Migraine - Yoga Therapy as a way out of tightness and powerlessness

By Anke Schneider and Dr. Günter Niessen

Yoga Therapy transforms problems into potential
If we act anyway, either by inactivity (yes - not acting is also an action) or by taking the next necessary step, then it is also possible to give action a good and wholesome direction. In the Yogasūtra of Patañjali, verse I.20 speaks of five yogic virtues. The verse begins with confidence - śraddhā - which grows into conviction based on our experience, and continues with - vīrya - the power that arises from clarity and is necessary to follow one's own path. This sounds easy at first, but my experience is that stress arises and grows in many people as a result of this, and then expresses itself in a wide variety of disease patterns when we only care about others, essentially listen to others, or do not live our best lives for the sake of pleasing and praising our surroundings. It is now clear that "for my good" - an ethical basis such as that of yoga, Buddhism, or other humanistic, mystical-religious wisdom traditions - means the same as "for the good of all." Yoga and its therapeutic possibilities always lead to the same goal: to balance, homeostasis, peace with oneself and what is happening, even if this is only a first step on the spiritual path.

In this small article, we would like to describe how this path becomes viable despite the many obstacles, such as a disease like migraine. It is a description from our own experience and with a focus on feasible steps.

Causes of migraine
The causes of this condition are as varied as there are people who suffer from it. Beneath the many individual reasons, however, lie commonalities and triggering factors shared by many sufferers. Most of those we spoke to suffered from a subjectively high level of stress, triggered by inappropriate self-demand, high external demands, unsound lifestyle choices, minor or major traumas in childhood and adolescence, and especially the feeling of being trapped in their situation. Narrowness and powerlessness often block one's own development possibilities and prevent the adoption of a new perspective. So far, neither Anke Schneider nor I have experienced a client who did not get the first episode of a migraine in the context of a life crisis.

In individual cases, poor eating habits, negative self-assessment or perfectionism, as well as fear of not being good enough or sadness about certain life events and intense, especially negative feelings, can influence the severity and frequency of migraines. It is believed that almost half of all Germans will experience an episode of headache that meets the criteria of a migraine during their lifetime. Currently, about 8 million people in our country suffer from this condition. OR: About 12 to 14% of all women and 6 to 8% of all men in Germany suffer from migraine. OR/AND: After back pain, migraine is the second most common disease in the German population, resulting in lost work time and significant economic consequences.

Symptomatology of migraine
The list of symptoms is so colorful that we could write an entire book about the external appearance and subjective experiences of those affected. Migraine is never simply a headache; other sometimes serious preceding and accompanying symptoms are always present. On the contrary, the often unbearable headache is at best the culmination of the symptoms. Within seconds, hours or even days it announces itself with harbingers, the so-called aura. Restlessness, anxiety, palpitations, nausea, insomnia, loss of appetite or ravenous appetite, forgetfulness, but also abdominal pain or radiating pain down the body and extremities with tingling, burning and sensitivity to touch often precede. Tension in the neck and jaw muscles often accompanies a seemingly impenetrable carousel of repetitive thoughts. As it progresses, the symptomatology often becomes increasingly focused on the perception of confinement; of a skull that seems too small for all the thoughts and feelings within it, so that nausea and vomiting increase, the eyes switch to tunnel vision and become so sensitive that once it gets to that point, the sufferer can only retreat. Powerlessness characterizes the subjective perception of this process and is fed by the experience of most migraine sufferers that it is relatively indifferent what they would do, which doctor they would go to or which medication they would take.

Goals of Yoga Therapy in migraine
Yoga therapeutically, the individual external situation, the manifestation of the symptomatology and the factual possibilities of the affected person give the framework of the measures. Basic considerations are: 

  • Create space - that is, width, so that the skull is no longer too small
  • Regulate sense of time: As yoga therapists, we can give time because slowing down enables mindfulness and mindfulness is the prerequisite for having choice. Having a choice is the opposite of powerlessness.
  • Enable relaxation, because continuing like this is not an option
  • learning to recognize the body's stress response at an early stage enables - with a little practice - the active transformation of the central and autonomic nervous system's response; "courage response" instead of "stress response
  • Truly taking ownership, that is, responsibility for oneself to move out of patterns into meaningful action, empowers those affected and is the opposite of powerlessness
  • Enabling people to look, i.e. also to hold the space together for this, so that those affected can learn to understand each other and then make good decisions
  • From the point of view of Āyurveda, physical measures naturally always relate individually to the whole person. With the predominance of a Vata dosha increase meaningful nourishing measures (nasyam with ghee), calm environment, regular, easily digestible food and predominant Pitta dosha also expelling measures including therapeutic vomiting (vamana), bitter substances and intensive clove tea are recommended. Of course, there are an incredible number of nutritional measures that would go beyond the scope of this article.

