Download Classic Migraine

 Classic Migraine
How yoga can minimise symptoms and improve
quality of life
Jessica Dewar
25 March 2015
5OO+Hr TTC
Classic Migraine and Yoga
Contents
Background ............................................................................................................................................. 3 Introduction............................................................................................................................................. 3 Understanding migraines .......................................................................................................................... 4 Types of migraines and their associated symptoms ..................................................................................... 5 Diagnosis................................................................................................................................................. 5 Treatment ................................................................................................................................................ 6 Triggers ................................................................................................................................................... 6 Complications .......................................................................................................................................... 6 Case Example ....................................................................................................................................... 8 Yoga Sequence ........................................................................................................................................ 8 Aims ............................................................................................................................................... 8 Objectives ...................................................................................................................................... 8 John’s personalised sequence ....................................................................................................... 9 Conclusion ............................................................................................................................................. 10 References ............................................................................................................................................. 11 Page 2
Classic Migraine and Yoga
Background
“Yoga Chitta Vrtti Nirodha: Yoga is the control of the mental processes (Patanjali, Yoga Sutras 1.2)”
It is understood that through the practice of yoga, one is seeking to connect God and soul, body,
mind and spirit in pursuit of being led from Samsara (reincarnations) to Kaivalya (liberation).
Yoga has been taught and practiced throughout the world for thousands of years. Whilst some
practitioners are seeking to attain Kaivalya, many a man has begun yoga to acquire the health
benefits associated with the practice.
Hatha Yoga, one of the many kinds of yoga, pays particular attention to, and places huge
importance on, the application of correct technique. This not only refers to the technique of asanas,
but also pranayama, bandhas, kriyas, mudras etc. Only through correct application of technique
does a practitioner become fully aware of, and ultimately connected to, the body, breath and mind.
From here, one can attain ultimate bliss. If we therefore consider how powerful this practice can
be, it makes sense to assume the health benefits associated with yoga can be monumental.
As yoga teachers, we have a responsibility to ensure students are participating in a practice that
meets their level of experience and will allow the student to progress, both physically and mentally.
This requires the teacher to be aware of pre-existing illnesses or injuries the student may posses,
giving the teacher an opportunity to design a personalised sequence that meets their needs. This
sequence must contain fundamental elements of yoga, including (where appropriate) asanas,
pranayama, kriyas, bandhas, mudras and so on. The intention of the sequence is for the individual
practitioner to achieve optimum health, with a particular focus on reducing and/or removing
completely the existing injury/illness.
This paper will specifically address how yoga can help a Classic Migraine sufferer to reduce or
eradicate associated symptoms through the practice of yoga.
Introduction
It is said there are more than 1 billion people worldwide who suffer from symptoms of migraines,
predominately in western countries. That’s 15% of the world’s population, highlighting how
common migraines are and therefore how likely it is a teacher will have a student who experiences
them.
Well-trained yoga teachers play an integral role in a person’s successful progression in their yoga
practice, but from a more holistic view, in a person’s ability to improve their current health status.
Practitioners who suffer migraines are not a homogenous group. Like all human beings, they have
varied biopsychosical factors that impact upon the individual both mentally and physically.
Therefore the diagnosis and symptoms experienced will vary from person to person. Note: It is
argued migraines are not a disease or illness, but merely a symptom in response to many other
factors such as autoimmune related issues, gluten issues, thyroid imbalances and so on.
Research tells us migraines are more prevalent in women, commonly beginning during
adolescence. For perimenopausal women, migraine severity commonly intensifies before eventually
reducing in severity and for some, ceasing completely. For others, 3-10% of elderly women will
continue to suffer the effects of migraines. Overall, for both male and female sufferers of migraine,
18-43% are expected to have the illness life long.
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Understanding migraines
Little is known about the actual cause of both headaches and migraines however it is widely
understood genetic and environmental factors are causal factors. Some research suggests migraines
are a neurovascular disorder where increased excitability of the cerebral cortex and abnormal
control of pain neurons of the brain stem result in migraine symptoms.
Some find it difficult to draw clear distinctions between the headache and migraine, however for
the purpose of this paper, the World Health Organization (WHO) definition and International
Headache Society’s diagnostic criteria of the Classic Migraine has been used.
