Sometimes it seems our modern society has perfected the art of stress-filled living, but we certainly didn't invent the headache. People have been suffering them throughout recorded history and ancient Yoga literature is filled with mentions of headaches and Yoga strategies for handling them.
Headache is one of the most universal human ailments. Most everybody gets one now and then, and there are millions who suffer from chronic, even daily headaches. It is estimated that twenty-six million people in this country are afflicted with migraines.1While many systems of the body can be involved in headaches, it is the nervous system that is primarily responsible for the pain.
Your nervous system includes the brain, the spinal cord, and the nerves that radiate into all parts of your body This system commands and coordinates every activity in your body, including thought, speech, and language recognition; all your senses; and the functioning of your muscles and organs. Since many muscular problems as well as digestive, respiratory, and cardiovascular disorders have origins in the nervous system, a relaxed, healthy nervous system is essential for general health. Hence, the calming of the nervous system is a basic goal of Yoga therapy.
Functionally, there are two nervous systems that work side by side: the voluntary (VNS) and the autonomic nervous system (ANS).
The voluntary nervous system controls the functions of skeletal muscles— those that you move voluntarily. Nerves known as motor neurons carry messages from the brain to the muscles, allowing you to move your body the way you want.
The autonomic nervous system is not within your typical voluntary control. It directs involuntary functions such as those in the cardiovascular, respiratory, and digestive systems. The ANS controls your heart rate and whether your blood vessels are dilated or constricted (open or narrowed)—an important factor in migraines. Within the ANS, there are two complementary systems: the sympathetic and the parasympathetic nervous systems.
When the sympathetic nervous system is stimulated, you feel more alert and energetic; your heart rate accelerates, you breathe faster, and your muscles tense up. This system is responsible for the fight-or-flight response. The parasympathetic nervous system encourages the body to relax. It lowers the heart rate, slows the breathing, enhances muscle relaxation, and boosts digestion. Ideally, the sympathetic and parasympathetic nervous systems work together in a harmonious give and take to regulate your responses. One reason we practice Yoga breathing is to stimulate the parasympathetic nervous system, calming the muscles and all bodily functions.
Neurons and neurotransmitters are the essential components of the nervous system and are involved in headaches, particularly migraines. Neurons are cells that transmit signals within the nervous system, although they don't do this by direct contact with each other. An electrical impulse travels down the neuron, causing the neuron to release a chemical that passes a signal on to the next neuron. The chemicals are neurotransmitters, which have names you might recognize, such as serotonin and norepinephrine.
There are pain sensors in your skin and other organs throughout your body. When the pain sensors are stimulated, they send messages to the brain, where the pain signals are processed and you feel pain. When you are feeling emotionally healthy, some of the pain signals are decreased and you actually feel less pain. When you are under stress, the pain signals can pass all the way to the brain without being diminished, so the pain is worse. Therefore your emotional state and stress level have a direct influence on the degree of pain you feel in your body.
The two most common types of headaches are tension headaches and migraines. Each can last from a couple of hours to several days, and the pain can be mild to severe. They can occur in both children and adults. Although they are unpleasant and can even be unbearable, these headaches are not in themselves dangerous. They do not cause any permanent damage, and do not stem from any other underlying medical condition, so they are called “primary headaches.” There is a third type of primary headache called cluster headaches, but these only occur in about 1 percent of the population, usually in males. Cluster headaches come in groups over a few weeks, with excruciating pain, but then may disappear for months or years. Cluster headaches are similar to migraines, in that the blood vessels are involved.
While not all headaches require medical attention, if you have chronic or severe head pain you should see a doctor before starting Yoga or any other treatment. Although rare, it is possible to have “secondary headaches” that result from another condition and can be potentially fatal if untreated. Some of the most dangerous headaches are caused by brain tumors, ruptured aneurysms, and meningitis. However, an occasional mild headache during a stressful time or a mild upper respiratory infection is probably not harmful and does not necessarily require a visit to the doctor.
The mechanism for tension headaches is complex and includes problems with neu-rotransmitters within the brain, as well as aggravating factors such as external stress. Tension headaches are often described as a tight feeling around the head, like a band circling the head and squeezing. They sometimes feel like a tight hat above the eyes or cause neck pain that goes to the base of the skull. These headaches are felt on both sides of the head simultaneously, and feel like a steady ache rather than a throb. The pain can be mild or severe to excruciating, but there are usually no associated symptoms such as nausea.
Tension headaches are not dangerous but can be distressing or even debilitating. They often occur near the end of a stressful day, although some unlucky folks can wake up with a tension headache in the morning. The good news is that the practice of Yoga can be very successful in preventing and treating these headaches.
