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Thursday, May 16, 2013

Brad's Perspective on Migraine Headaches

by Brad

The first time I had a migraine “aura,” I was working at my computer and wondering why there was this small area of flashing light in the center of the screen. I was using a new large screen Apple display and I was concerned that it might be malfunctioning. It didn't take too long, however, before I realized something was wrong with me: my vision was screwed up. Stroke? Migraine? Something else? I decided to quickly conduct an experiment: I walked down to the bathroom, shut the door and turned off all the lights and with my eyes open or closed, I saw the same thing, a growing crescent and jagged shaped object that was oscillating in my filed of vision. As I walked back to my office, I suspected this was a migraine aura, something that I had heard about (in words) but never experienced.

As fate would have it, I ran into a neurologist colleague in the hallway and explained what was going on. He immediately replied, “Do you get headaches?’ I said, “Of course, everyone gets headaches.” “Not so,” he explained. “Only about 50% of people get headaches.” And he motioned towards his office where he pulled out a neurology textbook, and turned to a page with a sketch that looked remarkably like the aura that I was in the midst of experiencing: a 30 minute timeline with a multicolor oscillating crescent shaped object, now twice its original size and now moving to my left field of vision. This was exactly what I was experiencing, and I could now predict that I must be about halfway through this phase, with about 15 minutes to go….  So I walked outside a bit to get some fresh air, but then retreated inside as the light was now too bright (“photophobia”).

What was surprising in retrospect was that I didn't get a migraine headache, which would be expected to follow in greater than 95% of cases immediately after the aura phase. I was apparently one of the (lucky) few percent who get an aura (visual disturbances, photophobia, etc.) but without the headache, or what is referred to as a “silent migraine.”  That was some 10 years ago.  And my last aura was just last Sunday during an afternoon walk with Nina, although by the time I got home, the aura was over, I retreated to my bedroom, closed the curtains and lied down for an hour. I needed to shut down….

Phases of Migraine Headaches by Brad Gibson

Since my first aura, I’ve taught a lecture on migraines to pharmacology students at UCSF for over 10 years. I’ve also talked with a lot of friends and students about their own experiences. And I have my own (somewhat atypical) experiences to draw from as well. This is what I’ve learned:
  1. When you experiencing an aura, you pretty much can’t do anything for about 30-60 minutes until it’s over, so it’s best to sit down and just wait it out. You really can’t do anything else – no reading, no computer work, no physical activity.  Even walking might be too much. If you’re fortunate enough to have access to pain medications (NSAIDs, triptans, etc.), this is the time to take them.
  2. Although I’ve been spared the worst aspects of the throbbing headache phase, at this point the body (and mind) just wants to shut down. No lights. No sound.  No movement. If you have taken pain medications during the aura phase (if you had an aura, but not all people do), you’ll be hoping they’ll kick in soon.  Lying on a bed in dark and quiet room is a good option if you can do it.
  3. Besides the throbbing headache, some people also get nausea, vomiting and other side effects of the migraine headache. Beside pain meds, one can also consider anti-emetics and sedatives for these additional symptoms.
  4. After the headache, most people are exhausted and depressed, although (some lucky few?) experience a type of euphoria. This could last a few hours to a couple of days.
So, what can yoga do to help any of this?  One possibility is during the trigger phase, when a largely unknown set of environmental and/or physiological states may “cause” the migraine to be set off in the first place. Certain foods are triggers for some people (wine, nuts, milk products, beans etc.). For others, stress can be a major player (see Preventing Migraines (and Other Headaches), Part 1). Personally, I don’t think it’s a coincidence that the majority of my migraine auras have been experienced mid-day, typically after sitting a computer for several hours. Bad posture, eyestrain, and neck and back issues associated with sitting and staring at a computer screen are for me the most likely culprits. While there are a number of drugs that are known to be partially effective at preventing migraine attacks and/or their severity, such as certain beta-blockers (propranol, timolol) and calcium channel blockers (verapamil), anti-seizure meds (valproate), this is still relatively unexplored and poorly understood territory. I think it’s worth considering how yoga might be helpful in mitigating some posture and body alignment issues (see Preventing Migraines (and Other Headaches), Part 2) as well as reducing daily levels of emotional stress that might contribute to migraine triggers (see Preventing Migraines (and Other Headaches)). Keep in mind that Nina’s suggestions in these posts are for preventing headaches from being triggered, not for practices to do during any phase of an active migraine.

A second phase where yoga could be beneficial would be the pain or headache phase of migraines, as well as the long postdrome that some migraine sufferers endure that can last up to a day or more. Most people don’t resort to the best and more expensive meds for this phase (e.g., the triptan class of prescription serotonin agonists such as sumatriptan) and rather use over-the-counter NSAIDS (aspirin, ibuprofen) or if the headache not too painful, just wait it out. While most yoga asanas at this point are not an option (remember, no one want to do much physical activity as this can worsen symptoms), Savasana, breath awareness, and other meditative or restorative poses would seem to me to be helpful and appropriate, as long as there are no inversions. Anyhow, I would check out Baxter’s suggestions on this in his post Yoga and Migraine Headaches.
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