According to WHO, migraines are loosely defined as a primary headache disorder which is of the
most common disorder of the nervous system. They can also be the result of medication overuse
headache. Specific symptoms of migraine (general) are:
•
•
•
•
Commonly begins at puberty and most affects those aged between 35 and 45 years.
It is caused by the activation of a mechanism deep in the brain that leads to release of painproducing inflammatory substances around the nerves and blood vessels of the head.
Migraine is recurrent, often life-long, and characterized by attacks.
Attacks include features such as
o headache of moderate or severe intensity;
o nausea (the most common characteristic);
o one-sided and/or pulsating quality;
o aggravated by routine physical activity;
o with duration of hours to 2-3 days;
o attack frequency is anywhere between once a year and once a week; and
o in children, attacks tend to be of shorter duration and abdominal symptoms more
prominent. (WHO)
It is understood that up to one-third of people with migraine headaches experience an aura
(Classic Migraine): a temporary visual, sensory, language, or motor disturbance. Auras typically
signal that the headache will soon occur, however this does not necessarily always eventuate.
Examples of auras
Lifestyle and genetics are strongly related to a person experiencing symptoms of migraines. Whilst
genetic influences cannot be directly impacted, lifestyle alterations can be made. It is therefore our
role as yoga teachers to offer students the right tools and techniques to improve lifestyle habits and
consequently, their overall health.
The sequence we offer the practitioner (who suffers migraines) must therefore address the
symptoms, consider lifestyle influences and ensure correct technique is applied to achieve
maximum benefit.
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Types of migraines and their associated symptoms
The severity with which one experiences a migraine varies considerably from person to person.
Therefore, different types of migraines have been identified and are as follows:
Type
Symptoms
Common Migraine
Without aura
Classic Migraine
With aura
Ocular Migraine
Cause vision loss or blindness lasting less than an hour, along with or following
a migraine headache.
Status Migrainosus
A migraine attack that lasts for more than 72 hours.
Familial hemiplegic
migraine & Sporadic
hemiplegic migraine
A person who has migraines with aura and with accompanying motor
weakness, which can last for hours, days or weeks. If a close relative has had
the same condition, it is called "familial", otherwise it is called "sporadic".
Probable Migraine
A person has some characteristics of migraine, however not enough evidence is
present to diagnose as a migraine with certainty. This is often in the presence
of concurrent medication overuse.
Chronic Migraine
Chronic migraine is a complication of migraines, and is a headache that fulfills
diagnostic criteria for migraine headache and occurs for a greater time interval.
Specifically, greater or equal to 15 days/month for longer than 3 months.
Diagnosis
With a specific focus on the Classic Migraine (migraines with aura), according to the International
Headache Society the following symptoms must be present:
Diagnostic criteria:
A. At least 2 attacks fulfilling criteria B–D
B. Aura consisting of at least one of the following, but no motor weakness:
1. fully reversible visual symptoms including positive features (eg, flickering lights, spots or
lines) and/or negative features (ie, loss of vision)
2. fully reversible sensory symptoms including positive features (ie, pins and needles)
and/or negative features (ie, numbness)
3. fully reversible dysphasic speech disturbance
C. At least two of the following:
1. homonymous visual symptoms and/or uni-lateral sensory symptoms
2. at least one aura symptom develops gradually over ≥ 5 minutes and/or different aura
symptoms occur in succession over ≥ 5 minutes
3. each symptom lasts ≥5 and ≥60 minutes
D. At least one of the following:
1. Headache attacks lasting 4-72 hours (untreated or unsuccessfully treated)
2. During headache at least one of the following:
- nausea and/or vomiting
- photophobia and phonophobia
E. Not attributed to another disorder
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Treatment
For those who experience migraines, the most common methods of treatment, once accurately
diagnosed, include;
-­‐ cost effective medications
-­‐ simple lifestyle modifications
-­‐ patient education
Typical medications prescribed include;
-­‐ analgesics
-­‐ anti-emetics
-­‐ anti-migraine medications
-­‐ prophylactic medications
Commonly those who suffer migraines do not receive effective care. For example, according to the
findings of WHO, “…United States of America and the United Kingdom, only half of those
identified with migraine had seen a doctor for headache-related reasons in the previous 12 months,
and only two-thirds had been correctly diagnosed. Most were solely reliant on over-the-counter
medications”.
