Magazine: Yoga Journal
Issue: May/June 1996
Author: Kelly Schnell Huotari

BANISHING THE MIGRAINE MONSTER

I immediately started begging the recovery room nurse for morphine after waking up from gall bladder surgery last year. But I wasn't seeking relief from postoperative soreness. It was much worse than that. I was gripped with a severe migraine attack that overshadowed any discomfort I may have felt from the invasive surgery. My head was throbbing with a nauseating pain that I had already come to know intimately-a pain I fear and loathe.

Acute headaches are simply unbearable. Just ask anyone who's ever experienced one. For years I've desperately sought relief, bouncing from one doctor and emergency room to the next, eagerly gulping down all the medication I could get my hands on. But prescription medications alone weren't enough to defeat what I call "the migraine monster." What I really needed was a prescription for change, and thankfully I found it: It involved an evaluation of my lifestyle, including how I work, rest, eat, and most important, how I deal with the stress our world dishes out on a daily basis.

More than 45 million Americans suffer from at least one headache a year and at least 20 million of us know the pain of migraine. The effects are devastating. According to the National Headache Foundation, in l994 headaches afflicted more people than motorcycle accidents, car collisions, and industrial accidents combined. Industry lost $50 billion due to absenteeism and medical expenses, and sufferers missed more than 157 million workdays.

Despite the statistics, however, people with headaches have traditionally gotten little sympathy from friends, family, coworkers, and even the medical community. Dr. Robert Taylor, who treats chronic and severe headaches at the Oregon Health Sciences University Hospital in Portland, Oregon, calls headaches an invisible disability. "People with headaches get no sympathy because they look healthy. They're not wearing braces or using crutches, and they don't get a disability placard for their car. But during an attack, these people are disabled."

As more information becomes available, attitudes are changing. New research has pinpointed some of the physiological triggers of migraines, daily chronic headaches, and muscle contraction headaches. As a result, there are many more options for treating and preventing these debilitating disorders. Perhaps the biggest breakthrough in headache treatment is the revival of an ancient concept: Headaches, like most illnesses, involve the whole person-body, mind, and spirit-and therefore the whole person must be treated.

Many new drugs are available for preventing and treating headache symptoms, including sumatriptan (sold under the brand name Imitrex), which has proven to be highly effective. But doctors are starting to realize that medication alone is not the answer. Dr. Bradley Galer, a neurologist at the University of Washington's Multidisciplinary Pain Center in Seattle, Washington, recommends that people cut down the number of medications they're taking and focus instead on nondrug strategies. "Headache patients need a synergistic approach. They need their medications tidied up, they need to do relaxation therapies on a regular basis, and embark on an exercise program, to name just a few treatment options. And quite frequently, when done together, there's more bang for the buck and the patients gradually notice differences."

Most important, headache sufferers need to take control of their pain. Steve Graff-Radford, D.D.S., who specializes in pain management at Cedars- Sinai Medical Center in Los Angeles, says patients who feel they have control over their headaches do remarkably well. "By teaching patients a means of control, you reduce the frequency and intensity of the headaches dramatically."

Headache Variations

The most common types of headaches include migraine, tension, and daily chronic headaches, and it's not unusual to suffer from more than one of these disorders. In fact, one type of headache can actually trigger another. For example, a migraineur may suffer tension headaches caused by the anxiety that comes with migraines. Conversely, muscle contraction associated with tension headaches can irritate nerves which can trigger a migraine.

Migraines are characterized by recurrent episodes of severe, throbbing pain, which is usually felt on one side of the head only. Nausea and vomiting may occur, and attacks can last from a few hours to several days. About 20 percent of migraine sufferers have classic migraines, which start with an aura of flashing lights or disturbed vision, often accompanied by feelings of numbness throughout the body, confusion, and hallucinations. Lewis Carroll reportedly came up with the idea for Alice In Wonderland while experiencing an aura. The other 80 percent suffer from common migraines, which are not preceded by an aura.

Health professionals classify migraines as vascular headaches. In the 1920s researchers conducted brain biopsies on migraine patients and discovered that during an attack arteries in the head first constrict and then later dilate. The throbbing pain that accompanies a migraine is thought to be caused by blood pumping through the dilated arteries. Today researchers believe that the constriction and dilation of the blood vessels is triggered by a rapid drop in serotonin, a chemical substance found primarily in blood platelets. In 1993 French researchers conducted tests linking migraines to a defect in chromosome 19-information that could someday lead to gene therapy. This study, along with others, also substantiates the theory that migraines are hereditary. Migraines affect three times as many women as men, with changes in estrogen levels just before, during, and immediately after menstruation causing some women to be more susceptible to attacks.

