A Joyous Return to Yoga

Last week I went to my first yoga class in more than a year. It was amazing.

My body felt better. My mind felt better. My head even felt a little better. At home, my practice is always half-hearted and rushed. It is more about getting through what I need to do. What I’ve always loved about yoga is focusing on the good my body can do instead of how my health drags me down. I feel strong and whole. I haven’t found that in my home practice, but I felt it in class.

Maybe because I felt safe with the teacher walking me through everything I had to do. I pushed myself, but gently. My neck and shoulders, already loosened up after a massage on Monday, felt better than they have in a year. Seriously.

Having only a few good hours most days, usually in the morning, has kept me from class. If I devote that time to class, then I don’t get anything else done. Tuesday I went to class, then had a great rest of the day. More energy and strength followed. I got my good hours and then some.

Maybe it was a fluke, but Monday and Tuesday were great days. I felt good physically and mentally. I’d like to attribute it to massage and yoga. Or maybe it was the return to exercise, as not exercising contributes to headaches. (Although I doubt one day made much difference!)

In any case, I’ve planned a new routine. Such plans aren’t usually successful for me, but I think I can do this. Massage at 9:30 a.m. Monday and yoga in that time slot on Tuesday and Thursday.

Just like that I swung from despair to hopefulness. I’m trying to temper my excitement, but it is hard. Not only did I do something I love last week, I think it actually helped my head. *fingers crossed*

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Negative Thoughts, Part Two: If Only I Worked Harder…

There’s a common wisdom that illness can be overcome through hard work. Work is definitely involved, but effort isn’t the only factor. I know this, just as I know I’m not lazy or faking it. I also know I work really hard to improve my health. Still there’s a nagging thought: I must not be getting better because I’m not dedicated enough.

To reassure myself, I looked at the review of my 2007 treatments and treatments I planned for 2008. The lists are so long I tire remembering all appointments I’ve been to. This should be proof that I’m trying to get better. Too bad my inner perfectionist tells me I should be able to do more, no matter what the project.

During my (mild) meltdown last night, Hart asked how he could help. I asked him to tell me that I do work hard at getting better. He looked so pained when he told me I work as hard as I possibly can. Having him say that was so reassuring. If he thinks I’m trying hard enough, I must be.

I wish I didn’t need outside confirmation for things like this. Ha! That sentence makes me laugh. Of course I’m too stubborn and independent to ask for help. Of course I want to do it all on my own. I simply can’t — none of us can. Maybe I’ll remember that for a few days at least.

And maybe I’ll remember I’m working my butt off to get better.

Maybe Birth Control Pills Would Be OK

Talking to Hart about hormonal birth control, migraine and stroke risk got me wondering what my risk really is. If it is low, multiplying the number by eight isn’t that big of a deal. Kersti explains this well in her comment on the post:

[T]he problem with statistics is that they’re misleading. 8 times more likely… 8 times what? You need to find out what the baseline actually is, and you need to find it out for your own ethnicity, gender, circumstances before you know if this is a problem. If for example the baseline is 10% then 8 times is pretty ghastly, however, if the baseline is 0.01% then you’re still at 8 times 99.92% likely to NOT get one.

I’m kind of embarrassed I didn’t think this through before I wrote the post. I’m always urging readers to think critically. No matter how much I recommend caution, I too fall into the trap of fear. “Stroke? Eight times more likely? No way!” is how I reacted yesterday.

According to the American Heart Association’s stroke risk factors, I’m at very little risk. That’s reassuring. I’ll talk with the doctor on Monday and see what she recommends.

Check out the this BBC article on understanding — and critically evaluating — statistics, which Kersti suggested.

Classic Post: Assessing How Much Your Headaches or Migraines Affect Your Quality of Life

See a doctor for headaches and you’ll likely be asked to take the MIDAS or HIT tests to assess how your migraines or headaches affect your quality of life. You may find your results even more helpful than your doctor does.

