The Migraine Brain

by Bernstein, Carolyn; McArdle, Elaine

  Biofeedback may be a good choice for you if you don’t want to use drugs or want to cut back on how much medicine you use. It’s also good if you have a medical reason for avoiding drugs—if you are pregnant or trying to get pregnant, for example. Many patients like biofeedback because they are active in affecting their migraines, as opposed to passively taking a pill. As with any CAM treatment, talk to your doctor before trying it. Biofeedback is not good for some patients, such as diabetics, since it may block absorption of insulin.

  One of my patients had such severe migraines that she missed her brother’s wedding, something she still regrets today. She decided to try biofeedback at the Women’s Headache Center. With the help of our staff biofeedback instructor, she learned how to change her body’s responses to stress in order to stave off migraine. Many people breathe too shallowly, which increases their stress response, but my patient had an even worse habit. A monitor showed that whenever she got upset, she unconsciously held her breath for long periods. When this was pointed out, she began learning to use diaphragmatic breathing, a deep-breathing technique that’s remarkably helpful for inducing relaxation. She saw immediate results on the biofeedback equipment, and learned to make a conscious connection between her physical reactions and her stress levels. After a few more sessions, she learned to link deep breathing with staving off migraines, which worked very well for her.

  Biofeedback sessions typically last from thirty to sixty minutes, and you may need four to ten sessions before you master the technique. Some insurance plans cover biofeedback. Always mark your treatments in your headache diary, so you can measure your progress and see if biofeedback is helping you reduce your headaches. You may also want to take your score on the MIDAS scale before you begin biofeedback, and then again six to ten weeks afterwards, to monitor any change.

  To find a biofeedback instructor, contact the Biofeedback Certification Institute of America. Make sure you check the instructor’s credentials. Biofeedback instructors must be health care providers or working with a health care professional.

  Other Relaxation Techniques

  You can learn relaxation techniques by yourself, without biofeedback training. One of the simplest and best is deep breathing. Yoga and meditation, which we discuss below, are also excellent methods for relaxing.

  You can purchase CDs or DVDs, or download onto your iPod music or nature sounds that can help you relax as you do these exercises, or use relaxation tapes to guide you through these methods. Relaxation techniques are also very helpful when you are trying to fall asleep, which makes them particularly relevant to migraine health, since restorative sleep is essential for warding off migraine attacks.

  Deep Breathing

  “Deep breathing is my secret weapon. It works—which I learned the hard way when I ran out of my medication on a long car trip. I was freaking out, sure I was going to get really sick, and I didn’t know what to do. I began to get upset, and so I started deep breathing to calm myself down. I breathed in and out, slowly, for ten or fifteen minutes, focusing on my breath, trying not to think about anything including whether I was about to get a migraine. To my surprise, it really worked. I didn’t get a migraine. I still use medicine because it kills my migraines flat, but I’m so happy to know I have something else in emergencies.”

  —Fiona, 49, writer

  If you find yourself suddenly feeling anxious or stressed—or you feel a migraine on the way—take a few minutes for deep breathing, a proven method for counteracting the stress response. You’ll very likely feel better, and you’ll almost certainly be better able to handle a problem, even a crisis. Deep breathing is helpful for many anxious situations, whether you are responding to a child crying or a near-miss in congested traffic, or trying to avoid getting upset during an argument. For people in particularly high-stress situations—firefighters, say, or critical-care nurses—it can be invaluable in helping to stay calm. And it provides your body with extra oxygen, which is really good for you.

  Deep breathing engages your parasympathetic nervous system—the relaxation system—and, in turn, starts to reverse your other stress responses. Your skin temperature will rise, you’ll stop sweating, and your brain will calm.

  It’s simple: Breathe slowly. Breathe in through your nose and out through your mouth. Try counting to four as you breathe in, then count to six as you breathe out. Breathe down in your belly rather than up in your chest. Watch your stomach rise and fall, without scrunching up your shoulders or tensing any muscles. Keep breathing. Do this for three or five or ten minutes, and you will feel a significant physical change in your body and mind: you’ll be calmer, more relaxed, better able to handle the challenges you face.

  Progressive Relaxation

  This is a very simple technique that you can do anywhere. Get comfortable—lie down or sit in a relaxed position—and close your eyes. Starting with your feet, tense up the muscles, then relax them. Move up your body to your legs: tense the muscles in your calves, then relax; next tense your thighs, then relax; then tense the stomach, arms, shoulders, then relax; move up your body to your scalp—tense the muscles of your face and head, then relax them.

  Creative Visualization

  This is simplest technique of all. Close your eyes and think pleasant thoughts. Imagine yourself on a beach or in the mountains. If you add deep breathing, you’ll get an even better response.

