Breathing technique (pranayama) with imagery

Reduce severity and/or frequency of migraines per week. We will note severity by type and quantity of additional oral medication required. She will practice alternate nostril breathing techniques using guided imagery. We will meet 4 times over one week. We will start at 10 min and lead up to 20 min. HW practice daily using Insight Timer to help.

JLM is a 47 yr old female suffering from severe migraines. She has suffered from these since she was 3 yrs old according to family, but was officially diagnosed at 10 yrs old. She has a high stress job while managing her family. She is currently under a medication that she receives as an injection once per month to help manage the migraines. About 3x week, she still has serious enough ones that require additional intervention usually by taking prescription oral medication to help with the pain.

We planned to meet 4 times over one week. I would start with a simple centering exercise to bring awareness to the breath and focus inward. We would then practice alternate nostril breathing techniques using guided imagery. The idea was to start at 10 minutes of pranayama with imagery working up to a final goal of 20 minutes. Homework consisted of daily practice using Insight Timer to help keep track.

We used Raja Yoga. The goal was to still and calm the mind with imagery and pranayama. My intention was for her to use this technique to help calm the mind and body on a regular, daily basis as well as whenever she felt migraine symptoms occurring. The idea was to allow her mind to remain calm and less reactive before and after a migraine occurred. I also hoped that she would be able to mentally step back from the symptoms occurring in her body and be a witness to her experience without getting caught up in it.

At the beginning of each session, we practiced centering and breath awareness. We worked on deepening her breath and extending the exhales. This allowed her to focus inward in preparation for the imagery, and primed her for deep breathing with Nadi Suddhi, which was to follow. I provided imagery to address the senses of sight, touch, smell and sound. After the first session, she told me where she imagined she was and we used that imagery for future sessions. Towards the end of each session I introduced stress relieving imagery to inhale peace and healing and exhale any tension, unwanted feelings or emotions.

I suggested she continue to do her short practices of Nadi Suddhi with imagery. I mentioned that increasing the total time of pranayama per day would be helpful. I also mentioned she could use only imagery as a healing/calming tool throughout the day. This would allow her to practice invisibly even if other people were present.
At the last session, I introduced Ha breath (kapaalabhaati) as an alternative to drinking caffeine to help keep her alert without affecting her sleep.

It was difficult for JLM to find time to do 10 unbroken minutes of pranayama. In our first session I explained that doing consistent short sessions was more beneficial than doing a longer session inconsistently. She did break it down into smaller chunks of about 5 minutes of pranayama, which she did twice a day.
The results of the stress and sleep scale didn’t change from the start date to the end date. The lack of change is not surprising, as she only practiced for a week and for a short time. My hope is that there might be more benefit over a month with an increase in the amount of pranayama.
She did report, though, that doing the pranayama when she felt prodromal symptoms of a migraine seemed to postpone the migraine for a few hours. That, in turn, gave her a feeling of relief and lowered stress because she could plan what she needed to get done before becoming incapacitated.

Yes, I had to adapt by reducing the total amount of minutes for pranayama homework so she could experience success in her practice. We did not get to 20 minutes total. However, during our in-person sessions she was able to easily perform 11-13 minutes of guided Nadi Suddhi without strain or feeling that the practice was lasting too long.

The takeaway is that I felt that it was more important for the client to experience success with smaller milestones than to try to reach a goal that might be too much for her at this point in her practice. It was a big deal to add one more thing onto her plate, so it truly was a success for her to do these shorter practices for this week.

I won’t be so ambitious with minimum times for practice. Because she was so stressed, the value for her to add one more task wasn’t instantly visible, since measurable results were not immediate. Starting with shorter times is probably best, and hopefully a client would see a benefit after doing short practices consistently over a longer period of time. Once they gained the benefit, they could increase their time from there.
Another option I could try in the future is to prerecord guided imagery that could be used with the pranayama. JLM said the time felt much shorter with a voice to guide the imagery.
Another way to access the mental portion of the stress response might be to reframe the situation using one of the sutras or other teachings. This would not be a quick fix, but rather a supplement to a more physical practice that would cut through physiological symptoms of stress.