By Katie Golden

In Dr. Robert Cowan’s paper “CAM in the Real World: You May Practice Evidence-Based Medicine, But Your Patients Don’t,” he explores the notion that patients with migraine disease often incorporate complementary and alternative medicine (CAM) into their treatment regime, although it is a topic often left out of the discussion between physician and patient.

Some examples of CAM are yoga, meditation, acupuncture, massage therapy, homeopathy, biofeedback, and natural supplements.

Dr. Cowan believes most physicians lean on evidence-based medications that have been proven in FDA-approved clinical trials, while dismissing alternative methods that are harder to study under standard scientific procedures. He reports that less than 20 percent of headache specialists surveyed incorporate any type of CAM into treatment plans.

On the flip side, over 80 percent of patients report they use some form of CAM, and only half tell their doctor about it because they are afraid of being judged.

My CAM Journey

I strive to manage my migraine disease through a mix of medication and complementary and alternative medicines. I’m very open with my headache specialist about what I want to try, and she’s always been supportive.

Throughout my journey, I’ve tried massage therapy, dry needling, natural supplements, biofeedback, chiropractic, meditation, and more. Yoga is the one self-healing measure I have found the most comfort in. It gives me the greatest relief, energizes my soul, and challenges me the most.

Taking the Yoga Practice with You

At the end of my favorite yoga class on Sunday nights, my yogi says, “Take the support from this group into the rest of your evening and take this practice with you throughout your week.” Yoga doesn’t just live on the mat in a class; it can guide you through your day. It’s taken years of diligent practice to find what “taking your practice with you” means to me.

I practiced Bikram yoga, or hot yoga, for years. It helped me during a difficult time in my life. When my migraine disease became chronic, any form of yoga seemed impossible. Actually walking down the street seemed impossible.

Looking back, it made perfect sense to get out of bed and get on my mat. My muscles were always in a constant state of fatigue, which only contributed to my pain. I needed to open up my body and my heart center. Yet all I could focus on was working and sleeping. I was in survival mode.

When my doctor suggested I go on short-term disability, I decided to make exercise a priority. I felt weak. I had no control over my body. It was something my athletic boyfriend had been urging me to do as well. I enlisted the help of a trainer, who had no knowledge of my condition, but who researched workouts and modifications that would help me succeed and not incite a migraine.

Baby Steps Are Worth It

Some days, I felt I was making progress … baby steps towards endurance. Then I would have a setback, losing weeks of work to being confined to bed. When I returned to the gym, I felt like I was starting all over again. Frustration does not even begin to explain the defeat I felt.

After a year of weekly training sessions, I felt brave enough to step onto my mat in a classroom. I told the yogi about my health issues and limitations; I wasn’t sure I could endure an hour-long class. She told me she would give me modifications, but the most important thing was just to stay in the room for the entirety of the class, which I did!

I had put so much pressure on myself to be able to gracefully transition between poses or hold my gaze steady while balancing on one foot. But that wasn’t where I was yet, and I had to learn to give myself some slack. No one was looking at me, no one was judging me … except myself.

Each class was a crapshoot, never knowing if stretching out my body would be healing or hurtful. With each session, I learned something new about the practice and about my body. Eventually, I felt more in tune with what my body was trying to tell me—I had just never stopped to listen before. I could no longer ignore the signals that screamed for me to eat more regularly, drink more water, or stretch out my body.

Taking Yoga Off the Mat and Into Your Life

Over time, I learned that returning to the fundamentals of yoga could help me daily.

In yoga, your breath is connected to every move you make. For example, breathe in while you bring your arms up, touching the palms above your head. Breathe out while releasing the arms and moving them down to the sides of your body. This connection of breath and movement takes practice, but I found it helped me in my daily life. When giving myself a shot of Toradol, I breathe in and insert the needle and breathe out when I inject the medicine.

It might sound silly, but focusing on the breath can help me to ignore the pain of receiving the injection. That is just one way that I take my yoga practice off my mat and into my week.

When I notice that my balance is off, I’ll work on certain poses that challenge my balance, such as tree pose. To just gain a quick boost of energy, I will do an easy sun salutation. I have no shame in doing yoga wherever I am and whenever I need it. The airport is definitely a place where my weary body yells at me to pay attention to it. These are other ways in which I integrate yoga into my daily life.

Consistency Brings Results

A 2014 study assigned migraine participants to either a conventional care group, or a yoga group that practiced five days a weeks for six weeks, along with their conventional care.

At the end of the study, the yoga group reported greater improvement in the intensity and frequency of their migraine attacks compared to the conventional care group.

Movement, even in the most basic form, can become difficult for those with chronic pain. I encourage everyone to explore yoga. That could mean learning simple stretching techniques, finding a way to connect your breath with movement, or letting go of your inhibitions and attending a class.

Don’t have money for a class? No problem. There are many free classes available online. I personally use “Yoga with Adriene” on YouTube. From the fundamentals to upper level poses, her style is easy to follow.

Yoga may not be a cure, but the fundamentals could help you feel more in control of your body.

Other CAM options:

• Massage Therapy: Massage therapy can include multiple techniques like Swedish, deep tissue, Shiatsu, Thai, myofascial trigger point, and hot or cold stone. One study showed that those who received 12 myofascial trigger point massages during a six-week period, instead of ultrasound, reported the highest positive change in headache frequency, perceived headache pain, and greater improvement in their pressure-pain threshold.
• Acupuncture: Acupuncture is likely the oldest form of CAM. Thin needles are placed strategically along one or more of the five meridian lines believed to be necessary in balancing a person’s energy or chi. Needles are inserted into the top layer of skin to increase blood flow and stimulate nerves, muscles and tissues. A 2015 study found that a group of patients who received 16 sessions of acupuncture within a 20-week period reported a positive change in the frequency and intensity of their migraine attacks, as well as an increased pain threshold. At a three-month follow-up, the results were the same, but at 12 months post-treatment, the effects had worn off.
• Natural Supplements: The following list of over-the-counter supplements or vitamins have been used to treat migraine, either in conjunction with preventative medications or alone. Due to the potential for side effects, your doctor should always be included in decisions to use any of these supplements:
  • Butterbur
  • Vitamins B2, B6, C, D, and E
  • Magnesium
  • Potassium
  • Fish Oil
  • Coenzyme Q10
  • Petadolex
  • Peppermint oil
  • Flax seed
  • Feverfew

Please note: The U.S. Pain Foundation and the INvisible Project do not recommend any specific modalities to treat cluster headache or any other chronic pain condition. Your doctor should be informed of any decisions that vary from your treatment plan.