The word migraine is French for the Greek hemicranios,meaning “half a head,” because it typically occurs on only one side of the head.2 The pain is usually described as throbbing or pounding, and it is frequently accompanied by nausea and vomiting. People with migraines usually feel the need to avoid bright lights and loud sounds, and would like to be able to sleep off the headache. About 10 percent of migraine sufferers get an “aura” before the headache begins, which may consist of flashing lights or other changes in vision. This aura can serve as a warning signal and an impetus to take the proper medication or begin an appropriate Yoga program immediately, to head off the migraine.
Migraine headaches are in the category of vascular headaches, meaning blood vessels are involved. Doctors once believed that migraines occurred when the blood vessels became constricted, leading to an aura, and then became dilated, leading to the head pain. It is now recognized that migraines may be related to a deficiency of neurotransmitters such as serotonin, but science is still lacking a complete understanding of their origins. Up to 90 percent of people with migraines have at least one family member who also has migraines.
If you are trying to get rid of your headaches, it is important to understand that there are a wide variety of treatments, and individuals respond differently to each of them. What works for one person may not work for another, and even for the same person, what works one time may not work the next. For this reason, the Yoga philosophy of treatment is to take a multifaceted approach to discover what might help.
There are quite a few different prescription and over-the-counter medications for headaches. One of the problems with treating frequent headaches with medication is the development of rebound headaches. Rebound headaches occur when the medicine used to treat the headache wears off and the pain reappears, often leading the sufferer to take more medicine. This is a difficult and painful catch-22 situation, because the best treatment for rebound headaches is to stop the medicine that seems so badly needed. Because of the phenomenon of rebound headaches, most doctors agree that frequent tension and migraine headaches are much better treated preventatively whenever possible, through medicines or other techniques such as Yoga.
Antidepressants may be used to prevent chronic headaches and frequent migraines. The antidepressants work by making more neurotransmitters available to transmit nerve signals. Some medicines that are used to treat high blood pressure (a vascular condition) can be used to prevent migraines.
Tara was in her late forties and had suffered from severe migraines for more than twenty years. She had seen numerous medical specialists and tried medications with limited success. For a year, her pain had been increasing to the point that she was requesting Demerol shots from her doctor. Since long-term migraines are a complex problem, I suggested we take a holistic look at her health and that we approach her migraines from several directions.
First I referred her to a physician who discovered that Tara's migraines were brought on by certain foods. This was a major breakthrough. Tara and her husband had joined a wine and cheese club just before the attacks had started escalating, but she had never made the connection until her physician suggested that she see what would happen if she eliminated wine and cheese from her diet. This initial step began to help. The next breakthrough was when I learned that Tara was a night owl, going to bed after midnight and getting up by 6:30 A.M.to get the kids off to school. One of the major tenets of healing headaches from a Yoga standpoint is to go to bed early and get plenty of sleep. Tara felt that getting to bed by 10:00 P.M.would be quite a challenge, but she agreed to give it her best shot.
I recommended Core Routine II for Tara when she did not have migraine symptoms. I gave her a separate routine to practice when she first felt a headache coming on. This routine is outlined later in this chapter.
Tara practiced her Yoga on a daily basis and was pretty consistent with her diet and sleep improvements. After only a month, she noticed a significant decrease in headaches, and after two months Tara's symptoms had been reduced by half and she was no longer requesting Demerol injections. After a year and a half, Tara is almost headache free and elated with the new freedom this gives her. “I had to make some difficult changes,” she told me, “and I wasn't sure I'd be able to do it. But being free of those migraines has given me a new lease on life, and that makes all the little sacrifices worthwhile.”
Tara's situation perfectly illustrates the intricate nature of headaches, and the multifaceted approach that often is necessary to treat them. This can be true of all primary headaches, because they may have a variety of interrelated causes. Typical triggers of chronic headaches include food sensitivities, hormonal changes as in the menstrual cycle, inadequate sleep, change of weather, and emotional factors such as stress.
The primary use of Yoga for headaches is prevention. The Yoga philosophy helps headaches because it encourages you to look at yourself holistically and to consider all possible contributors to your headaches. If you are serious about eliminating your headaches, you may need to make some lifestyle changes.
The first step is to discover what sets off your headaches. If you have chronic headaches and haven't identified your personal triggers, you can benefit from keeping a diary in which you keep track of your headaches, noting their severity and any possible contributing factors that preceded the headache. Foods that commonly activate migraines are alcohol, aged cheeses, red wine, chocolate, dairy products, nitrates in hot dogs and lunchmeats, MSG, aspartame (NutraSweet), and changes in your usual amount of caffeine intake (either too much or too little). Environmental factors include perfumes and weather changes. You should also keep track of other possible contributors such as stress levels, amount of sleep, irregular eating patterns, hormonal changes, and any other medications you may be taking (see the Resource Guide).
