As a physical therapist (PT), there's one thing I'm sure about when it comes to the human body: It is meant to move. Our anatomy and physiology are fine-tuned to navigate and interact with the world. While a healthy human body manages to recover better from the aches and soreness that come with physical activity, that recovery can be challenging for people with migraine if it exacerbates migraine symptoms like headache and neck pain.
Understandably, many people with migraine give up on movement. "A migraine attack can be brought on or exacerbated by exercise, particularly in people with chronic migraine," says Andrew Charles, MD, professor of neurology and director of the UCLA Goldberg Migraine Program. However, he says that healthcare providers usually encourage people with migraine to continue to try to exercise. "Thinking about how to manage exercise as a trigger is something that can become very important, especially for those with chronic migraine," he says.
For sure, exercise isn't easy for anyone in pain, but it is essential for a healthy life.
Starting slow and choosing practices that are more likely to help rather than hurt — like the five in this article — are essential for success.
A Daily Movement Practice to Relieve Headache and Neck Pain
Mammen G et al. Physical Activity and the Prevention of Depression: A Systematic Review of Prospective Studies. American Journal of Preventive Medicine. November 2013.
DeBoer LB et al. Exploring Exercise as an Avenue for the Treatment of Anxiety Disorders. Expert Review of Neurotherapeutics. August 2012.
Mandolesi L et al. Effects of Physical Exercise on Cognitive Functioning and Well-Being: Biological and Psychological Benefits. Frontiers in Psychology. April 27, 2018.
Geneen LJ et al. Physical Activity and Exercise for Chronic Pain in Adults: An Overview of Cochrane Reviews. Cochrane Database of Systematic Reviews. April 24, 2017.
This movement practice is inspired by a conversation with a person with chronic migraine for which exercises are important to do on a consistent basis to reduce neck pain, even on days they feel they are in too much pain to move.
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It's important to note that if this movement practice causes body pain, headaches, or a migraine attack, slow down the movement, ease off a stretch, or simply stop and try again later. No progress is made if we risk injuring ourselves each time we move, so perform these movements slowly and consistently.
For those fortunate enough to not have a chronic pain condition, these exercises can help correct poor posture tied to office work or a generally sedentary lifestyle. This guide will help integrate more movement into daily life, and, with regular practice, maybe even result in fewer or less severe migraine attacks.
1. Diaphragmatic Breathing: 4-7-8 Breathing
How to perform:
Find a comfortable place. This is your time. Relaxed breathing is the goal. Breathe at a natural pace; don't force your breathing. Hold your breath only for a comfortable moment; your body knows what is right for you. Please stop the exercise immediately if you start to feel dizzy or lightheaded and talk to your doctor about it. If you have any heart or lung disease, please talk to your doctor before starting this exercise program.
- Start either lying face up or in the seated position. Lying down will be easier for anyone new to diaphragmatic breathing.
- Place one hand flat on your rib cage and the other hand flat on your stomach.
- Each inhale pushes up through the stomach causing your hand to rise. Each exhale flattens the stomach and lowers the hand on your stomach.
- Breathe in for 4 counts through your nose. Hold your breath for 7 counts. Exhale audibly for 8 counts through your mouth. Repeat this breathing pattern 4 times.
- This pattern might be difficult at first, and, at the start, it can be easier to count the same breath ratio rather than to count out seconds.
Why it’s important: Breathing is an automated function of the body: You don’t have to think to breathe in and out. This automation is well regulated by the body’s nervous system. As we move about, our sympathetic nervous system ramps up the “fight-or-flight” response, and, as we rest, our parasympathetic nervous system (the “rest-and-digest” response) activates. Deep breathing turns on this system, allowing our muscles to relax and stretch.
Lastly, fully inhaling or exhaling helps stretch and move tissue, joints, and muscles that make up the rib cage and midback.
Diaphragmatic breathing and progressive muscle relaxation are some of the most effective methods of relaxation, according to Dawn C. Buse, PhD, psychologist and clinical professor of neurology at Albert Einstein College of Medicine in New York. Here is an audio file of Buse demonstrating these techniques.
2. Levator Scapulae Stretch
How to perform:
- Begin by sitting tall on a fixed surface with both feet on the ground. Begin diaphragmatic breathing.
- Left levator scapulae stretch:
- Tilt head forward.
- Tip right ear to right shoulder.
- Turn head to right toward the armpit.
- Hold for 30 seconds to a minute.
- Be mindful to keep the left shoulder from rising up or tilting the body to the right.
- Repeat on right side.