  Acupuncture

  Acupuncture is an ancient Chinese technique for restoring and maintaining health that uses very thin needles inserted at key points in your body to unblock energy and allow it to flow freely in your body. Over the past few decades, it has gained enormous popularity in the West. Mainstream medical organizations including the American Medical Association (AMA) and World Health Organization, as well as the National Center for Complementary and Alternative Medicine, have noted its benefits in treating illness.

  According to acupuncture theory, energy or qi (pronounced “chee”) flows throughout the body along certain channels called meridians, and pain is a result of a blockage of that energy flow due to injury, illness, or emotional stress. Needling specific points unblocks the energy and the pain goes away. (Medical acupuncturists note that these meridians correspond to the nervous system, and believe acupuncture is stimulating certain nerves.)

  Acupuncture is used to treat ailments from acne and cancer to menstrual cramps and stroke. Many migraine patients find it very helpful for preventing migraines or aborting them. Some choose to rely solely on acupuncture; others use acupuncture as a complementary treatment along with medications. One of my patients had an 80-percent reduction in the number of migraines after several acupuncture sessions. Some patients also get relief with acupuncture from the pain of a migraine in progress.

  Acupuncture has few if any side effects. You won’t get rebound headaches or endure other unpleasant results. As long as you visit a certified acupuncturist—and if you prefer, you can see a medical doctor trained as an acupuncturist—there is virtually no downside. If it doesn’t work for you, you’ll be out only the cost of the session. Some health plans today cover a certain number of acupuncture treatments. So, if you’re looking for a drug-free treatment option with no health risks, this may be a good choice.

  Let’s clear up some myths about acupuncture. First, acupuncture needles are not painful. They are much thinner than needles used for injections. At most, you may feel a twinge when a needle is inserted. Second, you probably won’t have needles inserted in your face or scalp when you’re being treated for migraine. Because the energy channels or meridians begin and end at the body’s extremities—your feet and hands—the best points in which to insert needles are often farthest from the site of the illness. In treating headache, many of the best points are in the hands, feet, or lower legs.

  Different headaches involve different meridians. The acupuncturist will ask questions about your pain: where it begins, where it runs, other symptoms, in order to determine the appropriate meridians to target.
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br />   The key is finding an excellent acupuncturist. Ask your headache specialist, your primary care doctor, and your friends for recommendations. In most states, acupuncturists are required to be licensed, although some states are more rigorous than others in the licensing process. A few states allow only medical doctors to perform acupuncture. Be sure you check the credentials of anyone you see to make sure he or she has been trained in a certified acupuncture school and is licensed, if your state requires it.

  To find a certified acupuncturist in your area and other information, go to www.acupuncture.com, which includes links to lists of certified acupuncturists, acupuncture schools around the country, and other resources. If you prefer to see a medical doctor trained as acupuncturist, go to the website of the American Academy of Medical Acupuncture at www.medicalacupuncture.org.

  The Headache Acupressure Point

  Acupressure works on the same theory as acupuncture but instead of needles relies on the massage of key points on your body. You may already be familiar with the acupressure point on your body related to treating headache, which is the soft area between your thumb and first finger. This point involves the energy channel or meridian that runs up to your head and around your eyes (the area that a pair of goggles would cover). Firm massage of this point may help relieve your headache. It’s certainly worth a try—it’s free, harmless, and may work.

  That particular point probably won’t help if your headache originates in your occipital area (at the back of the head) or the top of your head, as those areas are related to different meridians. And while acupressure may do in a pinch—no pun intended—it’s not nearly as accurate as acupuncture and is less likely to work in many circumstances. Many acupuncture points are in very small crevices between tendons or bones, reachable by acupuncture needles but not by the simple application of surface pressure. Depth of pressure matters, too. If a point is close to the surface of the body, acupressure may suffice, but acupuncture may be called for if the point resides deeper in the body. The headache acupressure point is located close to the surface of the skin so massaging it can be effective. But it’s very difficult to reach other migraine points through acupressure alone.

  Yoga

  “I have a lot of muscular tension in the neck which really triggers a lot of my headaches. In yoga, I do stretches specifically for my neck. I only go to class once a week, on late Friday afternoons, which is what I can fit in right now, but it helps a lot. It releases the week’s tensions and gets me going for the weekend.”

  —Theresa, 38, social worker

  In the past thirty years, yoga has become one of the most popular forms of exercise and relaxation practiced in the Western world. Through stretching postures and breathing, yoga promotes balance and wellness in both mind and body. Numerous studies over decades show yoga as very effective in reducing stress, improving immune system functions, and leading to a happier, healthier state of mind and body. It can improve your mood, relax you, help with concentration and focus, and increase your strength and flexibility. Yoga is not for everyone, but many people find they feel much better after even one session. I’m an enthusiastic proponent and practice it myself. I find it very helpful for staying physically and mentally fit.

