Classic Migraine. 5OO+Hr TTC. How yoga can minimise symptoms and improve quality of life. Jessica Dewar. 25 March 2015

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1 Classic Migraine How yoga can minimise symptoms and improve quality of life Jessica Dewar 25 March OO+Hr TTC

2 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 References Page 2

3 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. Page 3

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 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

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.

4 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 o attack frequency is anywhere between once a year and once a week; and 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. Page 4

5 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 Classic Migraine Ocular Migraine Status Migrainosus Familial hemiplegic migraine & Sporadic hemiplegic migraine Probable Migraine Chronic Migraine Without aura With aura Cause vision loss or blindness lasting less than an hour, along with or following a migraine headache. A migraine attack that lasts for more than 72 hours. 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". 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 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 Page 5

6 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 Page 6

7 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. Page 7

8 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 am (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 Page 8

9 3. activate the nervous system through strengthening the spine 4. improve lung capacity 5. open the heart and chest 6. 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 Parighasana Ushtrasana Supta Virasana Paryankasana Chakrasana Rocking Jathara Parivartanasana Paschimottansana Sarvangasana Series Savasana 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 Extends and works the spine strongly Opens the chest, works strongly on the spine, improves circulation to the head Assists with breathing problems, preparing for Chakrasana. 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 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 Improves circulation of the upper body, works the entire body, relieves migraines, calms the mind and reduces stress Allows the entire body to rest and rejuvenate, reduces stress, slows the mind and brings complete awareness to the body Page 9

10 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. Page 10

11 References Indea Yoga Teacher Training Level 1 Manual Indea Yoga Teacher Training Level 2 Manual Discussions with Caroline Scott, Nutritionist and Dietician, Australia; SAGE Journals, Classic Migraine, Wikipedia: The free encyclopaedia, Migraine; World Health Organisation (WHO), Headache Disorder, Fact Sheet No. 277, October 2012, Page 11

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MIGRAINE A MYSTERY HEADACHE

MIGRAINE A MYSTERY HEADACHE The migraine is a chronic neurological disease that is characterized by moderate to severe episodes of headache that is mostly associated with other central nervous system (CNS)