Another type of vascular headache, called a cluster headache, is far less common. Cluster headaches overwhelmingly strike men and are characterized by pain behind one eye. They are considered to be more painful than migraines, but the attacks are much shorter, usually lasting less than an hour. Cluster headaches occur in groups or clusters over the course of a few days or weeks.

Also known as muscle contraction headaches, tension headaches-the most common form of headache-show up as a steady ache or constricting band of pain around the head. Generally caused by muscle contractions in the neck, face, and scalp, these headaches result from emotional triggers such as stress, depression, or anxiety.

It's not uncommon for migraine and tension headache sufferers to start experiencing frequent, dull headache pain between acute attacks. Experts agree that in the majority of cases the cause of these intermittent headaches is the very medication the patients took to relieve the initial pain. Prescription and over-the-counter analgesics can actually trigger what are termed rebound headaches, when taken more than two days a week on a regular basis. "For my patients with rebound headaches, one of the first things you have to do is undo," says Dr. Steve Baskin, clinical psychologist and director of the New England Institute for Behavioral Medicine in Stamford, Connecticut. "Other treatments for headaches won't work if a patient is overusing analgesics. They're doomed to fail."

Avoiding the Triggers

Although researchers are still investigating the root causes of headaches, they have identified many possible suspects. Common food triggers include alcohol, caffeine, aged cheeses, monosodium glutamate or MSG, food with nitrates (such as hot dogs), and sugar substitutes. Poor posture and other back and neck problems can also trigger headaches, along with hunger (which results in a drop in blood sugar), oral contraceptives, changes in weather, bright lights, excessive noise, cigarette smoke, allergies, and disruptions in sleep patterns. Most experts agree, however, that the most common trigger for migraine and tension headaches is emotional stress. Headache sufferers, particularly those who experience migraines, are thought to be highly responsive emotionally, reacting quickly to stress. An important first step in managing headache pain is to identify the triggers. Many headache specialists, including Dr. Joseph Kandel, medical director of the Neurology Center of Naples (Florida) and coauthor of the book Migraine: What Works (Prima Publishing, 1996), recommends keeping a headache diary. "People have a lot of power and control over the frequency and severity of their headaches. Basically the way to have that control is to find your triggers and adjust them."

But identifying headache causes can be tricky. For example, just because a patient suffers a migraine after drinking a glass of red wine doesn't mean she'll have an attack the next time she drinks a glass, says Dr. Graff- Radford. "A number of factors have to be in line in order to trigger the headache. This may include a glass of red wine and a drop in her estrogen level, because she's close to her menstrual cycle and may have experienced an increased stressor that day."

Once the stressors have been identified, the next step is lifestyle modification. This could include eliminating suspect foods and giving up smoking, although experts warn the results probably won't be immediate. A headache sufferer who stops drinking coffee probably won't see any improvement for about four to six weeks. In fact, in the interim, the headaches could actually worsen.

It's essential that headache sufferers get their lives in order. That means eating three small meals at regular intervals throughout the day, going to sleep and waking up at the same time each day, and exercising regularly to relieve stress and stimulate the release of endorphins, the body's natural painkillers. This advice is especially important for migraine sufferers. "Migraineurs need to be organized and cyclical creatures," says Dr. Kandel. "It sounds very rigorous, but it's not actually that bad once people get into the habit of doing these activities."

Getting Help

In an ideal world, a headache sufferer would simply be able eliminate the factors which cause emotional stress. Since this is next to impossible, specialists instead teach their patients how to cope. Biofeedback is one of the most effective ways to achieve this: Patients learn to actually control basic physiological functions normally thought to be involuntary. Tension headache patients learn to relax their muscles and regulate their breathing, while migraine sufferers are taught to warm their hands and feet, which can improve or even stop a migraine. (While there's no scientific evidence for this, most experts agree that warming the hands and feet diverts blood away from the brain, which alleviates head pain.) By controlling breathing, muscle tension, and blood flow, headache patients are basically learning to control their reaction to stress.