  Yoga can also treat illness. Specific yoga postures—called asanas—are used for specific ailments, and some of the forward-bending poses are especially helpful for migraine. We don’t know why, although we do know that yoga releases endorphins, your body’s natural painkillers. The breathing exercises of yoga, called pranayama, also help to reduce stress and bring a calm mind. Yoga postures promote flexibility and bring various parts of your body into proper alignment, and so can help with muscle spasms. For migraine sufferers, this kind of stretching can iron out kinks in your neck and back, and may even help relax the muscles of your scalp, which is often a tender, sensitive part of your body.

  A recent study in India found that migraineurs who used yoga in combination with meditation and other relaxation techniques had fewer migraines with less pain. Anxiety and depression were also significantly reduced. A control group of migraineurs who didn’t do yoga but concentrated on avoiding migraine triggers and changing their diet and other aspects of lifestyle showed no improvement at all—or got worse.

  Some patients are afraid to try yoga, worried they’ll be required to perform headstands and other difficult physical tasks. But the great yogis tell us this: If you can breathe, you can do yoga. You don’t have to be able to place your foot over your head to get significant benefits. Even very simple poses, along with yogic breathing, are really good for you. It is the practice of yoga—rather than reaching specific goals—that is the point. Every little bit helps.

  If you are interested in trying yoga for migraines, I strongly recommend that you find a yoga class taught by a certified yoga instructor. Eventually, you can learn to do yoga on your own or use a DVD or CD to guide you. But in the beginning, an instructor is essential to help you learn the poses and the breathing. Even better, at least at first, is to have one-on-one sessions with a yoga instructor who can focus on your specific needs, including your migraines. A good instructor will always recommend that you back away from any pose that feels uncomfortable to you.

  If you are just starting out with yoga, I recommend a gentle practice such as Hatha yoga or Iyengar yoga. Until you are more experienced, avoid more intense approaches such as hot yoga, power yoga, or Ashtanga yoga because the pace can be daunting for a newcomer. Hot yoga—in which the room is kept at high temperature to induce sweating and the poses move quickly—may be bad for you if your Migraine Brain is sensitive to extremes in temperature.

  Actress Marcia Cross, who is a spokesperson for Imitrex, uses yoga to help treat her migraines.

  Especially in larger cities, there are all styles of yoga classes, including those for moms, where babysitting is provided. You can Google “yoga” in your area to find a class, but, again, make sure that your yoga instructor is credentialed and has a certificate to demonstrate it. The International Association of Yoga Therapy, www.iayt.org, has many resources including a search engine for finding a yoga instructor in your area.

  A couple of times a week is the optimal regimen for yoga practice. But if you can only go once a week, that’s fine, too. It can be helpful to attend class with a spouse, partner, or friend—not only will he or she benefit, but it helps to include them in your search for migraine wellness. And it’s easier to stay motivated when you have a yoga buddy.

  Here is a partial list of poses that can help with migraine.

  Hands to feet (Pada Hastasana)

  Child pose

  Warrior pose

  Triangle pose (Trikonasana)

  Standing side stretch

  Take this list with you to your instructor, and have her or him show you how to do them. It’s really not best to teach yourself by using a book, videotape, or DVD. If you do these poses wrong, they may not work—and you could possibly hurt yourself.

  Your instructor may have other poses that she recommends for migraine. Try them and see if you feel better. Of course, if you get migraines or have other health problems as a result of something that’s supposed to help you—whether that’s yoga or any other treatment—don’t continue.

  Meditation

  Meditation is a practice of calming your mind through focused breathing and mindfulness, which means to stay in the moment rather than think about the past or future. Meditation is a centuries-old practice, has many forms, and is very beneficial for both mental and physical health.

  The simplest form of meditation is simply to breathe deeply and focus on your breathing instead of thinking about anything else. You can chant a mantra or repetitive sound, but you don’t have to. The point is to stop your restless mind from jumping around—worrying about work or family or yourself—and bring yourself to a state of calm. There are many other methods of mediation, and many centers around the United States and the world in which you can learn this practice, in such st
yles as Zen meditation, Buddhist meditation (with many subtypes), and transcendental meditation. You can also purchase meditation tapes and learn to meditate on your own.

  Meditation has been proven to lower stress levels by reducing heart rate and lowering blood pressure. It can help you sleep better, refresh your brain (which rarely gets a rest), and—important for migraine—may affect the pain cycle. It’s safe, free, and you can do it anywhere, any time. You don’t have to sit in a quiet room, although some people prefer this. You can enjoy walking meditation, where you concentrate on your breathing as you walk. You can practice mindfulness anytime—when you are doing the dishes, think only of doing the dishes; when you are talking with your child, think only of this moment and be completely present in it.

  Meditation has gained enormous popularity and credence in recent years. A growing body of medical knowledge supports the benefits of meditation in a variety of situations: it improves recovery rates from surgery and chemotherapy, for example. It is used increasingly in a variety of settings including corporations, hospitals, and schools, to help people cope with pain, rage, and other emotions, to learn to focus better, and to de-stress.