I hate group exercise. As a longtime fan of solo running (which I find clears my head), the idea of stepping into a class with choreographed movement, music set to a remixed beat, and
(most problematically) other people has always sounded completely unappealing. Which is why, as dramatic as it sounds, I signed up for a Pure Barre class last February out of pure desperation.
A post-birth pelvic injury had left me unable to run, and I was determined to find something that would help get me back to a place where I could hit the pavement again. If someone had told me Prancercising would help (and yes, that's a thing), I probably would have tried that too.
After reading a friend's post about how Pure Barre helped her recover after her pregnancy, I thought, "Why not?" So I signed up—and two months later, found myself running again, which was proof enough for me that barre workouts had helped re-establish the core strength I'd lost during pregnancy.
But even though I was back to running, I kept going to barre classes for another reason:
Barre had unexpectedly helped my chronic headaches.
But how is this possible—or was it just psychosomatic?
"Barre workouts focus on core strength, which can measurably improve posture," says Lauren George, co-creator of the Enhance Barre Above Program and owner of Clemson Fitness Company in Clemson, South Carolina. "Research has shown that good posture can help prevent tension in the head, neck, and shoulders."
I figured I must have a muscular imbalance due to my injury, which my physical therapist confirmed during months of pelvic rehabilitation.
"I would say that there is a correlation between those who have increased amounts of upper-body strength and a decreased frequency of headaches," says Jason Kart, a physical therapist and owner of Core Physical Therapy in Chicago, Illinois. "I treat patients with headaches routinely, and the demographic is mostly women ages 18 through 50."
Kart says many of those women discover their pain stems from decreased upper-body strength. "The big thing to remember is that much of this pain can actually be from upper cervical joint instability that refers out to the head and eyes—think of it as sciatica for the head."
Oh, man, can I relate to that description. I've suffered from chronic head pain since I was a teenager and came to rely on a heavy rotation of ice, over-the-counter medicines, massages from my mother, and the solace of a dark room. Today, at 34 years old, each bout sends pain radiating from the back of my head through the right side of my body and leaves me thinking the same thing: I wouldn't wish this on anyone.
But were these awful headaches I had come to think of as migraines actually migraines? The answer is yes and, well, no.
See, it's quite easy to confuse a tension headache with a migraine and, if you're like me, you can indeed experience both of them. Lucky us.
The difference between tension headaches and migraines, however, lies in the location, frequency, and nature of the pain, according to Daniel Franc, M.D., a neurologist at Providence Saint John's Health Center in Santa Monica, CA. Migraines, which affect approximately 20 percent of adults, are typically episodic, affect one side of the head, and are often associated with nausea and a visual aura, such as the appearance of flashing lights prior to the head pain, Franc says.
"The management of migraine headaches often starts with the identification of particular triggering factors," he says. "These factors include foods and beverages, including processed meats, cheeses, and alcohol (particularly red wine or beer). Other factors notorious for setting off headaches are poor sleep and tension. Women frequently have migraine headaches that are associated tightly with reproductive hormone levels and the menstrual cycle, and hormone-related migraine headaches frequently will improve at menopause."
So that explains why my migraines typically occur around my period or when I indulge in a glass of wine (one of my triggers), leading me to lean on my prescription for Imitrex, a popular drug that falls into the triptan class of medicines used to treat migraine and cluster headaches.
On the other hand, chronic tension headaches are typically less irregular than migraine headaches—and can even occur on a daily basis, according to Franc. "These frequently occur in the bilateral forehead, neck, and back of the head," he says. "Tension headaches are frequently associated with stress, sitting at a desk or at a computer, driving, poor posture, and neck strain in sleep."
So that explains why my pelvic injury paired with a job that requires me to sit at a desk for hours were the perfect ingredients for chronic tension headaches.
Figuring out exactly what type of pain I was in was critical.
"Pain is your body's best way of telling you that something has gone wrong," says Aideen Turner, a physical therapist and the CEO of Virtual Physical Therapists. "But not all pain is the same. Knowing what type of pain you have is of utmost importance so the appropriate therapy may be administered."
