Behavioral therapies such as paced breathing, mindfulness meditation and progressive muscle relaxation can help prevent migraine attacks. Learn how to add breathing and relaxation exercises to your migraine management plan.
Research shows that paced breathing exercises and other relaxation therapies can help reduce the frequency of attacks and bolster your body’s ability to manage stress. Increases and decreases in stress are common migraine triggers.
Dr. Dawn C. Buse is a licensed psychologist who helps people live well with chronic diseases, including migraine. Below, Dr. Buse shares insights on how relaxation techniques can help prevent attacks and tips on how to use paced breathing exercises for migraine management.
Can relaxation therapies help manage migraine?
Evidence has shown there are five types of behavioral therapies that are effective for migraine prevention:
- Relaxation therapy
- Cognitive behavioral therapy
- Mindfulness based therapies (including mindfulness-based stress reduction and mindfulness-based cognitive therapy)
- Acceptance and commitment therapy
“Relaxation based on breathing and focusing or distracting the mind have been used by people and cultures for thousands of years to manage pain and distress,” says Dr. Buse. “These are innate responses. If you’re a parent and your child hurts themselves and you say, ‘OK, take a deep breath’—that’s what you’re doing. Paced breathing in the form of Lamaze training has been used to help women manage pain during childbirth since the 1960s. These are ancient human coping skills.”
These are examples of acute pain management, or managing pain while it is happening. However, research shows that the behavioral therapies listed above can be effective in preventing migraine attacks from happening and/or reducing the intensity and duration of attacks when they happen.
Biofeedback, relaxation therapies and CBT—which are often taught together—have good evidence for preventing some percentage of attacks, reducing the number of headache days and improving quality of life and other variables for people with migraine. The rates of effectiveness in preventing migraine are similar to the effectiveness rates for traditional oral therapies for migraine prevention.
Studies of mindfulness-based therapies for migraine—which are fewer and more recent—have shown improvements in quality of life, reduction in disability, reduction of symptoms of depression and anxiety, and other positive outcomes. However, the degree of prevention of migraine attacks varied from person to person and study to study.
There are many healthy practices individuals can learn regardless of whether they are participating in the behavioral therapies listed above. For example, someone can learn and practice paced breathing, guided visual imagery or meditation on their own. One practice that combines mental focus, paced breathing, stretching and strengthening is yoga. In fact, a meta-analysis of studies exploring yoga therapy for migraine found that people with migraine who practiced yoga experienced substantially reduced headache frequency. However, researchers found no significant impact on pain intensity when migraine attacks did occur.
How does paced breathing help prevent attacks before they happen and manage migraine symptoms when they do occur?
Relaxation techniques such as breathing, yoga and mindfulness meditation help calm the sympathetic nervous system and activate the parasympathetic nervous system. The parasympathetic nervous system controls the “rest and digest” functions and the body’s relaxation response, which includes slowing the heart rate, improving circulation throughout the body and relaxing the muscles, among other functions. Activating the parasympathetic nervous system helps counter the sympathetic nervous system, which controls the “fight or flight” response that can be triggered by stress, pain and other experiences.
By incorporating relaxation techniques into your daily routine, you increase your ability to notice when the sympathetic nervous system is activated. This in turn helps you more effectively calm your nervous system by engaging the parasympathetic nervous system, therefore calming your mind and body.
“Someone living with migraine may have a nervous system that is very responsive to changes both externally and internally,” says Dr. Buse. External changes like an approaching storm or change in barometric pressure and internal changes such as hormonal fluctuations, not getting enough sleep or going through a stressful period can affect the nervous system and lead to an increased chance of a migraine attack.
“Regularly practicing these behavioral strategies and healthy lifestyle habits— such as getting enough quality sleep and regular exercise—shores up the resiliency of the nervous system so it can better withstand these changes,” says Dr. Buse. “If we think about the risk of an attack as a constantly changing threshold, internal and external challenges in life can lower the threshold and make it more likely to have an attack. Relaxation practice and healthy lifestyle habits can raise the threshold for an attack or add a bit of protection. By practicing paced breathing, relaxation, mindfulness meditation, yoga or another relaxation exercise of your choice for 20 minutes multiple times per week, and by getting enough exercise and quality sleep, you can raise your threshold for attacks.”
