In our previous post, we covered the root cause, potential triggers, and some lifestyle changes for migraines. In this post, we plan to cover the management of migraine symptoms – primarily the headache. The poses suggested in this post are known to alleviate the symptoms if done correctly under the guidance of an experienced Yoga therapist. All the poses are based on Iyengar Yoga.

As mentioned in the earlier post, migraine is a secondary manifestation of the primary disorder, which is caused by an imbalance in the autonomic nervous system. So, please note that the management covered in this post is just a short-term solution with the aim to alleviate the symptoms of migraine. If you really hope to get rid of the migraine, the root cause has to be eliminated – i.e. you have to bring back the homeostatic balance in the autonomic nervous system. Many times, the primary disorder manifests itself in the form of hypertension, diabetes, insomnia, anxiety, PTSD etc., and in some cases the primary disorder may remain dormant and may not ever show up in itself. We plan to deal with the subject of managing the primary disorder through balancing the autonomic nervous system through therapeutic Yoga practice in our next post. A consistent practice under the guidance of an experienced yoga therapist is known to have helped people come out of the disorder.

What needs to be managed?

Let’s look at the state of the body (physical and physiological), state of mind (psychological/emotional and nervous system), and breathing pattern when you are hit with a migraine attack:

1. At the physical level, you have a severe throbbing headache. Your vision may be blurred and you may become more sensitive to sensory inputs like light and sound. You may feel the tension in muscles – particularly the neck, shoulder and jaw.
2. At the physiological level, you may see an increase in heartbeats, blood pressure, and many times palpitation.
3. At a psychological level you may feel anxious, nervous, loss of concentration (cognitive capabilities).
4. The autonomic nervous system is strongly tilted towards sympathetic tone (fight-and-flight – also called stress response). This means stress hormones and neurotransmitters like Cortisol and Epinephrine/Norepinephrine are significantly in access.
5. You are breathing more from the thoracic and clavicular region utilizing the top and middle chambers of the lungs; and minimal from the lower part of the lungs that engage the diaphragm. In other words, the breathing is thoracic or chest breathing (which is stimulating to the mind) and not diaphragmatic breathing (which is calming/relaxing to the mind).

So, you see a clear link between the body, mind and breath – everything is disturbed and tilted towards the sympathetic tone – i.e. fight-and-flight.

Symptom Management

As we discussed in earlier posts, Yoga therapy involves aligning body positions (Yoga poses) and channelizing the breath (Pranayama) in a proper way, in a right sequence for a certain period of time, and use body-mind-breath link to influence the physical, physiological, psychological parameters and balance them. Below, we will cover some Yoga poses modified for the purpose of the management of migraine symptoms. The progression of poses has to be carefully designed and these final poses have to be attended gradually. An experienced Yoga teacher will help you with that.

In this section, we will cover some poses that are known to manage the symptoms of migraine. Once you have practiced these poses under guidance, you need not wait for the full flare of migraine but you can start as soon as you sense the flare of migraine.

Easing the distress of migraine headaches through the suggested restorative Iyengar Yoga poses involves well supported passive positions, with a head wrap, minimal movement, and minimal external input of sensations. All of this is aimed at minimal activation of the reticular formation (the CCTV system of the body) and calming down the agitated autonomic nervous system.

As covered in our earlier post title “Why 20 Minutes of Cooling Down is Important in Yoga Practice”, it typically takes 20 minutes or so for the Catecholamine and Cortisol to be cleared from the bloodstream, and over activation of the Sympathetic Nervous System to calm down. The hormones Epinephrine and Norepinephrine (in 80:20 ratio) are collectively known as “Catecholamine”. Hence, these poses need to held (cumulatively) for more than 20 minutes to be effective.

Head Wrap and Eye Pillow

Headwrap is very effective in migraine. Any large elastic bandage (typically 8cms in width and 4 meters in length – called Crepe Bandage in India) will work for a head wrap.

