Yoga teachers want our students to feel good, become healthier and enjoy their yoga practice, but in some rare cases, a student may experience a headache during or right after their yoga session. Why is this, and what should the teacher do?

The answer, as always, is – it depends! A headache may be due to the practice the student just did, or it may be due to the environment where she did the practice, or it may have nothing at all do with yoga and is related to some other biopsychosocial factors in her life. We can evaluate each of these three broad possible causes, but first, let’s make sure that the headache is not a sign of something really serious.

 

Red flags requiring immediate attention

Yoga teachers are not doctors, and even yoga therapists should not attempt to diagnose students while in a yoga class (that should be saved for the clinic and one-on-one consultations.) Teachers are not expected to be able to clinically treat students or know every danger sign. However, it is useful to be aware of a few key symptoms that may signify a serious condition. These include:[1]

      • Headaches that are getting worse over time or last for more than 3 days
      • Sudden onset of severe headache 

      • Headaches associated with high fever, stiff neck, or a rash 

      • Onset of headache after head or neck injury 

      • Problems with vision or profound dizziness
      • Vomiting
      • Difficulty speaking, confusion or loss of consciousness

If a student presents with any of the above conditions, strongly suggest that she sees a health care professional as soon as possible.

 

Types of headaches

Headaches are not unusual and can happen to anybody at various times. The International Headache Society in their International Classification of Headache Disorders 3rd edition, identify 14 different types of headaches with many sub-classifications.[2] There are 2 basic categories of headaches, primary and secondary. Primary headaches are usually caused by a vascular (blood flow) condition or through muscular origins. Secondary headaches are related to inflammation, injury or other trauma to the head or neck region. The most common primary types are tension-type headaches and migraines. Both of these can be associated with neck pain as well.[3]

The pain of a headache can be quite variable: from a sharp, shooting pain to a mild, dull throb. It can feel like the head is being squeezed or an aching in one specific region. The location is also variable: from the sinus headache at the front of the face, behind the forehead, to shooting pains in the back of the head or at the temples. The symptoms of a migraine may go beyond the head and can include lethargy, brain fog, nausea and vomiting.

 

Non-yoga related causes

While it is certainly possible for a student to develop a headache while in a yoga class, the cause of the pain may be due to what she did or did not do before coming to class. Headaches can be caused by dehydration, low blood sugar, anxiety and psychological stress, a lack of sleep and hormonal changes or disruption. The stress of rushing to get to a class can be enough to trigger a headache for some students. For others, the rush to class may mean skipping a meal, causing a drop in blood sugar levels. Simply eating a little before class or drinking a cup of water may be enough to prevent the headache. Paradoxically, caffeine can both cause and cure headaches. Migraines can be triggered by chocolate, coffee or tea, but caffeine can also reduce inflammation and resolve a tension-type headache.[4]

When a student presents with a headache, the teacher should not assume automatically that it was the yoga practice that is to blame. There are a lot of external factors which may be the cause. If the teacher really wants to get to the bottom of the situation, any evaluation should include life beyond the studio. What is life like for this student on the days when she doesn’t get a headache or doesn’t do yoga? What psychological stresses are happening with her partner, kids, work, neighbours, etc. Are there some correlations worth noting?

 

Environmental causes

If the student finds that her headaches arise only during yoga, again it may not be the practice per se, but rather where she is doing the practice. Some studios still use essential oils or incense to which many students have allergic reactions. These can result in a headache, probably of the sinus headache type. If the studio is very brightly lit, it can trigger headaches for some and migraines in others. If the music is fast and bouncy, choreographed for a fast flowing vinyasa class, this too can be a trigger for some students. To establish that the environment is the cause may require the student go to a different location to practice for a week or so, or practice at home and see if her headaches go away.

 

Possible yoga practice causes

If none of the above reasons for the headache are valid, then it may be possible that something in the yoga practice itself is responsible. Yoga practice includes breathwork, movements of the head and neck, muscular engagements and stretching, as well as postural changes. Some styles incorporate high temperatures. Any of these could be a trigger for a headache.

If a teacher often employs strong pranayama practices, such as Kapalabhati or Bhastrika, the carbon dioxide balance in the blood will be altered. Due to something called the Bohr effect, we need a certain level of CO2 in our body to allow the oxygen atoms carried by the blood to be released into the brain and other tissues[5]. If we hyperventilate and reduce our CO2 levels too much, this will make our blood more alkaline and reduce the amount of oxygen received by the brain, possibly leading to a headache. For students who suffer headaches, it is advisable for them to skip pranayama practices and see if this stops the pain from arising.

In active Hatha yoga classes where the students are changing positions, from lying down or folding forward to standing upright, blood pressure changes may not be adequately keeping up to the postural changes. If the heart is not pumping enough blood to the brain due to lower than normal blood pressure, headaches can result. When a student does develop a headache, she may be well advised to lie down or at least stay at one level for the rest of the class. For example: if doing standing poses, do not add forward folds or deep backbends. If sitting, again, don’t change the height of the head relative to the floor. Stay on one level and see if this helps.

