Tension Headaches and Yoga

by Baxter

Let me start off today’s post by personally wishing you all a Happy New Year! We are seven days into 2014 already, and Nina and I are excited to continue our work here at Yoga for Healthy Aging in the coming year. Today’s post comes out of something a few friends mentioned the day after their NYE celebrations: a lot of them had hangover headaches! Surprise, surprise! But I just happen to be preparing a workshop on headaches for the upcoming Yoga Journal Conference in San Francisco in a few weeks, and when I reviewed what we have written on the topic, I was surprised to find that we had not specifically talked about the most common form of headache that people experience (fortunately not hangover headaches): tension or musculoskeletal tension headaches. Sure, we alluded to it on our pretty thorough discussion on Yoga and Migraines last year, but I thought it would be well worth a focused look at tension headaches today. So here we go!

Tension headaches are indeed the most common headaches people experience, although the exact causes are not yet entirely clear. According to the Mayo Clinic website:

“A tension headache is generally a diffuse, mild to moderate pain in your head that's often described as feeling like a tight band around your head.”

Very encouragingly, the site states, “managing a tension headache is often a balance between fostering healthy habits, finding effective nondrug treatments and using medications appropriately.” Why do I find this encouraging? I am always excited when modern western medicine discovers that lifestyle and non-drug therapies are the better first choice in addressing a health concern. Bravo!

It is important, before we discuss yoga options for tension headaches (TH) to be clear on what constitutes a tension headache, and how it is different from migraines, for instance. A tension headache typically has the following qualities and presentations:

• dull, aching head pain
• sensation of tightness or pressure across the forehead and sides and back of head (headband distribution)
• tenderness on the scalp, neck and shoulder muscle

I am sure some of you can identify with this and are likely massaging those areas right now! Modern western medicine splits tension headaches into two categories, those that are episodic and those that are chronic. Episodic tension headaches can last from 30 minutes to a week. The more frequent they are, the more likely they are to become classified as chronic. If your headaches occur 15 or more days a month for at least three months, you are bumped up to the chronic camp. Let’s hope that is not in the cards for you!

Tension headaches can be hard to distinguish from the less common migraine headaches, and can even occur in people who also suffer from migraines. The Mayo Clinic points out some helpful distinguishing features between the two:

“Unlike some forms of migraine, tension headache usually isn't associated with visual disturbances, nausea or vomiting. Although physical activity typically aggravates migraine pain, it doesn't make tension headache pain worse. An increased sensitivity to either light or sound can occur with a tension headache, but these aren't common symptoms.”

The fact that physical activity does not usually worsen tension headaches is helpful to know when you are considering whether or not to do an asana practice when you already have a headache. And it is a way to test out your particular headache to see if it is tension or migraine.

It is still not clear what the underlying cause is for these common headaches. Some specialists link them to muscle contractions anywhere above the shoulders that might be encouraged by emotions, tension or stress, even though research does not support muscle contraction as the cause. The most common theories suggest that people with tension headaches have a heightened sensitivity to pain and stress. And related to that, stress turns out to be the number one trigger of tension headaches. Statistically, according to one study, 90% of women and 70% of men experience tension headaches at some point in their lives, with the peak incidence in people in their 40s.

The gang at Mayo Clinic did disappoint me a bit. Following their initial statements about non-drug treatment, they launch into medication choices before discussing lifestyle and alternative therapies—you all came so close! But when they finally do get to the non-drug options, stress management and improved posture are two of the three main recommendations. We have discussed this in many other posts, so by now we all realize that yoga rocks for addressing these options. And yoga does get the nod as a possible preventive treatment option for tension headaches.

Nina did a nice job in her headache prevention posts Preventing Migraines (and Other Headaches), Part 1 and Part 2 in outlining good yoga options for migraines and tension headaches (see also Peaceful Poses for Stress, Anxiety, Neck Pain and Headache Prevention). In general, because tension headaches are not typically worsened by physical activity, an active asana practice could be appropriate for when you have a headache as well as for headache prevention. I cannot tell you how many times students have come into class complaining of a headache, only to state on departure that their headache was now gone. And since most of the classes I teach include some short vinyasa portions, either reclining or standing, such as Sun or Moon Salutations for a few rounds, as well as static poses, a short pranayama session and a 10-minute Savasana (Relaxation pose), I can conclude that a well-balanced yoga practice can be both preventative and prescriptive.

Here are some of my favorite specific approaches for treating and/or preventing tension headaches:

Releasing muscle tension in neck and head. Even though muscle contraction does not appear to be the main cause or clear cause of tension headaches, I’d still focus much of the yoga asana practice on the area at and above your shoulders to release any excessive muscle tightness. Our shoulder series Opening Tight Shoulders, along with Owl and Curious Dog neck movements (see Neck Muscle Strain and Spasm) would be excellent additions to a daily home practice.

Refining your asana choices. Monitoring the effect of certain groups of yoga poses to see if they aggravate or improve headache symptoms is always a good idea. The more you start to understand how your body interacts with the practice, the better your personal practice will develop to support lessening your chances of getting tension headaches.

Finding the best stress practices for you. In addition to the more active practices of yoga, experimenting with quieter options is also essential in preventing and treating tension. A weekly restorative class or home practice (see Mini Restorative Practice) or the periodic use of Supported Relaxation pose (see Savasana Variations) and a yoga nidra recording (see Yoga Nidra and Deep Physical Relaxation) will work nicely for many. Pranayama practices such as 1:2 ratio breathing (the inhalation is 1/2  the length of the exhalation) or gradual lengthening of both inhale and exhale equally are great beginning breath practices to try. Short sitting or reclining meditation practices for 5 to 10 minutes are also great stress reducers.

Resetting pain sensitivity. Just as regular stretching of the hamstrings in Standing Forward Bend (Uttanasana) tends to lower the intensity of the perceived stretch discomfort over time, a general yoga practice has the potential to lower the heightened pain sensitivity that some people may have. There is no study to presently prove that last assertion, but it seems reasonable to observe in your own situation if adding in a regular, reasonable home practice begins to change the frequency and intensity of your tension headaches.

Please let us know what you find out if 2014 is the year you ramp up your practice with the intention to improve your tension headaches!

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