I've worked extensively with a biofeedback therapist to control both my migraines and tension headaches with some encouraging results. I visit my therapist's office on a weekly basis, spending an hour in a semidark room, reclining in a big comfy chair-the kind usually reserved for watching football games on a lazy Sunday afternoon. The therapist tapes sensors to my fingers to measure my hand temperature, as well as to my neck, back, scalp, and face to assess muscle tension. By watching a monitor, I receive immediate feedback as to my body's slightest changes. Through creative imagery, my therapist encourages me to relax and increase the temperature of my hands. I imagine I'm holding a warm cup of cocoa or that I'm lying on the beach and all of my body is in the shade except for my hands. Like most patients, the first time I tried to warm my hands, the temperature gauge immediately plummeted. It usually takes about eight to 10 sessions, combined with daily practice, to master the basics of biofeedback. Stubborn type A personalities-and I confess that I'm one- can take somewhat longer.

I'll never forget the first time I got rid of a migraine by warming my hands. My pain was intense and moving my head, even slightly, was sheer agony. I hooked myself up to a home temperature monitor and, with all the concentration I could muster, willed my hands to become warmer. Within five minutes, my hand temperature shot from 69 to over 95 degrees; my fingers were red and swollen and I could feel the blood coursing through them. Tentatively, l moved my head to check the status of the migraine. Instead of the stabbing pain, I felt nothing. It was wonderful.

Other Forms of Relief

My biofeedback training also includes progressive relaxation, which is a common therapy for headache sufferers: By alternately contracting and relaxing major muscles throughout the body, tension is released. Another time-honored way to release muscle tension is through acupuncture. According to Chinese medicine, when chi, or life force isn't circulating properly through the body, illness can result. Acupuncture is used to clear the meridians or channels along which this energy runs. Modifying this ancient healing method, researchers at the University of Washington's Multidisciplinary Pain Center, in Seattle, Washington, are currently conducting tests in which needles are inserted into the tight, knotted muscles of tension headache sufferers. Although test results have not been finalized, neurologist Bradley Galer says the procedure is helping a significant number of patients. "By going into a muscle with a needle, we seem to be able to release the muscle tension which contributes to the headaches." Dr. Galer says this modified form of acupuncture has also helped some migraine patients.

Many chronic headache sufferers disenchanted with allopathic remedies have benefited from adding herbs to their daily regimen. Although their healing power is often overlooked by modern medical practitioners, herbs have been used to treat headaches since ancient times. Records show that feverfew, for example, has been used to treat stress-induced headaches since the first century C.E. It is the only herb that has been scientifically validated as an effective headache remedy. While freeze-dried feverfew leaves work best when taken on a regular basis, most medical experts warn against using the herb for longer than six months.

Ginger, an antihistamine and an anti-inflammatory, controls some migraine headaches when taken on a regular basis. Herbalists recommend taking four 600-milligram doses of powdered ginger a day; fresh ginger can be substituted. There is no evidence of any side effects. White willow bark, containing salicylate compounds-effective pain relievers-can also be taken at the onset of a headache. Herbalists recommend buying capsules containing five to 11 percent salicin and taking no more than l,000 milligrams a day. Other helpful remedies include teas made from camomile, a nervous system relaxant, and ginseng, which nullifies stress symptoms.

Any successful headache-relief program should also include breathing techniques. By attaching a sensor to my diaphragm and watching my breathing patterns on a monitor, I've learned how to take deep, relaxing breaths. I have strict instructions from my therapist to stop whatever I'm doing every hour to practice rhythmic breathing, while consciously relaxing my muscles.

Anyone familiar with yoga will see a strong parallel to techniques such as biofeedback. Both provide a greater awareness of and control over the body's reaction to daily stress. Judith Lasater has taught yoga for 25 years. Author of the book Relax and Renew (Rodmell Press, 1995), which describes the healing effects of restorative yoga, Lasater agrees that biofeedback, with all of its electronic gizmos, can achieve many of the same objectives as yoga. "Yogis rely purely on their own perceptions to regulate their internal state," she says. "We all have biofeedback loops in our own bodies, but for some people in the scientific age, it's reassuring to use a machine." Lasater recommends that headache sufferers practice restorative poses such as Supported Half Dog Pose and Supported Bridge Pose on a daily basis. She says that learning to relax through yoga can be very healing for anyone with chronic head pain.

Through relaxation I've grown strong enough to take on the migraine monster. My headaches are less frequent and those I do get aren't as severe. More important, I feel I have control over the pain. Finally, I'm fighting a winning battle.

Kelly Schnell Huotari has worked as a print and television journalist for the past decade. She currently lives in Portland, Oregon, where she works as a freelance writer.

Resources National Headache Foundation, (312) 907­p;6232.

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