Carol suffered from chronic neck tension and headaches that were not relieved by medical treatments. She consulted Dr. Brofeldt who believed her headaches stemmed from poor posture that put tension on neck muscles. He prescribed yoga, exercises, and meditation to help correct her posture and relax her muscles. Carol worked with a yoga instructor who tailored sequences to address her needs. Her headaches decreased in frequency as she improved her posture and learned to relax through yoga and meditation. The document discusses how poor posture can lead to tension in neck muscles referred to the head, and how yoga, breathing exercises, and addressing emotional issues can help treat and prevent tension headaches.

1. Yoga Cure for Headaches
When neck tension is at the root of your headaches, yoga can help alleviate
the pain.
By Ellen Serber
For years Carol woke up in the middle of the night with a shooting pain in her
neck that soon became a throbbing headache. Most nights she was unable to go
back to sleep, and in the morning she felt exhausted and depressed. Seeking
relief, Carol consulted numerous medical doctors, including two neurologists.
Though every specialist Carol saw concurred that her problem was muscle
tension, no one offered an effective means to treat it. They prescribed muscle
relaxants, antidepressants, prescription pain-killers, and even an oxygen tank,
but these measures failed to bring Carol any lasting relief. They did, however,
make her so drowsy she couldn't drive and push her further into depression.
Ultimately, Carol consulted Tomas Brofeldt, M.D., at the University of California's
Davis Medical Center in Sacramento. Brofeldt is a doctor of emergency medicine
with a special interest in headaches. Trained in structural engineering as well as
medicine, Brofeldt treats head pain using yoga to correct posture. He believes 75
percent of all headaches arise from muscle tension in the back of the neck,
specifically the semispinalis capitis muscles, due to problems in posture.
The first problem Brofeldt noticed when he examined Carol was that her
shoulders were rounded, and her thoracic spine and head were slumping
forward, creating tension in her neck muscles. Because the muscles of the neck
and upper back connect to the head, tension in the neck can be referred to the
forehead and behind the eyes, causing headaches. Brofeldt prescribed simple
exercises for Carol to do throughout the day. He also advised her to do aerobic
exercise, such as walking uphill, lightweight resistance exercise to build strength
in her upper body, and yoga for alignment awareness and stretching. He
suggested that she meditate 10 minutes a day in an attempt to calm her busy
mind. Brofeldt kept in touch with Carol in the following months to encourage her
to stay with the program.
Even though Carol was not inclined to do yoga, she followed Brofeldt's advice
and came to me for private yoga classes. I had just returned from the Iyengar
Teacher's Exchange in Estes Park, Colorado, with a long list of therapeutic
sequences developed by the Iyengars at their clinic in India, including some for
headaches. I modified the sequences to suit Carol's particular needs, and she
began to practice them before she went to bed.
Carol has come to understand that her headaches have a psychosomatic quality
and has acknowledged the difficulty she has relaxing and letting go in both
passive yoga poses and meditation. She is now able to observe herself with

2. humor, and her headaches have diminished in frequency. Although she still gets
headaches a couple of times a month, Carol now "has a handle on it" and knows
that if she doesn't follow her daily physical routine, the headaches recur.
Muscle Tension and Headaches
Brofeldt believes that headaches are unique to the human race, originating from
our need to constantly hold the head upright. We hold the mouth closed and the
head upright by contracting the temporalis and the semispinalis capitis muscles.
What we perceive as headaches are actually symptoms of muscle fatigue from
these "headache muscles," according to Brofeldt. Often, pain from these
stressed postural muscles is referred to other sites, for example, from the neck to
behind the eyes. Stressed postural muscles may also cause nausea, generalized
fatigue, lack of concentration, and visual disturbances.
In people who have rounded shoulders, a strong curve in the upper back, and a
tendency to hold the head forward, like Carol, the "headache muscles" are held
in a chronically foreshortened state. The more forward the head position, the
more the muscles have to hold. Chronically overworked, the muscles become
fatigued and go into spasm. Brofeldt compares this to a "charley horse" and says
that just as we would stretch a calf muscle in spasm, we need to stretch the
"headache muscles" to bring relief. We should retrain the upper back to extend,
the chest to open, the shoulders to roll back and down, and the head to rest on
the midline. A yoga practice which focuses on alignment and somatic awareness
provides the tools for this retraining.
Being aware of our bodies can help us to perceive the onset of a headache and
stop it early in its course. The first sign of a headache is often a tightening of the
shoulders and neck (trapezius and semispinalis capitis). This fatiguing
contraction of the "headache muscles" causes a reduction in blood flow to the
vessels of the head. As the muscles contract, a reflex increase in sympathetic
tone (the part of the nervous system activated during stress) shunts blood to the
muscles, causing blood vessels to constrict in neighboring tissue. If the muscle is
not relieved and is forced to further contract, the increase in intramuscular
pressure may prevent blood and nutrients from reaching the starving muscle
cells. If the cycle isn't broken, chemical mediators are released that forcefully
dilate vessels, sharply augmenting the pain, and the headache becomes a
migraine. Brofeldt believes that most migraines are due to this protective reflex
against end-stage muscle ischemia, or muscles starved of blood.
Severe head pain, nausea, and sensitivity to light force the migraine victim to
retreat into a state of complete rest. He or she must stop, lie down, and cease all
stimulation and activity. The sufferer must fall into a deep, delta sleep, the kind
that leads to complete relaxation, so that the painfully exhausted "headache
muscles" can revitalize. In the delta stage of sleep, the muscles are totally
relaxed and can be restocked with glycogen and nutrients. People who have

