|Year : 2013 | Volume
| Issue : 3 | Page : 167-170
Effects of yoga on tension headache
Bindu Menon1, Vungarala Satyanand2, P Habeeba Karishma3
1 Department of Neurology, Narayana Medical College and Superspeciality Hospital, Nellore, Andhra Pradesh, India
2 Department of Philosophy of Nature Cure, Narayana Yoga Naturopathy Medical College and Hospital, Nellore, Andhra Pradesh, India
3 Student, Narayana Yoga Naturopathy Medical College and Hospital, Nellore, Andhra Pradesh, India
|Date of Web Publication||29-Aug-2013|
Department of Neurology, Narayana Medical College and Superspeciality Hospital, Chintareddypalem, Nellore - 524 002, Andhra Pradesh
Source of Support: None, Conflict of Interest: None
Background: Stress is an important triggering factor for tension headache. Yoga is one of the effective therapies in reducing stress levels. Studies had shown that shavasana is as effective as electromyography (EMG) biofeedback in reduction of tension headache.
Aim: The aim of this study is to evaluate effect of yoga, namely yoga asana and relaxation technique on tension headache.
Materials and Methods: Thirty patients diagnosed to have tension headache according to the International Headache Society Criteria II were included in this study. Patients were subjected daily to one yoga session for 1 month. Headache intensity by visual pain analogue scale (VAS) was assessed before and after yoga.
Results: There was a significant reduction in VAS after yoga therapy. This study shows that yoga is beneficial in reduction of stress levels thereby reduction in tension headache.
Conclusions: The results of this study suggest that yoga has a potential beneficial role in treatment for tension type headache. Further, larger studies are required to substantiate its benefits.
Keywords: Shavasana, stress, tension headache, yoga
|How to cite this article:|
Menon B, Satyanand V, Karishma P H. Effects of yoga on tension headache. J NTR Univ Health Sci 2013;2:167-70
| Introduction|| |
Headache is a common health complaint. Epidemiological surveys have found headache to be one of the third most frequent complaints of the top 14 problems.  The global prevalence of headache was found to be 46% with tension type headache accounting for 42%, followed by migraine (11%), and chronic daily headache (3%).  Tension headache is a type of primary headache, which is a bilateral pressure like tightening or non-pulsating headache lasting from 30 min to 7 days.  Tension headache decreases with increasing age.  Stress is an important trigger for tension headache. , Tension associated with stress concentrates on the neck muscles. If these muscles are relieved from the influence of stress, tension headache can be reduced.  Yoga is one of the powerful tools in reduction of stress-related problems. Yoga is an ancient science interrelated with physical, mental, and spiritual healings; thereby reducing stress and anxiety.  Hatha yoga deals with third and fourth limbs, that is, asana and pranayama of Astanga yoga. Asana if properly done will have its influence on every organ, muscles, and joints. It simultaneously increases the strength, stamina, and maintains emotional levels.  Yoga influences the stress disorder helping a person to attain physical and metabolic stability.  A study compared the results of electromyography (EMG) biofeedback and shavasana, concluding that the average number of sessions required for shavasana was less than that for biofeedback.  Yoga breathing has been repeatedly shown to be a valuable resource for people suffering from stress-related problems.  The causes for tension headache are many like occupational, financial, and family stress.  In this study we evaluated the effects of yoga on tension headache.
| Materials and Methods|| |
The present study included 30 patients of age group ranging 20-60 years. This study was conducted in the neurology outpatient department of a tertiary care hospital in South India. Patients with primary complaints of headache who satisfied the diagnosis of tension headache according to International Headache Society II (IHS II) criteria were included in the study. Patients with migraine, secondary causes of headache, on antipsychotics or antidepressants, medical conditions which was a contraindication for yoga asanas, preoperative cases, pregnant and lactating females, personality disorders, and any orthopedic ailments were excluded from the study.
The study was approved by the institutional ethics committee. Signed, informed consent was obtained from all patients after giving a detailed description of the study.
Patients who fulfilled the criteria of tension headache were informed about the role of yoga. Patient who gave their consent were included in the study. Detailed history regarding demographic data, duration, frequency, and triggering factors for their headache was taken.
The headache intensity was noted with visual pain analogue scale (VAS) at the first visit to hospital. No prophylaxis or pain killers were prescribed. They were taught yoga and each session lasted for 30 min. These patients were asked to do the yoga session daily at home. A phone call was made for 1 week and feedback was taken and documented in the proforma. Patients were asked to call back in case of doubt or any inconvenience during yoga. These patients underwent a comprehensive yoga session for 30 min, which included sukshma vyayama, yoga asana, and shavasana for a period of 1 month.
