How mini relaxation breaks can prevent--and sometimes abort--pain

You're having another one of those days: After sleeping through your alarm, you arrived late to your 9 a.m. meeting, which ran an hour over schedule. You drank two too many cups of coffee and scurried around frantically to prepare several important documents. With all this pressure, it comes as no surprise that your head is now pounding. In a flash, you realize that this is your third monster headache this week.

If this sounds familiar, you're not alone. Over 45 million Americans suffer from chronic, recurring headaches, 90 percent of which are classified as "tension-type," where the pain is typically generalized all over the head. In fact, headaches beat out backaches as the number-one cause of time lost from work in the country.

"If you're under stress and out of shape, at some point your body is going to speak loudly to you," says Joseph Primavera III, Ph.D., co-director of the Comprehensive Headache Center at Germantown Hospital and Medical Center, in Philadelphia. "And if you're genetically inclined, headache may be the voice that comes in loud and clear."

Unfortunately, as they sense a headache coming on, many sufferers try to get done as much as they can before the headache gets bad.

"That's like stepping on the gas in your car when the gas tank is on empty," says Alvin Lake, Ph.D., division director of psychology and associate program director of the head-pain treatment unit at Michigan Head Pain and Neurological Institute in Ann Arbor. "It's much better to slow down and get quieter as the headache begins to intensify."

In fact, research now suggests that relaxation techniques can sometimes be powerful medicine in the treatment of headaches. "Research clearly shows that relaxation training combined with preventive medication--prescription drugs taken daily to prevent pain--works better than either one alone," says Dr. Primavera. "Relaxation also gets you more bang for your buck from painkillers like aspirin and acetaminophen, as long as you're not overusing them." People who use too-high levels (about 8 to 10 pills a day) of these analgesics, however, may not respond well to relaxation techniques until they reduce the medication. Some research suggests that stopping to relax--even for five minutes--at the first sign of trouble may be enough to abort a headache in some people. All it takes is the willingness to develop a sensitivity to early and subtle warning signals.

"The common, intuitive idea is to try to relax when you're really tense, but in fact, it's very hard to relax after you're really tense," says Dr. Lake. "By then you've got all these stress hormones raging, and you're just not going to shut them off by dropping your shoulders. It's much better to anticipate that you have a hectic afternoon and be relaxed when you walk into that meeting, rather than wait until you're right in the middle of it and then try to think of relaxing."

"As you become aware of how your body talks to you, you get sophisticated enough to hear it whisper," says Dr. Primavera. "Then you can address the signs early on and your body will never have to shout."

One of the most effective tools for increasing body awareness is biofeedback, a mainstay treatment in headache centers around the country.

Research shows biofeedback can help relieve headache pain. In one study, a group of patients with severe headaches unrelieved by medication who used biofeedback (accompanied by relaxation techniques) reduced headache severity and number by 42 percent. A comparison group who simply tracked headache activity showed no improvement.

Many people think that biofeedback is itself a form of relaxation, but it's not. Instead, it uses equipment that measures various physiological markers of relaxation and then "feeds back" this information to you.

One biofeedback unit used with headache patients is called a "thermal monitor," in which a slim wire is taped to your finger and is hooked to a small unit that displays the temperature readings of your finger.

A typical session goes something like this: You're asked to lie back in a comfortable sofa chair, close your eyes and allow yourself to begin to relax. A clinician guides you through mental imagery, in which you may imagine something like being on a serene beach and feeling the warmth of the sun or water on your body.

"As you relax, one thing that happens is your blood vessels dilate, which raises your finger temperature," says Dr. Primavera.

As hand temperature rises, you may feel a distinct pulsing, tingling or swelling in your hands. This temperature rise causes the monitor to emit a very soft tone, which indicates that you're relaxing successfully. The monitor also provides a visual display of your finger's temperature. This concrete display of your body's physiological level of relaxation is biofeedback's unique power.

"Human beings don't have much proprioception for relaxation," says Dr. Primavera. Proprioception is sort of like sensory awareness, or bodily intuition. It's the reason why you know your hand's behind your head even though you can't see it.

