What helps with migraine besides medication: relaxation techniques with evidence

“You know what they say. Just relax a bit and it’ll stop hurting.”

A colleague said this to someone with migraine, kindly meant, over coffee, the day after he had spent the previous afternoon in a darkened room with a bucket by the bed. He did not know whether to smile or to get up and leave. That one sentence held two things at once: a grain of truth and a great injustice. The truth is that relaxation techniques have very good research evidence in migraine. The injustice is the hint that the person is causing the migraine themselves — that they would be well if only they relaxed better.

In this post I want to separate those two things. I will look at which relaxation techniques have evidence in migraine, why they work at all, how to practise them so that they have an effect, and where their limits lie. But first, something that needs to be said clearly.

Migraine is not a psychosomatic symptom

Migraine is a neurological disease. It is not a bad tension headache, it is not a sign of a weak character, and it is not “all in your head” in the dismissive sense people like to use. It is a disease of the brain with a strong hereditary component, in which the nervous system is more sensitive to change — in sleep, hormones, meals, weather, light and also stress. During an attack, a sequence of events unfolds in the brain and the membranes around it that neurologists now understand quite precisely, and for which there are medicines developed for exactly that mechanism.

How common it is can be seen from the largest global study of disease burden (Global Burden of Disease): roughly one person in seven has migraine, and in the analysis for 2016 it ranked second among all diseases by years lived with disability. It is more common in women than in men and hits hardest in the years when people are working, raising children and building relationships.

So first: diagnosis and treatment are led by a doctor — your GP and, where needed, a neurologist. I do not write about medication in this post and I do not recommend any; that is not my field. My field is what happens around the illness: stress, anxiety, relationships, habits, thoughts about pain. And that is exactly where relaxation techniques are useful — not instead of a doctor, but alongside one.

If you are interested in a broader view of why the body hurts even when test results are normal, and how psychotherapy approaches that, I wrote about it in “The tests are normal, but it still hurts”. Migraine is a different story, though: here the scans often show nothing, yet the diagnosis is clear and the illness is real.

What the research says

When American headache experts (the US Headache Consortium) reviewed the research on non-drug approaches to migraine in 2000, they gave the highest grade of evidence to three groups: relaxation training, biofeedback (on its own or combined with relaxation) and cognitive behavioural therapy. Later reviews, including one by Don Penzien and colleagues in 2015, confirmed that grading. For migraine prevention, these approaches count among well-established, empirically supported treatments.

It matters what exactly that means. The research does not show that relaxation cures migraine. It shows that people who learn relaxation techniques and practise them regularly experience, on average, less frequent attacks, often less severe ones too, and that they cope better in the days between them. The effect does not appear overnight but over weeks of regular practice.

I write about biofeedback and cognitive behavioural approaches in more detail in Biofeedback and cognitive behavioural approaches to migraine: what we know and what we don’t. Here I stay with the techniques you can learn yourself and practise at home.

Why would relaxation affect migraine at all?

If migraine is not psychosomatic, how can something as “psychological” as relaxing have any effect on it? A simple but useful picture helps, one that neurologists use too: the attack threshold.

A brain with migraine has a lower threshold. That part is biological and relaxation will not change it. But various loads press against the threshold — too little sleep, a skipped meal, hormonal shifts, a long day at a screen, tension in a relationship, worries piling up. When enough of them accumulate, an attack becomes more likely. Relaxation does not remove the sensitivity, but it can reduce the part of the load that comes from physical and emotional arousal. That leaves more room before the threshold.

The model is simplified, and neurologists would add to it in many places. But for everyday life it is useful, because it explains two things at once: why relaxation helps, and why it is not your fault when an attack comes anyway. Sometimes the loads stack up so that something you have no influence over — a hormonal change or a change in the weather — tips you over the threshold.

The relationship between stress and attacks is particularly interesting. Richard Lipton’s team showed in 2014 that the risk of an attack is often higher not during stress itself but after it, when the tension eases. There is more about this in Stress and migraine: why the attack often comes only after the pressure. For relaxation techniques this means something practical: the benefit lies not only in calming down when things are bad, but in the body learning more gradual transitions between tension and rest.