Assessing Your Quality of Life
The Daily Headache
May 6, 2006

Whether you have them every day or every three months, headaches definitely affect your quality of life. MIDAS and HIT are two questionnaires to assess the extent of the impact.

Before I recognized how seriously I was affected, a doctor gave me the MIDAS test. The highest score on the test, which indicates severe disability, is 21+. My score was above 100. Needless to say, the results floored me.

This was what it took to see just how bad my headaches were. In the ensuing months, and years, I would recite MIDAS every time I questioned the realness of my illness. Every time I blamed myself, I repeated my mantra. This made a huge difference in how I perceived and dealt with my headaches.

If you question how real your headaches are, these tests are invaluable. They can also help you assess your pain from one time period to the next.

In addition, you can show the results to people who are close to you, but don’t really accept what you’re going through. As they remember the last one to three months, the pieces may slowly fall into place.

Boston Red Sox Pitcher Jonathan Papelbon on Migraine

Revered Boston Red Sox pitcher Jonathan Papelbon is a rare athlete willing to admit how debilitating a migraine episode is. Most athletes say they push through it, fueling the public’s perception that a migraine is “just a headache” — and that migraineurs are whiners. Papelbon said:

“They don’t go away,” he said. “You can usually feel the effects of them the day after, the aftereffects. But it’s hereditary, they don’t go away.

It’s just something that I’m going to have to deal with. It’s not just a headache, it takes over your whole body. People that don’t get them, they don’t really understand them.”

Papelbon later says that he is able to push through a migraine — only after he has taken the migraine abortive Imitrex. It seems like a small thing, but “tough guys” admitting the agony of migraine helps spread the word that it is a serious disorder.

Clinical Trials for Treating All Sorts of Headache Disorders

ClinicalTrials.gov is the place to go if you’ve considered participating in a clinical trial for your headache disorder, These are just the latest in 142 headache studies recruiting participants or will be recruiting soon.

Nearly every headache disorder is represented: cluster, tension-type, post-traumatic, migraine, cervicogenic, lumbar-puncture, medication overuse (rebound)…. Treatments range from medication and surgery to diet, coping skills training, relaxation, meditation, yoga, exercise… Again the list goes on.

The diverse collection of current studies include:

Even if you’re not interested in any of these studies, checking the government’s clinical database regularly may turn up something new that works for you. Searching for “headache” gets the most results, but you can also search by specific headache type. For example, there are 74 active studies on migraine and seven on cluster headaches.

Migraine and Gluten Sensitivity

In a desperate attempt to treat her migraines, herself (gluten-free) blogger Karen Yesowich Schmucker discovered she was sensitive to gluten. Adopting a gluten-free diet has reduced the frequency and severity of her migraines. Karen explains the connection in this guest post.

While there is data to suggest that a certain percentage of migraineurs also suffer from celiac disease or some form of gluten sensitivity, few neurologists routinely test their patients for it. One study done in Italy in 2003 suggested that 4% of migraineurs also had celiac. You may think this is a small number and that may explain neurologists’ reluctance to test for it. But consider this: few people in the general population are ever tested for gluten sensitivity or celiac disease. Until recently, doctors considered it to be extremely rare, but now there is reason to believe that the number of people in this country who have some form of intolerance to gluten is 1 in 133, or about 3 million. Over 90% of these people do not know of their gluten sensitivity. So how safe can we as patients feel about the small number of migraineurs who also have Celiac? We don’t really know how many of us are out there. Should we care? Would a gluten-free diet really help us? And what the heck is gluten anyway?

Gluten is a protein found in wheat, rye and barley. It is what makes dough from these grains sticky and hold together when baked. Gluten is also used in many other food products from soups and salad dressings to soy sauce and beer. Gluten intolerance is an autoimmune disease which, left untreated, will eventually destroy the villi in the small intestine, leading to malabsorption of minerals and nutrients. There are serious implications from malabsorption including osteoporosis, certain cancers and a host of other disorders. Go to the National Foundation for Celiac Awareness to find out more.