One of the biggest contributors to both migraines and tension headaches is stress. Contrary to popular myth, the fact that stress plays a role in migraine doesn't mean it is a psychological disorder. Stress has the same effect on migraines as it does on other disorders such as asthma and heart disease: It doesn't cause them, but it can make them worse. Yoga is one of the best methods of stress reduction. Practicing Yoga can help relax the tight and contracted muscles that are involved in tension headaches. By preventing stress or minimizing the body's response to stress, Yoga can prevent the onset of a tension headache or migraine. According to Dr. Dean Ornish of the Preventative Medicine Research Institute, “Many people find that meditation and Yoga may help decrease the frequency of migraines, since stress may cause your arteries to constrict and stress management techniques may help to prevent this from happening in the first place.”3
Yoga provides an effective alternative to medications because it doesn't lead to rebound headaches. For this reason, Dr. Richard Usatine works with his patients to approach their headaches holistically rather than simply prescribing medication. In more severe tension and migraines headaches, Yoga can be used safely in conjunction with medications.
Practicing a Yoga routine has specific benefits for headache sufferers in addition to general stress reduction. It can loosen up chronically tense muscles in the head, neck, and back. It can provide relief from sensory overload, and relax your mind so that your body can effectively combat pain. The Yoga philosophy overall can stop you from being locked in the viscous circle of pain-anxiety-more pain that leads to chronic headache problems.4
Identify your dietary triggers and make a point to avoid them. You may want to start by steering clear of red wine, aged cheeses, chocolate, nitrates, and MSG.
Keep a headache diary to help discover your triggers.
Eat a healthy diet that's relatively low in fat and high in complex carbohydrates.
Sleep at least seven or eight hours per night. If you are doing this, and it doesn't seem to be working, try going to bed earlier and getting up earlier.
Try to isolate other environmental and lifestyle factors that bring on your headaches, and take steps to minimize or avoid them.
For long-term and severe pain, consult with your doctor to construct a multifaceted plan of attack, including medication if prescribed, avoidance of triggers, and daily Yoga practice.
Practice the appropriate Yoga therapy routine from this chapter. Start with two or three days a week, working up to five or six days a week.
Yoga for Migraines
For Prevention of Migraines: Use Core Routine II once per day. Use Focused Breathing Part Two. Inhale and exhale through your nose, pausing briefly after the inhalation and the exhalation.
If Core Routine II is too difficult, practice Core Routine I or the easier Lower Back Routine for about two to four weeks each, and work up to Core Routine II.
At the First Sign of Migraine Symptoms: When you think a migraine is coming on, practice the Yoga Routine for Tension Headaches, as long as you feel you can.
During a Migraine: Do not practice Yoga during an acute migraine attack.
Yoga for Tension Headaches
One useful headache remedy is an ancient Yoga technique called the Six-Opening Seal. Traditionally, you would use your hands to partially seal off your eyes, ears, and nostrils. Yoga master B. K. S. Iyengar has popularized a modern adaptation using an elastic (Ace) bandage to wrap your forehead, ears, and eyes. This creates pressure and reduces sensory input to calm tension in the eyes and brain.
The following routine ends with three postures that call for the optional use of an elastic bandage. If you prefer not to use the bandage, just skip over it. This routine takes approximately fifteen to twenty minutes and should be practiced twice a day, once at the time you normally get your headaches, and one other time. Use Belly Breathing. Ideally, practice the routine twice a day until your condition improves, then practice it once a day. When you feel your condition has subsided, you may cut down to three times a week.
It is not dangerous to practice this routine when a tension headache is already present, and it can help alleviate the headache. However, it is best to start the routine before the onset of the headache.
This posture is used for all seated positions in this routine. It supports the spine and facilitates a good sitting position.
Sit comfortably in an armless chair, bringing your body slightly away from the back rest.
Let your arms hang down by your sides. Place your feet evenly on the floor at hip width. If your feet do not touch the floor, place a folded blanket or a phone book under them. Your thighs should be parallel to the floor, with your knees and hips bent at approximately a 90 degree angle.
Place your hands on your thighs with your fingers toward your knees. Bring your back up nice and tall, and gently pull your head back until your ears, shoulder, and hip sockets are in alignment. Do not force anything beyond your comfort level.
Use Belly Breathing, for 8 to 10 breaths. Gently draw the belly in toward your spine on the exhale.
Seated Alternate Arm Raise
This movement improves range of motion and brings circulation to your upper back and shoulders.
Start in the Seated Posture.
Let your arms hang at your sides, palms turned back. Look straight ahead.
As you inhale, raise your right arm forward and up overhead until it is vertical.