Another possible cause of headaches is movement or stresses in the head and neck. On the rare occasion when a student in one of my Yin Yoga classes complains of a headache, I will ask which posture were they doing when it started. Often it was the Sphinx pose (a low Cobra: lying prone with head lifted.) Lifting the head in Sphinx requires a significant neck extension, which could compress the vertebral arteries running through the cervical spine. For some students, the routing of these arteries is such that a deep neck extension compresses the arteries and reduces blood flow to the brain. When I ask the students to avoid lifting the head up, there is no headache.

The vertebral arteries supply about 10~15% of the blood to the brain. The majority of the blood is provided via the carotid arteries on the front, side of the neck and throat. For a few students, deep neck flexions or deep twists may compresses these arteries, again restricting blood flow to the brain.

Blood flow to the brain is obviously important, but head and neck movements may also create stress on the vagus nerve. The vagus nerve is the mainline communication pathway from the brain to the organs and disruptions of its function can have many undesirable effects, including causing migraines and cluster headaches[6].

In general, when a student mentions that they get headaches during their yoga practice, ask them to focus on keeping their head and neck in a neutral position and note if this prevents the problem. If it does, experiment with allowing certain positions and not others to determine exactly which movement is the primary cause of the headache.

Another traditionally cited cause of headaches is muscle tightness in the scalp, neck and shoulder region, although not everyone agrees with this notion.[7] Some research has shown that sufferers of tension-type headaches have reduced ranges of neck flexion and extension movements.[8] The idea is that tight muscles restrict blood flow or create nerve impingements. During the yoga practice, strong stretches of neck and upper back muscles may cause reduced blood flow to the brain, triggering the headache. Ironically, here the cause is also the cure. Since these muscles are too tight, to loosen them up we need to stretch them out. However, guided relaxation may be just as effective: teaching your student to learn how to release head, jaw, neck and shoulder tension may be all they need to learn. When the headache develops, an early Shavasana with focused relaxation to this region may be sufficient.

Remember, yoga teachers are not doctors. Even if you are able to help your student avoid headaches during her yoga practice, do encourage her to also talk to her doctor. Most people can move their head and neck without compressing arteries or nerves and do not suffer headaches. If your student does develop headaches through these movements, professional help may alleviate the condition or at least reduce the effect.

 

Want to dig deeper? Visit www.painscience.com for Paul Ingraham’s book-length tutorial, The Complete Guide to Chronic Tension Headaches: A detailed, science-based tour of stubborn headache diagnosis and treatment, for both patients and professionals.[9] There is no yoga mentioned but there are lots of details on what science knows and doesn’t know about headaches.

 

FOOTNOTES

[1] Page P. Cervicogenic headaches: an evidence-led approach to clinical management. Int J Sports Phys Ther. 2011;6(3):254-266. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3201065/

[2] https://ichd-3.org/

[3] Castien R, De Hertogh W. A Neuroscience Perspective of Physical Treatment of Headache and Neck Pain. Front Neurol. 2019;10:276. Published 2019 Mar 26. doi:10.3389/fneur.2019.00276. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6443880/

[4] It is for this reason that caffeine is included in some analgesics such as paracetamol or ibuprofen. See Derry CJ, Derry S, Moore RA. Caffeine as an analgesic adjuvant for acute pain in adults. Cochrane Database of Systematic Reviews 2014, Issue 12. Art. No.: CD009281. DOI: 10.1002/14651858.CD009281.pub2. https://www.cochrane.org/CD009281/SYMPT_caffeine-analgesic-adjuvant-acute-pain-adults. Also, see Baratloo A, Rouhipour A, Forouzanfar MM, Safari S, Amiri M, Negida A. The Role of Caffeine in Pain Management: A Brief Literature Review. Anesth Pain Med. 2016;6(3):e33193. Published 2016 Mar 26. doi:10.5812/aapm.33193. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5018099/

[5] Christian Bohr discovered this in 1904, so it has been known for a long time. See Wikipedia for more. 

[6] Yuan H, Silberstein SD. Vagus Nerve Stimulation and Headache. Headache. 2017 Apr;57 Suppl 1:29-33. doi: 10.1111/head.12721. Epub 2015 Oct 16. PMID: 26473407.

[7] https://www.mayoclinic.org/diseases-conditions/tension-headache/symptoms-causes/syc-20353977

[8] “…the ratio of extension and flexion muscles was reduced in [tension-type headache] patients compared to healthy controls... This decreased ratio may suggest a dysfunctional muscle activity, leading to a reduced force steadiness…Tension-type headache patients showed a deteriorated muscle function, indicated by a lower force steadiness and rate of force development, compared to the healthy controls.” See Madsen BK, Søgaard K, Andersen LL, Skotte J, Tornøe B, Jensen RH. Neck/shoulder function in tension-type headache patients and the effect of strength training. J Pain Res. 2018;11:445-454. Published 2018 Feb 23. doi:10.2147/JPR.S146050. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5827678/

[9] https://www.painscience.com/tutorials/headache.php