Pain originates from one or more of three types of pain receptor stimuli—mechanical, chemical, and thermal, Turner says, and headaches and migraines are caused by one of the first two (thermal pain is brought on by excessive heat or cold).
Turner explains that mechanical pain happens when your normal tissue experiences abnormal stress or abnormal tissue (usually a body part that's injured) is confronted with normal stress. "For example, bending your finger backward," she says. "Pain is the result, but once you stop, the pain abates quickly."
On the other hand, chemical pain is caused by the body's inflammatory response. "It's constant and doesn't get better or worse if you change the position," Turner says, noting that this is the kind of pain you get if, for instance, you hit your thumb with a hammer.
This is where most people confuse the migraine and cervicogenic (a.k.a. tension) headache.
Migraines are caused by changes in blood flow—hence their throbbing nature. "The changes in blood flow are thought to be caused by chemical changes in the brain, such as hormonal changes—which is possibly why migraines are more common in females," she explains. "Migraine sufferers are two to five times more likely to have major depressive disorder, so other chemical imbalances in the brain that also lead to mental illness can trigger headaches."
Tension headaches, on the other hand, are rooted in an underlying mechanical cause. "When you are stressed or concentrating on your work, like if you're using a computer, reading, using fine motor skills, driving in bad weather, your posture is usually with your chin forward," Turner explains. "When this position is maintained, it places mechanical stress on the upper cervical spine and creates aching and throbbing in the back of the neck around the top to the front of your head."
These headaches are not only regularly confused with migraines but are also very common after trauma, such as whiplash, when the soft tissue in the upper neck heals in a shortened position.
This is why when I began to see an improvement with barre exercise, I began to wonder if some of the "migraine" pain I was dealing with was instead a headache based on a structural issue with my body. After two decades of dealing with head pain, I had done enough research to know that there was indeed a difference.
When I asked my physical therapist about it, she confirmed that the pain I was explaining to her was indeed the result of an ongoing structural problem—perhaps an old injury that had been waiting around for just the right thing to set it on fire—and not related to something I ate or roller coaster hormones. Hello, pregnancy and birth-related pelvic injury.
Like I said, I'm one of those rare birds who gets to experience tension headaches and migraines. Because of that, it's important to know how to go about finding the right relief for both.
So, what's an extremely headache-prone girl to do, right?
In addition to prescription drugs, Franc says migraine sufferers might find relief from over-the-counter nonsteroidal anti-inflammatories as well as naturopathic treatments such as magnesium, riboflavin, and herbal medications such as butterbur and feverfew.
As for chronic tension headaches, Franc notes the most effective treatment is the reduction of neck tension through techniques such as physical therapy, massage, acupuncture, and relaxation.
"I find that meditation and mindfulness is a particularly good intervention for chronic tension headaches," he says. "Typically vigorous physical activity will make acute tension headaches worse, but daily exercise including relaxation-related exercises such as yoga can be preventative for chronic tension headaches."
Kart says studies have also shown manual therapy—including joint mobilization and manual neck stabilization exercises—give patients "the best chance to get better."
"I have found that migraines and neck pain are largely a behavioral issue," he says. "Patients are spending way too much time sitting at computers. This causes accelerated breakdown of ligaments, discs, and joints of the neck."
Guilty as charged.
And George maintains that exercise like barre workouts can also be the ticket to strengthening those upper-body ligaments and muscles. "Barre workouts focus on building muscular endurance in the upper body through targeted exercises with minimal impact," she says. "This allows participants to build strength in the upper body with lower chances of injury."
The truth is, she's right. As much as I never dreamed of signing up for a group exercise class like Pure Barre, I also thought there would never be an end in sight for my tension headaches (formerly known as migraines). Turns out, I was wrong about both things.
These days, I've incorporated other strength exercises at home and the gym, as well as yoga and Pilates. But I still take regular barre classes too—because, believe it or not, I might have come for the overall body strength, but it turns out I kind of love those Rihanna mixes after all.