Raising this threshold may help to prevent some migraine attacks, but remember that even when diligently practicing relaxation therapies and healthy habits, some attacks may still occur. “That’s not your fault, it’s the nature of migraine,” Dr. Buse says. “But we want to give you as many tools as possible to manage migraine to the best extent possible.”
Breathing Exercises for Migraine
To practice paced breathing for migraine, prepare a quiet and comfortable space where you can relax, then follow these steps:
- Put one hand on your chest and one on your stomach. Your goal is for the hand on your chest to remain relatively still, while the hand on your abdomen rises and falls with each breath. We often call this type of breathing “diaphragmatic breathing” because you will use your diaphragm—a muscle at the bottom of your lungs—to expand your lungs and allow them to fill with air.
- Breathe in through your nose and focus on the feeling of air passing through the back of your throat, coming down into your lungs and filling your lungs.
- After inhaling, hold your breath for a moment. Then when you are ready, exhale or blow your breath out through your mouth, trying to empty your lungs as much as possible.
- Pause for a moment after exhaling. Then, when you are ready, return to step 1 and inhale through your mouth.
- Once you have the hang of diaphragmatic breathing you can let your hands rest comfortably by your side or wherever is comfortable for you.
- Consider following “square breathing” counting, which is explained below. Alternatively, you can focus on gradually slowing your breath.
- Continue your breathing practice for a set period of time, working your way up in time, or for as long as you like. It is often recommended to practice for 20 minutes per session, 4 or more times per week for migraine prevention and general health. However, your body will benefit from any amount of practice, even just one minute.
- When practicing paced breathing, you may find that at some point you lose track of your breath and enter a deeply relaxed state. This is a good thing. Let yourself enjoy this state of deep relaxation.
People who are already familiar with basic breathing exercises for migraine and relaxation might find that square breathing works well to calm the nerves during stressful situations. To do square breathing:
- Inhale through your nose for a count of 4.
- Hold your breath for a count of 4.
- Exhale through your mouth for a count of 4.
- Pause for a count of 4. Then inhale again, repeating the pattern.
While doing paced breathing, you should only hold or slow your breathing to the point where it is comfortable for you. You do not need to take especially deep breaths for this to be effective, so don’t push your body beyond its comfort zone.
“The key is that the breath is steady and at a slightly slower pace than if you weren’t paying attention to your breathing,” says Dr. Buse. “Many people will work their way to a slower pace over time, just like an athlete trains for a marathon by starting with shorter runs.”
How often should you use breathing and relaxation techniques to manage migraine?
Research has shown that the ideal routine for people with migraine is to do breathing and relaxation exercises for 20 minutes per day, more days than not. However, even short sessions of paced, controlled breathing or relaxation throughout the day can have benefits.
“When I’m doing biofeedback in the office with a patient, during the first 10 seconds of relaxed breathing we can see a positive change,” says Dr. Buse. “Even little breaks of paced breathing or relaxation are good for the body. It may not follow the scientifically endorsed regimens that we’ve tested and studied, but I can see in clinical practice that it is beneficial. This is something that I practice myself and recommend to my healthcare professional colleagues as well.”
Dr. Buse also highlights that different activities work for different people and lifestyles. Experiment with different exercises, including breathing, yoga, mindfulness meditation and even just taking time for a walk or personal hobbies each day.
“Notice how your body feels,” Dr. Buse says. “Think about your breath, think about stretching, think about movement. Notice if your mind is stuck in a wheel of anxiety or stress. Can you shut that down for a moment and give yourself a little break? It’s good for your body and your mind, and you deserve that time.”
The American Migraine Foundation is committed to improving the lives of those living with this debilitating disease. For more of the latest news and information on migraine, visit the AMF Resource Library. For help finding a healthcare provider, check out our Find a Doctor tool. Together, we are as relentless as migraine.