As you exhale, bring your right arm down to the starting position.
As you inhale, raise the left arm forward and up overhead. Exhale on the return.
Repeat 4 to 6 times, alternating arms.
This sequence relieves tension and promotes circulation in your upper back, neck, and shoulders.
Start in the Seated Posture.
Place your hands on your thighs, palms up. As you exhale, raise both hands to eye level, palms facing you as though you were holding an open newspaper.
As you inhale, move your open hands forward, up, and overhead. Follow your hands with your eyes and head. Stop when your hands are directly over your forehead.
As you exhale, bring only your chin down toward your chest.
As you inhale, bring your elbows back and apart from each other, turning your palms forward and flexing your wrists backward. Lift your chin off your chest and look straight ahead, pressing your elbows back.
As you exhale, round your back forward like a camel, bringing your bent arms forward so they are in front of you. Keep a slight bend in your elbows. Your arms should be roughly parallel to the floor, with your arms and ears in alignment.
As you inhale, return to the starting position; then fully exhale.
Repeat slowly 4 to 6 times.
This gentle twisting motion stretches the muscles of your upper and lower back and tones the abdomen.
Sit sideways on a chair with the seat back to your right, feet flat on the floor and heels directly below the knees.
Exhale, turn to your right, and hold the sides of the chair back with your hands. If your feet are not comfortably on the floor, place a folded blanket or a phone book under them.
As you inhale, bring your back up tall, as if you were trying to touch the ceiling with the top of your spine.
As you exhale, twist your torso and head farther to the right.
Return to the starting position. Repeat the twist, gradually twisting farther with each exhalation for 3 breaths, but do not go beyond your comfort zone. On the last repetition, hold the twist for 6 to 8 breaths; then return to the starting position.
Repeat the same sequence on the opposite side.
This posture relaxes and gently stretches your lower and upper back. (If you have knee or hip problems, replace Sitting Cat with Knees to Chest, described.)
Start on your hands and knees, looking slightly down, with the heels of your hands directly below your shoulders and your knees at hip width.
As you exhale, sit back on your heels and bring your head toward the floor. Work toward resting your torso on your thighs with your forehead on the floor, but do not force it. Sit back only as far as comfortable.
Repeat 3 times, and then relax with your head down and your arms in front (as in Step 2), for 6 to 8 breaths.
If you'd like, an elastic (Ace) bandage can be used for the remaining postures. To apply it, start with the bandage rolled up. Hold the roll in your right hand, and with your left hand, press the free end against the back of your head. Start to wrap the bandage around your head. First wrap your forehead, then your ears and eyes, but not your nostrils. Wrap firmly, but not too tightly. If you wear contact lenses, it is best to take them out. When you are finished wrapping, slip the free end of the bandage under one of the folds.
If you do not want to wrap your eyes, just wrap your forehead. If your eyes are wrapped, simply slip the bandage up a little each time you need to see, then slip it back down again to cover your eyes in the pose.
Seated Forward Bend (Supported), Optional Elastic Bandage
This posture facilitates a general calming effect. It stretches the entire back of the body, including the neck, reducing symptoms of headache.
Caution: Be careful of seated forward bends if you have intervertebral disk problems. Check with your health-care professional if you are uncertain.
Sit on the floor, with your legs extended in front of you at hip width. Place a bolster under your knees and a pillow or blanket on your thighs.
Stretch your arms, hands, chest, and head over your thighs, and place your hands on your shins, ankles, or toes. Bending from the base of your spine, bring your waist, chest, and head forward; then relax.
Stay in this supported position for 2 to 5 minutes. If this posture feels uncomfortable, try it without the bolsters, blankets, or pillows.
Corpse (Supported) with Two-Step Exhalation, Optional Elastic Bandage
If you are not comfortable in the supported Corpse, just lie flat on your back in the classic Corpse.
Lie on your back supported by pillows or folded blankets under your upper back, with your hips on the floor, your arms relaxed near your sides, and palms turned up. If your head or neck is uncomfortable, place a small pillow under it. If your lower back is uncomfortable, place a pillow under your knees or lower the support under your upper back.
Inhale fully. Draw in the belly as you exhale half of your breath in 3 to 5 seconds; then hold the breath for 3 to 5 seconds. Finally exhale the rest of your breath. If you find yourself gasping for air, shorten the length that you hold the breath, or use Belly Breathing with a long exhalation.
Repeat 8 to 12 times.
Remain in the supported Corpse. Return to Belly Breathing.
Use Healing Triangles, Yoga Nidra, or Open-Ended Meditation, for at least 5 minutes.
Breathing Break
For general stress relief, take a breathing break once a day for three to five minutes, five to seven days a week. Use Alternate Nostril Breathing or Victorious Breath.