Here is the method:

• Begin from the side where you have the headache, and gently wrap over the forehead (eyebrows included) and temples. While you are wrapping the bandage over the forehead, bring the forehead skin down in such a way that the eyebrows also get pulled down a little bit. This will activate the “Ocular-vagal reflex”.
• The pressure should be gentle – not too much to pinch you, and not too loose. Tuck the loose end with the clip provided. Ensure that the clip is not at the back of the head as it may cause discomfort when you lie down in a supine pose like Savasana.
• Initially, you may have to get comfortable with head wrap. Hence practice it a few times with wrapping over the forehead. Once you are comfortable after days or weeks of practice, wrap a few layers around ears so as to reduce the sensory input of sound. Finally, include eyes as well. This will quieten the eyes and lessens eye pressure – further enhancing the Ocular-vagal reflex.

You can relax in any convenient position of yours with the head wrap – either sitting or supine. As you get acquainted with the restorative Yoga poses covered below, you can stay in those poses for as much time as you like – but a minimum of 20 minutes altogether. It takes about 20 minutes for the hormones Epinephrine/Norepinephrine to clear up from the bloodstream.

You also have an option to use an eye pillow. In that case, you may not wrap the bandage over the eyes. The eye pillow should be light in weight (look for flax seed-based), and should cover the eyes and their perimeter. Eye pillow gives a different soothing effect to the brain – again through the Ocular-vagal reflex.

The main reasons why head warp and eye pillow are effective is the activation of the Ocular-vagal reflex – we covered this in a post titled “Why Cover Eyes using a Blanket or Eye Pillow during Restorative Yoga poses”.

Now you may question, how the head wrap is linked to traditional Yoga? The idea of wrapping over eyebrows, ears and eyes comes from a Yogic Mudra called “Shanmukhi Mudra”, which is meant to close the six gates of perception. This is the same Mudra Guruji BKS Iyengar used on the world-famous violinist Yehudi Menuhin during his India visit in 1952, which was the beginning of their long friendship and also the journey of Iyengar Yoga form India to the west. The story goes like this – Guruji was asked to go to Mumbai to meet the violinist at the behest of famous philosopher J. Krishnamurti, whom Guruji had taught yoga. Menuhin was said to be very tired and told that he could spare only five minutes. Guruji requested him to lie down in Savasana (lying on his back) and used his own fingers for Shanmukhi Mudra. Within a few minutes, Menuhin fell asleep. After almost one hour, he woke up refreshed and told that he never had such a deep sleep in the last many years. The rest is history!

Poses

Savasana with Head Wrap

In addition to a regular set of instructions for Savasana (I would recommend referring to any good book on Iyengar Yoga). The book “Yoga – The Path to Holistic Health” by Guruji BKS Iyengar, is my favorite. The following are some additional points that help:

• Keep the head supported on a blanket so that it is a little elevated (not much).
• If possible close all the sensory inputs – light, sound, smell and also touch (keep the fan off, use of AC is okay). You may cover yourself with a light blanket if it’s too cold. This is to ensure that your mind is not occupied in managing these sensations, which otherwise makes it difficult to bring upon relaxation.
• Move your eyeballs away from the eyelids, so that they drop back and down in their sockets. This will prevent the mind from wavering and make your breathing deeper and diaphragmatic – taking your nervous system towards parasympathetic tone (rest-and-digest or relaxation response).
• Try to focus on (rather observe) the breath without controlling it. Inhale and exhale softly and quietly through your nose, with the emphasis on exhalation. Take care not to hold your breath. You will observe that slowly the breath goes from fast/shallow to slow/deep over a period of few minutes. This means you are going from a sympathetic tone towards parasympathetic. You can also focus on different parts of your body (including head) at the time of exhalation. As mentioned in one of the previous posts, exhalation encourages sympathetic tone and relaxes the muscles – and hence focusing on a particular part during exhalation will have a relaxation effect on that part of the body. Please note during inhalations, you just need to see how the breath is coming – focusing from the lower abdomen to the middle and then expansion of the chest – without trying to control it. There is a reason, beyond the scope of this post (and we will cover it sometime).
• Once you have a good sense of how you breathe, you can try to lengthen the exhalation. But, as said, initially you should not try to control the breath. We have covered the types of breathing and how it affects the state of mind in our earlier posts.
• You may also have a pulsation sensation on the part of the head covered with the bandage. You may also focus on that sensation and feel the relaxation it brings.