"We're designed to feel how much tightness there is," he says. "If I asked you to make a fist and then to make it tighter, you could feel the difference between those gradients. But if I asked you to relax more, you probably couldn't feel as much of a difference. But hooked up to a biofeedback monitor, you'd be able to see and hear that you're relaxing more. Eventually, with practice, you fine-tune your proprioception for relaxation and are able to unwind on your own," he says. "Like learning how to ride a bicycle--once you get the feeling, you just know you're doing it right."

The process of hand warming through mental suggestion has long been a migraine treatment, but exactly how or why it works to relieve headache is still a mystery.

"In the early days, we thought the increased blood flow and relaxed muscles themselves somehow helped a headache," says Joel Saper, M.D., neurologist and director of the Michigan Head Pain and Neurological Institute, in Ann Arbor.

"But now we think it's much more complex, that the process of relaxing does something helpful to your brain biology. Mental concentration seems to be the secret."

The fact that artificially warming the hands--by putting them in warm water, for example--doesn't work lends support to this theory that the brain's involvement in hand warming is the critical component. "Somehow not yet understood, relaxation with biofeedback may activate a part of the brain that has a therapeutic value on the pain mechanism," says Dr. Saper. And for many, but not all people, it really works.

To learn more about biofeedback, contact a center specializing in headache evaluation and treatment.

Luckily, you don't have to carve out huge chunks of quiet time to reap the benefits of relaxation. "If you tell people they need to light a candle and meditate and listen to ocean music for an hour a day, generally what you get is a guilty patient who does nothing," says Dr. Primavera.

"In fact, there's a continuum of relaxation," he says. "In the real world, maybe taking a deep breath, doing a stretch and staring out the window for a few minutes is all you're going to get. Luckily, that's often just enough to keep you from reaching the set point to trigger a headache."

A lot of us go into meditative states all the time, but we don't recognize them because they're so subtle. "Nothing induces a trance quicker than a boring kind of job, like doing the dishes," he says. "You do the dishes, you drift into thinking about being somewhere else; all of a sudden the dishes are done and you snap out of it.

"An experience like this is a very light trance, or hypnotic, state. And in fact, if you become more aware of trance states like this and take advantage of their relaxing quality in an opportune moment, you may not necessarily need to go all the way into a deep meditative state to get enough physiological response to ward off an impending headache."

Some years back, Dr. Lake and his colleague, Jeffrey Pingel, Ph.D., did a study in which they looked at which factors of biofeedback training seemed most beneficial over the long run. How frequently people said they thought about relaxation during the day determined who did best.

"We found that people who think about relaxation and take mini breaks throughout the day are the best responders," he says. "Frequency is more important than more prolonged relaxation periods." (See "Quick Fixes" on page 68.)

Of course, addressing the recurring sources of tension is another important component of pain control. "It's not efficient just to open a window when the house is too hot," says Paul Duckro, Ph.D., director of the chronic headache program at St. Louis University Health Sciences Center. "You must look for the thermostat."

Anger, for example, is an emotion long known to fan the fire of headaches. In a study with 139 headache patients, Dr. Duckro and his colleagues found that those who held in anger suffered more frequent depression than others and consequently felt more impaired by their headaches (Headache, November 1992).

"What we found is that anger in general is a problem, but anger held in tends to be worse because it's like a smoldering fire," he says. "It becomes bitterness and resentment. Like a person nursing his grudges, it starts to color the way he looks at life."

This bitter attitude creates a great distress inside that apparently leads to depression and greater headache disability in susceptible people.

As with physical signs of tension, tuning in to how you react to emotional stress is a key to effective pain management.

"The first thing we do is teach these patients to listen to their bodies, so when they start getting tense in response to anger, they can recognize it and relax," he says. For this, a combination of biofeedback and relaxation training are front-line treatments.

Cognitive-behavioral techniques are also employed for resolving suppressed anger over the longer term. They include exercises like:

* Looking at situations in which you become angry and asking: Can I change those situations?

* Examining your self-talk. What do you say to yourself that's just perpetuating the problem?

* Reevaluating your ability to be assertive. What could you do that would actually change the situation?

* Reframing the scenario. How can you look at the situation differently if you feel stuck?

"A headache is a wonderful mechanism to tell you whether or not your efforts are working because if you don't have one, you're doing something right, and if you do, then it means your body has gone beyond whispering," says Dr. Primavera.

"And," he says, "what you learn if you practice these simple techniques is that instead of using the headache as a barometer, you understand the more subtle signs."


By Sharon Stocker

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