Today the only treatment for gluten sensitivity is the complete and lifelong avoidance of gluten. Does maintaining a gluten-free diet help migraine? There is some evidence to suggest that some migraineurs are helped by it. Some report the total disappearance of migraine while others have fewer and less severe attacks. I fall into the latter category. I found out (by accident) a little over a year ago that I am gluten intolerant and I have followed a gluten-free diet since December 2006. Do I still get migraines? Yes, but not as many and not as severe. I have not had a classic migraine (with aura) in about a year. Does my neurologist think that gluten caused my migraines? No, but it could have created a situation where migraine was more likely to occur, especially since I had evidence of malabsorption and was deficient in several important minerals like magnesium, even though I was supplementing at 400 mg per day!

As a direct result of my experience, my neurologist now tests his patients who show gastrointestinal symptoms for gluten sensitivity. But he doesn¹t test all his patients. He (incorrectly, according to experts on celiac) believes that one must have these types of symptoms before testing makes sense. However, with celiac, symptoms often do not appear until the disease has progressed and a patient is not absorbing nutrients. Here are some of the symptoms noted in celiac literature: fatigue, anemia, migraine, eczema, psoriasis, mineral deficiencies, as well as gastrointestinal complaints such as bloating, gas, constipation and/or diarrhea. So the bottom line is: finding out you have gluten intolerance may or may not help your migraine, but the health benefits of discovery and treatment by themselves are compelling. I went gluten-free hoping to rid myself of debilitating headaches, but knowing what I know now makes me glad I did it regardless of the effect on my headaches.

If you do decide to get tested, make sure you do NOT start a gluten-free diet until AFTER the test results come in and your doctor tells you to start it. The test will come back negative if you are not actively eating gluten. If you go on a gluten-free diet please give it a good chance to succeed. I found some of my symptoms disappeared within three days, but the migraine-easing part of it took longer. Months longer. So be patient and don’t cheat. It can take up to 18 months for your system to heal. If you want to see how to navigate life gluten-free, visit my blog. You can find recipes there as well as tips for managing eating out, traveling and otherwise living a normal life gluten and headache-free.

References and Resources:

  • Association between migraine and celiac disease: results from a preliminary case-control and therapeutic study. Gabrielli, M.; Cremonini, F.; Fiore, G.; Addolorato, G.; Padalino, C.; Candelli, M.; de Leo, M.E.; Santarelli, L.; Giacovazzo, M.; Gasbarrini, A.; Pola, P. The American Journal of Gastroenterology, Volume 98, Number 3, March 2003 , pp. 625-629(5)
  • Migraine and Coeliac Disease. Headache: The Journal of Head and Face Pain 38 (8). J. Serratrice MD, P. Disdier MD, C. de Roux MD, C. Christides MD, P.J. Weiller MD.  (1998), 627­628 doi:10.1046/j.1526-4610.1998.3808627.x
  • Celiac Disease: A Hidden Epidemic. Peter H. Green, Rory Jones. HarperCollins Publishers. 2006. ISBN-13: 9780060766931 (Peter H. Green, M.D., director of the Celiac Disease Center at Columbia University. He confirmed that migraines can be a symptom of celiac disease.)
  • Living Gluten Free for Dummies. Dana Korn. Wiley Publishing, Inc. Hoboken N.J., 2006
  • All in Your Head. Untreated gluten sensitivity can affect your gut, your skin and your brain. By Alicia B. Woodward. Living Without magazine. Winter 2007. Pp. 11-16; 27.
  • Celiac Disease Foundation
  • Gluten Intolerance Group

Karen Yesowich Schmucker is a freelance graphic designer and translator who lives with her husband in Bellevue, WA. Karen also teaches Naginata (a Japanese martial art) near Seattle. A migraineur since age 12, she has been gluten-free since December 2006. Contact her at karen[at]kysdesigns[dot]com.