The following poses need to be first practiced under the guidance of an experienced Yoga teacher. Until the time one becomes comfortable with these poses, Savasana with head wrap can be practiced. It is important to note that head wrap, eye pillow and many of these poses may feel uncomfortable in the initial days. You will get used to them and start feeling comfortable with practice. So, don’t give up after trying just a few times.

Supported Savasana with Head Wrap

Savasana can also be done with the support of a bolster or a pillow for supporting the torso. The bolster support raises the chest and releases the diaphragm that helps in diaphragmatic breathing – enhancing the relaxation. The folded blanket should be used to lift the head and neck – soothing the mind.

Supported Forward Bends with Head Wrap

Forward extensions calm down the autonomic nervous system, increase diaphragmatic breathing and relax the agitated mind – both Amygdala (emotional limbic system) and Cortex (cognitive and thinking system). As the body, mind and breath are already overwhelmed during the migraine attack, these poses need to be done with complete support for relaxation and calming effect as suggested in restorative Iyengar Yoga. Headwrap provides additional smoothness to the nervous system. The forehead has to be elevated and rest on a support (and parallel to the floor), and not touching down on the floor as in the traditional versions of these poses. Paschimottanasana, Janu Sirsasana, Adho Mukha Virasana and Adho Mukha Swastikasana are good for this purpose.

Seated Pavanmuktasana with Bolster Support and Head Wrap

For those with problems sitting on a mat on the floor for forward bends, a variant of traditional Pavanmuktasana can be done while seated on a chair or couch with the support of a bolster in the front. Those with severe headaches and fatigue can also do this.

It can be done sitting on a long bench or a pair of chairs (placed opposite each other) or couch. In this pose, the head is supported at a height higher than the torso.

If you get a migraine when away from home and you can’t do the poses suggested above, here is a simple modified version – seated on a chair with your head on the office-desk or dining table. Rest your forehead on something like a thick book (with something soft on top of it). You can also place your palms one over the other (facing down). Bend your arms and support elbows on the desk. Keep shoulders down, with shoulder blades spreading and moving down and away from each other. Relax the tongue and the throat. Hold for five minutes or more.

Setu Bandha Sarvangasana and Viparita Karani with Head Wrap

These poses, again with full support, are extremely relaxing to the nervous system. But those who have not done it ever before may find them overwhelming because these are inverted positions, where the head is below the heart. Hence, experienced supervision is highly recommended before attempting these poses. A Yoga therapist will gradually introduce these poses – starting with a very basic pose where you are on a mat with bent legs and calf rested on the seat of the chair.

These poses trigger “Baroreflex”, which is extremely effective in immediate relaxation of the nervous system, if done correctly. We have covered the Baroreflex in detail in one of our most popular post titled “Baroreflex – The Secret Behind Inverted Poses like Sirsasana”.

Most of these supported poses of Iyengar Yoga are covered in the book titled “Yoga – The Path to Holistic Health” by Guruji BKS Iyengar. An experienced teacher may modify these poses further and provide a correct sequence to suit the condition of individuals. All the poses should be done with head wrap. One possible sequence can be:

• Seated Pavanmuktasana
• Supported Adho Mukha Virasana/Swastikasana
• Supported Paschimottanasana/Janu Sirsasana
• Setu Bandha Sarvangasana/Viparita Karani
• Savasana

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