Progressive muscle relaxation

The best-researched relaxation technique in migraine is progressive muscle relaxation, developed in the first half of the 20th century by the American physician Edmund Jacobson. The idea is simple: you deliberately tense individual muscle groups for a few seconds, then release them and notice the difference. You gradually move through the whole body — from the hands and arms through the face, neck and shoulders down to the belly and legs.

Why tense, if the goal is relaxation? Because most people do not notice that they are tense until the tension becomes large. When you consciously tense a muscle and let it go, you learn to recognise what tension feels like and what its leaving feels like. Over time you notice it in everyday life: at the wheel, at the computer, during an argument. A study by the German group of Bernd Meyer and Peter Kropp in 2016 showed that people with migraine who practised the technique regularly had fewer attacks than a control group, and changes were also visible in measurements of brain activity.

You will find a short guide to the exercise in the knowledge base under progressive muscle relaxation, and a shortened version further down in this post.

Breathing that calms the nervous system

Breathing techniques are rarely studied on their own in migraine. They are almost always part of broader relaxation programmes, so we have no data on how much breathing itself contributes to the effect. Even so, they make sense: slow breathing with a longer out-breath engages the parasympathetic branch of the nervous system, the one that calms the body, and is one of the fastest ways to bring arousal down.

With breathing it is important not to turn it into a task you can “get wrong”. You do not need to count precisely, and you do not need to breathe deeply. It is enough for the out-breath to be a little longer than the in-breath and for the rhythm to settle. You will find instructions under breathing with a longer out-breath. If breathing exercises make you anxious because you focus too much on your breath, you may find Breathing during panic: what actually helps useful — there I explain why, with breathing, less is often more.

Mindfulness: less of a fight with pain

Mindfulness is a newer research area in migraine. The best-known study is a randomised trial by Rebecca Wells and colleagues, published in 2021. People with migraine attended either an eight-week mindfulness programme or classes about headache. The number of migraine days fell similarly in both groups. But the mindfulness group reported less disability, better quality of life, fewer depressive symptoms and less pain catastrophising.

That is an honest result and worth attention. Mindfulness may not reduce the number of attacks more than other forms of help, but it changes something else: how you live with the illness. People who stop experiencing pain as an enemy that must be defeated immediately often wear themselves out less in fear of it. If you want to know what mindfulness actually is, you will find a short explanation under mindfulness.

What happens to thoughts during pain — “it’ll last three days again”, “I can’t stand this”, “it’ll ruin my weekend” — also has a research name: catastrophising. It arises in a similar way to anxiety, which I wrote about in “What if …”: why the brain would rather predict a hundred disasters than one calm day.

When to practise: between attacks, not during one

One of the most common mistakes is that people only remember the relaxation exercises once an attack has started. For most people, that is too late. During a full migraine attack, light, sound and movement are often unbearable, thinking is slow and nausea is strong. Progressive relaxation in that state will not stop a process that is already under way in the brain. During an attack, what you have agreed with your doctor applies.

Relaxation techniques work preventively. The effect builds through practice on days when nothing hurts: ten to fifteen minutes a day, for several weeks in a row. The body slowly learns how to move from arousal into calm, and remembers it even when the day gets complicated. For some people a short exercise can help in the early phase, at the first signs — but that is more the exception than the rule, and worth testing for yourself.

It helps to know what your attacks look like. People who keep a simple record of attacks, sleep, meals and stress often notice patterns they had not seen before. It is similar to what I described for insomnia in Hyperarousal: why chronic insomnia is not a sleep problem but an arousal problem — chronically raised arousal does not show itself in a single day, but in a pattern.

When “just relax” becomes an accusation

As a marriage and family therapist in training, I notice that migraine rarely stays one person’s business. Cancelled plans, children who have to be quiet, a partner who takes over dinner and bath time — all of this gets written into relationships. And in that space the sentence “just relax” often does not mean advice, but tiredness, helplessness or a hidden reproach.