Sukshma vyayama mainly concentrates on neck movements. Neck movements with rhythmical breathing included the forward and backwards bending, side bending, lateral bending, and clockwise and anticlockwise rotation of the head. During the start of each neck movement patient inhales and exhales when returning to normal pose. Patient breathes normally in the final position. All movements are performed in standing position with eyes closed with slow breathing. Each movement is performed 5 times which takes 5 min.
Asana postures include supta matsyendrasana and triyaka bhujangasana. These asana are done mainly with concentration on neck muscles and back muscles.
Supta matsyendrasana: Patient is allowed to lie in supine position with eyes closed with normal breathing. The hands are placed sidewards on the floor at the level of shoulders. Both legs are slowly folded at the knees and then bend the knees to right side. Simultaneously the neck is bent to the left side. This is repeated on the opposite side.
Triyaka bhujangasana: Patient is allowed to lie in prone position with eyes closed with normal breathing. Legs are brought together slowly and the palms are placed on either side of the chest. The head and chest are slowly raised and while inhaling head is slowly turned towards the right side. This is done on the other side also. Each asana is performed for 30 seconds on each side. This is practiced for 4 min and in between two asana, person is allowed to relax for 1 min.
Shavasana: Patient is allowed to lie down in supine position with eyes closed with normal breathing. Patient is taught the modified special breathing technique which involves selection of numbers from sixty and counting the number in reverse manner up to one, wherein with every counted number deep inhalation and forceful exhalation is done. This is practiced for one to two times. The procedure takes 20 minutes.
The intensity of pain is evaluated on a 6 point VAS.
0 No hurt
1 Hurts little bit
2 Hurts little more
3 Hurts even more
4 Hurts whole lot
5 Hurts worst
These headache scores were recorded during the first visit and after 1 month in the next visit to the hospital.
The data was analyzed with the statistical package for social sciences (SPSS) for Windows, version 11.5. Descriptive analyses were expressed as mean ± standard deviation (SD). Paired t-tests were performed between patients before and after treatment. P < 0.05 was considered to be statistically significant.
| Results|| |
Thirty subjects were included in the study; out of which 20 subjects completed yoga for the required duration, 10 patients were excluded as seven patients expressed their unwillingness to continue with yoga after having given initial consent and three patients being lost for follow-up.
Mean age of patients was 27.85 ± 10.43; male:female ratio was 1:9; average weight of subjects was 54 ± 10; average height of subjects was 158 ± 6; The duration of headache was ranging from 1-10 years. Average headache days of patients were 15. Trigger factors identified were stress (50%), journey (30%), and head bath (20%). The VAS score before yoga therapy was 3.95 ± 0.75 and after yoga therapy was 2.4 ± 0.88, which showed a significant improvement (P < 0.000) [Figure 1].
| Discussion|| |
In this present study, results showed that yoga provided a beneficial result in treatment of tension headache. Yoga is an ancient technique for improving health. Practice of yoga has increased in several countries for various ailments, particularly related to mental stress. Practice of savasana for 3 months has demonstrated an improvement of headache, insomnia, and nervousness in a study of 86 patients.  A yoga module conducted for 7 weeks reduced the stress levels and improves academic performance in students.  Studies had shown that chronic pain goes beyond the nociceptive pathway and has a negative effect on various other aspects of a person's life. Yoga has documented good clinical outcome in migraine as well as tension headache. 
Muscle relaxation techniques like; listening to music has shown to reduce anxiety.  Stress can produce spasms by interfering with coordination of different muscle groups involved in the functioning of neck.  Our patients had improvement in VAS after yoga, could be because of relaxation of various muscle groups.
In a study conducted on healthy adults, the yoga-based guided relaxation was shown to reduce sympathetic activity as measured by autonomic parameters, oxygen consumption, and volume of breaths.  Yoga asana has been found to act on disorders with lower levels of gama-aminobutyric acid (GABA)-like depression and anxiety.  Hence, the effect of yoga which was seen in our group could also because of chemical balance attained.
Hatha yoga promotes physical relaxation by decreasing activity of sympathetic nervous system, which lowers heart rate and increases breathe volume. The effect of stress is mainly deposited in the neck muscles; muscle relaxation attained through stretching of neck muscles was the main aim in practicing of asana for reduction of pain and stiffness in neck muscles. A deep breathing exercise provides extra oxygen to the blood and causes the body to release endorphins, which are naturally occurring hormones that reenergize and promote relaxation.  Yoga asana and relaxation techniques help in the reduction of anxiety levels and treated as a complimentary therapy.  The decreased peripheral nervous system (PNS) and GABAergic activity that underlies stress-related disorders can be corrected by yoga practices resulting in amelioration of disease symptoms that occur due to the underlying stress.  Various studies which have concluded that yoga decreases nuchal rigidity, increases endorphins, and GABAergic activity prove that yoga reduces tension. 
Our study showed that yoga is a beneficial therapy in the treatment of tension headache than other conventional therapies.
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