The kids are back at school (…..finally…… ) and families everywhere are getting back into their ‘routines’.
As a young child we crave routine because so much of what is happening around is new, and ‘unknown’ and we find safety and comfort in things that are familiar. As we go through life we become exposed to the same situations over and over. Our brains quickly get used to our daily habits and are constantly seeking for patterns to the extent that our brain will begin to anticipate certain events – for example, starting every morning with a coffee, or taking a pain relieving medication at the same time every day. Your brain will anticipate the arrival of the caffeine or medication and start to make changes so that the arrival of the substance (i.e. caffeine) doesn’t come as a ‘shock’ and the system is already preparing for it. Some might refer to the feeling this gernates as a craving, and indeed the response if we don’t provide the subtsance that is expected can cause some ill feeling – a withdrawal response. The result of a disordered and ‘unepxected’ day is a stress response or ‘reacting’ and using our ‘fight, flight or flop’ response.
Migraine is a routine illness, in that, there are routines we have that create or upset the status quo. The migraine brain craves routine.
Here are two key daily routines that can impact on migraines:
Driven by our circadian rhythm our brain goes through daily sleep/wakes cycles. Someone setting their alarm for the same time everyday will often find that after a while their brain starts to rouse and wake in the minutes before the alarm goes off. The internal clock is anticipating the alarm, and rather than be ’startled’ out of sleep it begins a gentler process of progressing from deep sleep to a state of wakefulness.
Right through the migraine cycle the interaction with the sleep/wake centres is obvious to see.
Not only do we see yawning, fatigue and unusual dreams/sleep behavior as a prodrome, but in the midst of an episode many sufferers will find comfort in getting to sleep, often waking improved and reporting that the reason for taking some medication is the drowsiness and sleep they induce.
We also frequently hear that changes in sleep patterns (too much or not enough) can be a trigger, with ‘brain fog’, lethargy and inability to process information being some of the most universally shared symptoms after pain, nausea/vomiting and sensitivity to light or sound.
A small investment in good sleep health may have a positive impact on the frequency, duration and/or severity of your migraines.
For the next month try going to sleep at the same time every night, waking the same time each morning (I’m sorry, yes, even on weekends) and provide your brain with some predictability. It’s just one piece of the puzzle, but in some it may be an essential piece.
The second area we can adopt a healthy routine is good neck health.
The science is patently clear now, that the area housing the trigeminal and upper cervical nerves is the ‘powder keg’ in all primary headache types including migraine. Sitting there on a daily basis, bubbling away waiting for a ‘spark’ (aka trigger) to blow it up.
It is not hard to believe that the neck is a driving source of this problem. Not only does the research show that treating the neck decreases trigeminal nucleus activity, but the stresses we put on our neck are almost universal.
Take a look around you at work, school, or the next time you are on a bus and count how many people are looking down or sitting slouched with their head forward of their body.
Now bend your index finger right back on itself and hold it their for 20 seconds.
The postures you are seeing are doing exactly the same thing to the top of your neck as what you have just done to your index finger, but because it builds up slowly and is relatively constant most of us we don’t notice it as much.
Imagine now how often we sit with our head forward or look down. In fact even when we go to sleep on our side we tend to curl forwards, and on our back tend to use a pillow pushing the head forward.
Our poor neck doesn’t get much respite other than when we are standing and looking straight ahead. Not a big percentage of anyone’s day.
The fact is we look down a lot because that’s where our ands are and that’s where we interact mostly commonly with our world.
Take another look around in your home or office and you will see that all the things we use most often we place between hip and shoulder height – hand height. So we have to look down.
What then can we do?
There are times when we look down and don’t need to. From the position of your car seat, to the location of the television in relation to your couch, working on a laptop instead of a desktop – there a numerous areas we can easily change with little or no expense in many cases.
A phone can be held at eye level by folding one arm across your stomach to support the elbow of the hand holding the phone.
Heavier tablets can’t be held for as long. If your routine is to read/watch tv from a tablet for long periods of time consider buying a tablet holder on a stand (often sold for musicians as a music stand). This can be adjusted to any height, easily packed away, and saves your neck an hour or so of being squeezed forwards.
Lastly, have an expert examine your neck.
The long-term changes that occur in the neck due to looking down or the head sitting forward cause reactive spams in the top of the neck. Whilst stretching and massaging these can provide short term relief, correction of the fault that is triggering the spasm is paramount to a more sustained result.
Part of the genius of the Watson Headache Approach ® was not only to prove how much this problem irritates the brainstem, but to find a method of treating it that is long lasting and sustainable.
A combination of treating the problem combined with often small changes in posture can have a profound impact on the neck, and as a result a significant decrease in the irritation of the brainstem, directly impacting on the area known to be the problem in migraines.
Start your journey to better sleep and neck health today and make your migraine a ‘routine’ condition.
Roger O'Toole is the Director and Senior Clinician of the Melbourne Headache Clinic and has over 10 years experience as a physiotherapist.