Looking at more holistic approaches like yoga, we can see how this practice combined with
positive changes in lifestyle, such as improved diet, can offer extraordinary healing possibilities.
Medications treat a symptom, the migraine itself, whilst yoga addresses the cause, bringing balance
to the body (Ida and Pingala).
Triggers
There are a number of triggers that are believed to cause the onset of a migraine. These can
include;
- Psychological triggers; stress, hunger, fatigue, abuse, menstruation and PTSD (post
traumatic stress disorder). Of these, triggers, stress has been reported to be the most
common. As stress is a significant health risk in western countries, such findings are
strongly correlated with the research that indicates migraine sufferers are more
predominately located in western countries.
- Dietary triggers; although there is no conclusive evidence to support what types of foods
are most commonly linked to the onset of migraine, up to 60% of sufferers have reported
diet as a trigger.
- Environmental triggers; like dietary triggers, there is limited evidence to explain what
environmental elements trigger migraine onset, however air pollution and lighting are
believed to contribute to the onset of migraine.
Complications
Psychological, dietary and environmental triggers are all influenced by one common theme –
lifestyle. As previously mentioned, a person who lives in a high stress environment, which can be
attributed to work, poor diet etc., are heightening the risk of a migraine onset.
If prevalence is increased, a person’s overall quality of life is declined. Fear of onset can result in
the development of sequale injuries/illnesses such as depression and anxiety, which can ultimately
damage ones social life, familial relationships and employment. Poor sleeping patterns, loss of
confidence, reduced or increased appetite, and digestive problems are all likely complications that
result from suffering migraine headaches.
There are also social and economic burdens associated with migraines. For example, as migraine
headaches are more prevalent in people during their most productive years, 15-50, the estimated
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financial cost to society due to loss of productivity is colossal. For example, in the United
Kingdom, it is estimated 25 million working or schools days are lost each year as a result of
migraine.
Rebound migraines are another common complication, which is directly correlated with overuse of
pain medications. In such cases, the frequency and severity of the migraine can increase which will
also have significant implications upon the person’s quality of life.
Women who have migraines with auras disturbance have an increased risk of heart illness, which is
a further example of why positive lifestyle choices, such as diet and practices like yoga, are crucial
to minimise this risk.
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Case Example
The practitioner - John:
30 year old Caucasian male
Single with no children
History of being very active; martial arts, rock climbing and weights training
Minimal to nil exercise over past 4 years
Healthy weight range
Eats well, however commonly skips breakfast and lunch
Drinks 2 litres of water daily
Drinks 5+ black tea with milk daily
Sleeping hours: 12.00am and rises 9.00-10.00am (struggles to wake / lacks energy in the mornings)
Lives in city
Uses own transportation
Employment:
Small business owner / photographer
Spends up to 8 hours per day on the computer
Medical History:
Had 2 spontaneous pneumothorax (collapsed lungs) - age 18 and 21
No plural in the lung cavity (packed with talc), lung stapled to ribs to maintain inflation
Heavily relies on aspirin for pain relief
Suffers hay fever
High stress (concerns with money/business)
Symptoms of migraine:
Can “smell” the pain – like rubber
Glowing tunnel vision – (aura)
Experience minimum twice weekly
Yoga Sequence
This sequence is designed specifically for John, taking into consideration his current lifestyle,
history and existing medical conditions, and aims to reduce and/or eradicate all symptoms of the
Classic Migraines he suffers. This sequence is also prepared in such a way that John can progress
in his practice. Due to John’s present difficulties with motivation, the sequence is 30 minutes in
duration. As John becomes more energetic, the duration can be extended. Additional breathing
and mediation techniques have been offered should John want to complete these also.
Considering John’s lifestyle and pre-existing injuries/illnesses, a gentle practice that focuses on
expanding the chest, opening the heart, strengthening the spine and improving circulation to the
head has been designed.
