects of yoga and pranayama, concurs with Dr. Holiday that headache sufferers often have upper respiratory, shallow breathing. They may also be unconsciously hyperventilating. He feels that pranayama (breath control) can be very helpful in reducing headache.
"There are many pranayamas that are appropriate for people experiencing different headaches. Each pranayama is adapted to the individual headache sufferer. The first step is simply observing and noting the breath before any intervention takes place," says Miller. "Each pranayama is categorized according to its energetic impact on the body/mind. For instance, Sitali incorporates the components of long, left-nostril exhalation, a cooling inhalation through either curled tongue or open lips, and relaxing head movements."
Another pranayama that is often recommended for chronically tense people is Nadi Sodhana, or alternate nostril breathing. "Even the traditional practice of Nadi Sodhana is adapted for headache sufferers," notes Miller, "by practicing Nadi Sodhana in Savasana, with an elevation under the chest and the arms at the side." In this manner of practicing Nadi Sodhana, air is inhaled and exhaled alternately through the left and right nostrils without using the fingers to block off the air flow.
Resolve Emotional Issues
Although postural considerations and breathing patterns are a major part of the headache picture, there are other key elements, says Richard Blasband, M.D., director of research at the Center for Functional Research in Tiburon, California. He talks of headaches from a bioenergetic (energy flow) perspective: "Many, but not all headaches are the result of acute stress," he says. "One of the manifestations of this state is chronic muscular hypertension. While usually the entire body is affected to some degree, many people, because of negative conditioning in childhood or for genetic reasons, are vulnerable to developing muscular tension, particularly in the head, neck, back, and sometimes the eyes. Without sufficient deep and appropriate emotional release," he continues, "headaches will almost always return. To achieve a lasting cure, one must solve the problem at its deepest emotional core."
Addressing this psychological material, with the tools of asana and pranayama, and possibly with psychotherapy, is an essential element in any prescription for headache relief.