3. Upper Trapezius Stretch
How to perform:
- Continue sitting tall with both feet on the ground. Continue diaphragmatic breathing.
- Left upper trapezius stretch
- Tilt head forward.
- Tip right ear to right shoulder.
- Turn head to left toward the sky.
- Hold for 30 seconds to a minute.
- Be mindful to keep the left shoulder from rising up or tilting the body to the right.
- Repeat on right side.
Why it’s important: These stretches counter the shrugged, hunched posture by stretching the levator scapulae and upper trapezius muscles that make up the upper shoulders and lower neck area. When we experience pain, we all have a basic impulse to shrug the shoulders, hunch the upper back, and lower our heads forward to protect our head. For people with migraine, that means the muscles around our neck and shoulders can become tight over time.
4. Doorway Stretch
How to perform:
- Approach and face a doorway.
- Place palms and forearms on each side of the doorway with elbows at shoulder height.
- Begin diaphragmatic breathing. Step through the door with one foot until you feel a desired stretch in your muscles around the chest. Hold for 1 minute or for a comfortable moment.
5. Scapular Squeezes
How to perform:
- Step back to the starting position in a doorway and step through with the other foot. Begin diaphragmatic breathing.
- With each in-breath, squeeze your shoulder blades together and down, as if you're pinching a pen in the middle of your back. Push up and out with your chest as you squeeze.
- With each out-breath, let your arms rest on the doorframe, and slightly round your upper back in a relaxed position.
- Repeat 10 times or for a comfortable number of times.
- On the last squeeze, hold for 3 breaths or for a comfortable moment.
Why it’s important: These two exercises open up the upper chest by stretching the pectoralis muscles and strengthening the low- and mid-trapezius muscles.
Tightness in the pectoralis major and minor muscles is commonly found in people with head, neck, and shoulder pain. These muscles pull the shoulder forward and lock the spine in a rounded position when tight. The doorway stretch relaxes the chest muscles and stretches the pectoralis muscles, while the scapula squeezes work to strengthen the lower and middle trapezius muscles.
Physiologically, when you strengthen a muscle, the body relaxes its antagonist muscle, or the muscle that opposes the action of another. In this case, building strength in the low- and mid-trapezius muscles increases the stretching ability of the pectoralis and upper trapezius muscles, building the body’s endurance for maintaining better posture throughout the day.
For Best Results: Be Slow, Be Consistent, Be Mindful
It is important to note that this movement practice heavily relies on a person using breathing to focus the mind on the body. At this point, it's good practice to “scan” the body and take note of how it's feeling at the moment. The body can be feeling good or bad at any given time and it can be especially distracting if you are feeling a lot of pain that day.
The best practice is to acknowledge how it feels and return your focus to the breath. If it's difficult to do this, consider slowing down, doing less, or stopping the exercises for the day. It's more important to listen to your body, focus on form and breath, and have consistency rather than force yourself to complete this movement practice.
If you feel anxious, unsure, or find this movement practice difficult, consider consulting a local PT for a physical examination before starting.
Getting Started
This practice works best when done at least twice per day. To help visualize how you can fit exercises and stretches for headache and neck pain into your daily routine, here's a sample schedule:
Morning:
- In bed lying face up with arms by your side, start with:
- Diaphragmatic breathing: 4-7-8 breathing
- Transition to sitting at edge of bed and perform the:
- Upper trapezius stretch
- Levator scapulae stretch
- Move to the doorway to bathroom and perform the:
- Doorway stretch
- Scapular squeeze
Midday:
- Seated at a fixed seat or lying on the ground, begin with:
- Diaphragmatic breathing: 4-7-8 breathing
- Seated in a fixed chair or on the ground, perform the:
- Upper trapezius stretch
- Levator scapulae stretch
- Doorway to bathroom or corner of the building
- Doorway stretch
- Scapular squeeze
Evening:
- Doorway to bathroom or corner of a building, perform the:
- Doorway stretch
- Scapular squeeze
- Sitting at edge of bed, perform the:
- Upper trapezius stretch
- Levator scapulae stretch
- Transition to lying face up, arms by your side in bed and end the day with:
- Diaphragmatic breathing: 4-7-8 breathing
Final Thoughts
Consistent daily stretching with good attention to detail on form, proper posture, and diaphragmatic breathing are the ingredients for good results without injury. On any given day, moving can be difficult because of pain, fatigue, or lack of motivation — on those days, it is best to be kind to your body while also remembering that the human body is meant to move. Be gentle. Gentle movement is still movement.