Aims
This sequence aims to reduce the severity and frequency of Classic Migraines experienced by John
by 50% in the first three months of practice.
Objectives
The objective of the sequence is to:
1. energise the body
2. calm the mind
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3.
4.
5.
6.
activate the nervous system through strengthening the spine
improve lung capacity
open the heart and chest
balance Tamas and Rajas, Ida and Pingala (Tamas is high at present)
John’s personalised sequence
The following sequence has been developed to address John’s Classic Migraine condition:
Asana Practice
Surya Namaskara Series
Uttanasana
Adho Mukha Svanasana
Adho Mukha Virasana
Benefits of Practice
Works whole body; includes asanas, pranayama, bandhas, kriyas
Improves circulation to the head; extends and works the spine strongly;
prepares well for advancing to Sirsasana in 3 weeks to 3 months time
Strengthens the back muscles and spine, improves circulation to the head,
improves joint flexibility, activates brain cells
As above. extends the spine well
Parighasana
Extends and works the spine strongly
Ushtrasana
Opens the chest, works strongly on the spine, improves circulation to the
head
Supta Virasana
Assists with breathing problems, preparing for Chakrasana.
Paryankasana
Assists with breathing problems, strengthens the spine, improves
circulation to the head which helps to reduce migraines, releases any
stiffness in the neck and shoulders
Chakrasana
Rocking
Jathara Parivartanasana
Paschimottansana
Opens the heart, opens the chest, improves lung capacity, extends and
works the spine strongly, improves circulation to the head
Releases each vertebrae, prevents stiffness in the spine
Strong work on the spine through intense twisting actions; cleansing and
strengthening abdominal organs
Calming asana, counter pose for Chakrasana, reduces pressure on the
heart
Sarvangasana Series
Improves circulation of the upper body, works the entire body, relieves
migraines, calms the mind and reduces stress
Savasana
Allows the entire body to rest and rejuvenate, reduces stress, slows the
mind and brings complete awareness to the body
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Classic Migraine and Yoga
Pranayama, Mudra,
Meditation, & Kriya Practice
Full Yogic Breathing
Shanmukhi Mudra
(closing the 7 gates)
So Ho Meditation
Jala Neti
Benefits of Practice
Calms the mind, brings awareness to the whole body, reduces stress
Redirects awareness inside the body. Heat from the fingers stimulates and
relaxes nerves and muscles in the face.
Powerful meditation technique, which connects the mudra with the
energy flow in the body. Brings awareness to the spine and works
strongly on all Chakras bringing balance to the body.
Daily in the morning for 3 months (or until symptoms subside)
Clears nasal passages and releases tension in the sinuses.
Sutra Neti
Vamana Dhouti
As above. Helpful for allergies, e.g. hay fever
1 x weekly for 3 months (or until symptoms subside)
Relieves tension in the body and commonly associated with relieving
symptoms of migraines
Conclusion
Today, we are seeing increasingly large numbers of people report symptoms of migraine
headaches, and it is widely accepted lifestyle plays a significant role in this. As migraines are
understood to be a symptom in response to other factors in our lives, sufferers of migraines must
first aim to become more aware of their internal processes. This can help to identify triggers and as
such, avoid them. Yoga can assist with through connecting body, breath and mind. Yoga will also
cleanse and balance the body systems, which can reduce or remove symptoms of migraines.
In John’s case, his yoga sequence has been designed in such a way that he can gradually build up
his practice as the symptoms subside and his energy levels improve. In time, John should
experience significant improvements in Classic Migraine symptoms experienced.
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References
Indea Yoga Teacher Training Level 1 Manual
Indea Yoga Teacher Training Level 2 Manual
Discussions with Caroline Scott, Nutritionist and Dietician, Australia; http://carolinenutrition.com
SAGE Journals, Classic Migraine, http://cep.sagepub.com/content/24/1_sup
Wikipedia: The free encyclopaedia, Migraine; http://en.wikipedia.org/wiki/Migraine
World Health Organisation (WHO), Headache Disorder, Fact Sheet No. 277, October 2012,
http://www.who.int/mediacentre/factsheets/fs277/en/
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