I hate to even say the word: Migraines. Many of us suffer from migraines, either as the person afflicted with them, or as a loved one. For me, it’s been a long journey to get past these debilitating headaches, but that’s just where they are: the past. Through experimentation and trial and error on my own migraines, here are some things that have helped me. If this helps with your migraines or your clients (even just a little bit), then we will have been hugely successful.
I can point to three things that seemed to have played a role in my dismissal of migraines forever:
- Pain-free, repetitive movement
- Neural gliding
- Time and change
Pilates as Pain-Free, Repetitive Movement
David Butler’s Explain Pain helped me understand that the severe pain and chronic nature of my migraines had entered into the world of central nervous processing. The pain receptors were completely lit up and overactive, like a house alarm that can’t be shut off. Butler says that one of the best ways to turn the alarm bells off is to convince the alarm system (brain) that there is no danger (pain). Enter pain-free movement. If movement is pain-free, then the alarm system that looks for even the smallest discomfort to get over-excited about can calm down and be quiet. For me, with migraines, the pain always intensified with exercise that felt like any sort of exertion at all.
Armed with the knowledge from Butler’s book, I added different kinds of work into my exercise routine, even when I had an active migraine. Since I had almost non-stop migraines for 7 years, I had to find a way to keep moving. I had to find a way to manage the pain and also a way to handle the depression. Being outside and taking long walks helped, but as a Pilates instructor, I turned to the tried and true method I loved. As an example, this is the routine I followed whenever I could:
- Footwork on the Reformer for 10-20 minutes.
- Arm Circles Supine on the Reformer for 5 minutes.
- Side-lying leg series on Trap Table for 10 minutes
- Supine, hands on the Push-thru-Bar with Scapular ret/protract. Elbow extension/flexion. 5 minutes
- Side-facing single leg press on chair for 5 minutes each side.
I was careful with the exercises I chose so as not to overly activate the upper traps and levator scapulae. I didn’t try to avoid them completely, but I also didn’t choose to do overhead work and cervical spine extension/flexion when the migraines were acute.
The tightness that usually accompanies migraines leads one to stretch… a lot! But instead of focusing on holding a muscle stretch I discovered neural glides.
A nerve that isn’t gliding, or that is “stuck”, will feel very similar to a tight muscle. In The Sensitive Nervous System, Butler takes an in-depth look at neural assessment and neurodynamics. Stuart McGill, in Low Back Disorders, shows an easy way to assess a non-gliding, pinched or tensioned nerve in the spine, spinal cord or meninges, an area most likely to be aggravated with a migraine.
Assessment Exercise for tension in the spine, cord and meninges.
a) The first picture shows how to assess on your own body, if there is a tensioned neural component to the migraine. First, raise your right leg. Flex the foot. Do you notice a hamstring stretch? Bring your leg closer until you do. It’s okay to bend your knee here if the only stretch you are feeling is either behind the knee or in the lower leg. Now lift your head off the mat. Does that increase your hamstring stretch? If yes, that is a nerve being tensioned. Why? Because there is no muscle attached from your hamstring to the back of your head.
b) See figure 2 for this assessment. Sit on the trap table or any table where you can’t touch the floor. Straighten the right leg and flex the foot. Do you feel a hamstring stretch? It’s okay if you don’t. Now drop forward into a flexed spine position. Does that increase the hamstring stretch or give you a hamstring stretch for the first time? That’s nerve tension.
c) Nerve Glide for the Spine, Cord and Meninges.
A nerve is not a muscle. When you have a tight muscle it’s okay to hold the stretch and give the muscle time to override the golgi tendon reflex, or the reflex that tries to prevent the muscle from stretching too far. A nice long 90-second hold of a muscle that is tight is okay. A nice long “stretch” of a nerve that is tense is not okay. You’ll just make it angry and it’s likely to be more aggravated, resulting in more pain for you or your client/patient.
The Spine, Cord and Meninges Nerve Glide.
Figures 3 and 4.