3. interrupted sleep patterns or who do not get enough sleep will not have time to
replenish.
Check Your Posture
Margaret Holiday, D.C., a chiropractor in Marin County, California, agrees with
Brofeldt's observation that the most common cause of headaches is the forward
head position, with rounded shoulders, a curved upper back, and the
accompanying muscular tension. "Anything that distorts the spinal curves has the
potential to cause headaches," she says. Holiday often sees alignment problems
in the feet reiterate throughout the spine and result in tension in the neck and
head.
Holiday notes that how we stand, sit, and work can affect headaches. A desk
worker, for example, who sits in front of a computer screen much or all of the
day, is at great risk for muscle tension. Often the computer screen is set too high,
creating neck strain as the head is held forward and the upper back rounds.
Placing the computer screen lower than the eyes, or angling it down, may help
relieve strain. Also, the abdominal muscles lose tone with hours of sitting, which
contributes to the inability to keep the spine in an upright, neutral position.
Holiday concurs with Brofeldt that sleeping well is important. She suggests
finding a pillow of a size and shape that supports the neck during the night. Do
not sleep on your arm or hand as a pillow, and if possible, avoid lying on the
stomach with the head turned.
Although the overwhelming majority of headaches are caused by muscular
tension, Holiday feels it is important to get a diagnosis from a medical doctor to
rule out serious medical conditions. Tumors, or more common conditions such as
food allergies or sinus infections, may be the source of recurrent headaches.
Headaches can also stem from trauma, such as whiplash or childhood falls, and
resultant injury to the cervical spine.
In addition to postural and structural factors, Holiday believes that dysfunctional
breathing patterns contribute to headaches. She teaches deep, diaphragmatic
breathing to release contracted muscles in the upper body and belly. She notes
that headache sufferers often "live in their heads; they don't breathe fully. They
need time to be in the body and develop the balance between the mental and
physical parts of themselves."
Breathe Away Head Pain
Richard Miller, Ph.D., a practicing clinical psychotherapist who has published
widely on the subjects of yoga and pranayama, concurs with Dr. Holiday that
headache sufferers often have upper respiratory, shallow breathing. They may

4. also be unconsciously hyperventilating. He feels that pranayama (breath control)
can be very helpful in reducing headache.
"There are many pranayamas that are appropriate for people experiencing
different headaches. Each pranayama is adapted to the individual headache
sufferer. The first step is simply observing and noting the breath before any
intervention takes place," says Miller. "Each pranayama is categorized according
to its energetic impact on the body/mind. For instance, Sitali incorporates the
components of long, left-nostril exhalation, a cooling inhalation through either
curled tongue or open lips, and relaxing head movements."
Another pranayama that is often recommended for chronically tense people is
Nadi Sodhana, or alternate nostril breathing. "Even the traditional practice of
Nadi Sodhana is adapted for headache sufferers," notes Miller, "by practicing
Nadi Sodhana in Savasana, with an elevation under the chest and the arms at
the side." In this manner of practicing Nadi Sodhana, air is inhaled and exhaled
alternately through the left and right nostrils without using the fingers to block off
the air flow.
Resolve Emotional Issues
Although postural considerations and breathing patterns are a major part of the
headache picture, there are other key elements, says Richard Blasband, M.D.,
director of research at the Center for Functional Research in Tiburon, California.
He talks of headaches from a bioenergetic (energy flow) perspective: "Many, but
not all headaches are the result of acute stress," he says. "One of the
manifestations of this state is chronic muscular hypertension. While usually the
entire body is affected to some degree, many people, because of negative
conditioning in childhood or for genetic reasons, are vulnerable to developing
muscular tension, particularly in the head, neck, back, and sometimes the eyes.
Without sufficient deep and appropriate emotional release," he continues,
"headaches will almost always return. To achieve a lasting cure, one must solve
the problem at its deepest emotional core."
Addressing this psychological material, with the tools of asana and pranayama,
and possibly with psychotherapy, is an essential element in any prescription for
headache relief.
Resources
Back Care Basics by Mary Pullig Schatz, M.D. (Rodmell Press, 1992).
How to Use Yoga by Mira Mehta (Rodmell Press, 1998).
Relax and Renew: Restful Yoga for Stressful Times by Judith Lasater, Ph.D.,
(Rodmell Press, 1995).

5. The Breath of Life audiotape series by Richard Miller, Ph.D., available from
Anahata Recordings, P.O. Box 1673, Sebastopol, CA 95473; (415) 456-3909.
The Breathing Book: Good Health and Vitality Through Essential Breath Work by
Donna Farhi (Henry Holt, 1996).
Yoga Remedies for Natural Healing: For Beginners, available from YJ's Book and
Tape Source.
The author wishes to thank B.K.S. Iyengar and Geeta Iyengar for their
generous teaching and Chris Saudek for bringing their therapeutic
sequences to the Iyengar Teacher's Exchange in Estes Park, Colorado.
Ellen Serber is a yoga and t'ai chi chu'an teacher in Point Reyes Station,
California. Visit her Web site at http://mydailyyoga.com.
January/February 1999