What specifically can we do with Yoga Therapy for migraine?
As yoga therapists, we can create a space on all levels where everything is allowed to be and nothing has to be. Our offer is the mat and a safe, warm and benevolent space of encounter, where the sufferers are not alone and get helpful suggestions to do it themselves.

  • But what is also meant is the space in one's own body, which no longer refers only to the head, but expands down the torso to the hands and feet. Only in this way can narrowness be transformed into wideness.
  • Space also refers to the breathing room, because every cell of our organism breathes with us and wants to participate in the energy that flows through our entire body with the breath. It is important with all measures to make them so slow that they can be experienced.
  • Giving space also means space for one's own language, new thoughts and the perception of one's own needs, otherwise it is not possible to go new ways.
  • Integrating space for rest and retreat into everyday life helps to prevent the developing narrowness in one's own mind from arising in the first place. The prerequisite for all interventions and suggestions is always the willingness to continue them yourself.
  • Affected persons may learn to Time at give. Perhaps there is no greater stressor than the feeling of not having time and still having to get so much done and also in a certain way. It is of no use to those affected to say that we all have the same 24 hours available every day.
    • Time is very subjective in its perception and varies not only from person to person but, as we all constantly experience, from moment to moment and depending on the subject, time of day, season of the year and all the external and self-chosen demands of life.
    • Having time for myself is a high good. Many people confuse this with selfishness, and yet they desire nothing more. The more entangled we are in patterns (samskāra), the more time is needed to leave the thicket behind.
    • Our breath needs space, but also time. No defaults, but the calm flow of the breath, which - if all goes well - slowly not only seeks width but also takes time. The rhythm of the breath slows down and with it our thought frequency and this in turn slows down the breath. Calmed minds are not heated and do not need so much oxygen.
  • Examining one's own values and being able to perceive one's actual, individual needs is another important step on the yoga path and especially for people with migraine. Often they report the feeling that their life is determined by others or that they do not live "their" own life and only meet the requirements of others.
  • Restoring or maintaining emotional balance is both important and difficult. We know today that it is our feelings that essentially determine how we act and react. We are entangled in what we experience as reality and our actions are shaped by the interpretation of our role. For example, we are workers or mothers, sons or strangers, etc., and we experience and interpret everything in this context, which is also cultural. Our actions are subject to constant evaluation. We try in the Yoga Therapy, to take the "small step back" and get a touch of distance to our own experience and reactions to what is happening. This distance, we paraphrase it as a moment of silence, pausing, or being less involved, allows for a change of perspective on what is happening and a re-evaluation. We write a new story of our lives and give meaning to everything. If this distance does not exist, we are, so to speak, passive and powerless, trapped in our own experience.

 

Specific suggestions for us as teachers or stakeholders are:

  • slow language of benevolence and understanding with soothing words of permission, invitation and clarity
  • Sufficient number of repetitions to allow a flow of movement and breathing to develop, and for those affected to develop a sense of security
  • simple Āsana are usually very effective, as they can be practiced both regularly and without much effort (change of clothes, use of mats)
  • Relaxation exercises for the eyes, jaw joints and shoulder region are particularly important
  • The practice should also include grounding Āsana with reference to the feet, being carried and secure, touching with the hands and directing attention away from the skull.
  • our experience shows that the number of targeted Āsana per exercise sequence should not normally exceed five to six, so that the regularity and internalization of the sequences are easier to achieve
  • dynamic practice is preferable to holding Āsana, stillness and pausing should be reserved for restorative postures
  • the Prānānyāma we keep very simple and calming, no breathing behavior and no heating or fast breathing techniques. For example, mental alternate breathing or Chandra Bhedana and toning are useful. What is important is the breadth of breathing from the chest to the abdomen and beyond, and to allow regular flow.
  • after some time, the journey of discovery to the natural pause after exhalation - Sunya - is the pearl of breathing experience. Working it out through the observation of movement in coordination with breathing, the active search in the process of perception of natural breathing allows the feeling of self-efficacy to be experienced.
  • Stretches should stay within the range of micro-stretching to avoid injury; the point is not to stretch away the headache
  • For advanced practitioners, we can invite reflection on the experience in conversation before and after the yoga session
  • giving a spoken relaxation sequence for regular practice is especially valuable and important, often a guided body-scan is also helpful, individually tailored visualizations and affirmations
  • our experience is also that simple techniques of meditation, if the people concerned are willing to engage in them, improve goodwill, confidence and self-esteem.

Finally,
Many sufferers take medication chronically, i.e. even during the seizure-free interval, to control or prevent the symptoms. Side effects can occur under the influence of these medications, and it is absolutely appropriate to ask about them. Those affected know this best themselves. Under painkillers, the own pain threshold is not adequately assessed, often without the affected person really realizing it. For us as teachers, this means that we should stay far, very far away from all limits. This applies to the movement limit as well as the pain limit. We would like to work in such a way that our yoga offer does not intensify the pain symptomatology.

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