A conversation might sound like this (a composite, not a real person):

“Again? You said you’d do those exercises.”
“I do them. Every day. And it still came.”
“Maybe you’re not doing enough of them.”
“Or maybe you don’t understand that this isn’t a switch I can turn off.”
“I don’t understand. I just don’t know how to help you any more.”

The last sentence is the most important. Under the reproach there is often not harshness but the helplessness of someone close who cannot do anything. When a couple puts this into words, the relationship to the relaxation exercises can change: they are no longer an exam to pass, but something a person does for themselves — and something a partner can support without policing. Even an agreement that an attack is not proof that “you didn’t practise enough” helps.

Exercise: a short progressive relaxation

This is a shortened version that takes about ten minutes. It is best practised once a day, at roughly the same time, when nothing hurts. Sit or lie down so that you are comfortable.

1. Hands and arms. Make fists and tense your arms for five to seven seconds. Then release them all at once and spend ten to fifteen seconds noticing how the difference feels — warmth, heaviness, tingling.
2. Face and jaw. Wrinkle your forehead, squeeze your eyes shut and gently clench your teeth. Let go. In migraine this part is often the most revealing, because many people only notice here how tightly they hold their jaw all day.
3. Neck and shoulders. Raise your shoulders towards your ears and hold. Let go and allow your shoulders to find a lower place by themselves.
4. Belly and legs. Tense your belly, then your thighs and calves, with your feet pulled towards you. Release each group separately.
5. The whole body. Stay for another minute or two with a longer out-breath and scan your body from head to toe. If you still feel tension somewhere, do not order it to leave — just notice it.

If tensing any muscle group triggers pain, skip that group or tense it only lightly. The goal is not strength, but the difference between tense and relaxed.

Where relaxation is not the answer

It would be dishonest of me not to say where the limits of what I have written lie.

Relaxation is not a treatment for migraine. It is a complement. If you have frequent attacks, if they are getting worse, or if you need the medication you take during attacks more and more often, that is a question for a doctor, not for a relaxation exercise.

Some headaches must not be put down to migraine. A sudden, extremely severe headache, “the worst of my life”, a headache with weakness on one side of the body, with speech problems or confusion, a headache with fever and a stiff neck, or a headache after a blow to the head need immediate medical help — call 112 (the emergency number in Slovenia and across the EU). A headache that is different from your usual ones is also a reason to see a doctor.

It does not help everyone equally. Research speaks of averages. Relaxation techniques help some people a great deal and others a little. For some, especially those who have experienced trauma, focusing on the body can at first trigger anxiety instead of calm — in that case it is better to seek guided help than to persist alone.

It is not a measure of guilt. If attacks come despite practice, it does not mean you did something wrong. Migraine has a biological basis that relaxation does not reach. And if you notice that low mood, lack of energy or loss of pleasure are constant companions of your migraine, that is worth taking seriously, much as I described in Depression and the body: pain, fatigue and digestion — and worth talking about with a doctor or psychotherapist.

Where psychotherapy has a place

Psychotherapy does not treat migraine. But it can help with what accompanies migraine and often makes it harder: chronic tension, anxiety about the next attack, perfectionism that does not allow rest, and relationships in which the illness becomes a source of resentment. In relational family therapy, in which I am training, we are also interested in how a family talks about pain — whether it is kept quiet, whether the person who is ill is seen as “difficult”, whether rest is something that has to be earned.

It often turns out that people with migraine do not know how to stop until an attack stops them. When they learn to stop earlier — including through relaxation techniques — they gain not only fewer attacks but a different relationship with their own body. I also work with English-speaking clients, in person in Ljubljana.

What to remember

• Migraine is a neurological disease, not a psychosomatic symptom. Diagnosis and treatment are led by a doctor.
• Relaxation training, biofeedback and cognitive behavioural approaches have good research evidence for migraine prevention.
• The best-researched is progressive muscle relaxation; mindfulness mainly reduces disability and fear of pain.
• The techniques work through regular practice between attacks, not as a fix during an attack itself.
• An attack despite practice is not your fault — and “just relax” is not advice, but often a sign of the helplessness of those close to you.