Here we look at exercise and its effects on the management of migraine
Did you know? Although some patients’ experience is that exercise triggers a migraine attack, increasing data from the research suggests that moderate regular exercise can be an effective way to reduce the frequency of attacks.
(Lockett DM and Campbell J F. The effects of aerobic exercise on migraine. Headache 1992; 32(1): 50-4.)
The therapeutic effects of exercise are well documented. Regular physical activity will improve your overall health and reduce the risk of developing diseases like high blood pressure, diabetes, depression and obesity. Benefits also include reducing stress, reducing cholesterol levels, improving the quality of sleep patterns and producing a feeling of wellbeing.
If you are prone to migraine you may have found that strenuous exercise can provoke an attack. This may have led you to avoid exercise as you have identified it as a trigger. If this is the case then you are missing out on the benefits that exercise can bring to your overall wellbeing.
The research evidence
Headache researchers are now finding evidence that suggests that moderate exercise can reduce the frequency and severity of migraine attacks in some people. They have found that regular exercise can be effective in preventing migraine.
Recent studies have shown that exercise changes the levels of a wide range of body chemicals. Exercise stimulates your body to release natural pain controlling chemicals called endorphins and natural anti-depressant chemicals called enkephalins. This could mean that embarking on a well planned exercise program could enable you to reduce your drug intake, particularly drugs taken daily to prevent migraine (prophylactic medicine).
Exercise as a trigger
You may well feel that all this talk about exercise and its benefits are wasted on you as you are one of those people who find that exercise gives you migraine.
If you have found that exercise has triggered an attack it could be due to the following reasons:
- You start exercising suddenly with no prior planning which means that your body has a sudden demand for oxygen.
- You have not eaten properly before exercising so that your blood sugar level falls as you become very hungry.
- You have not taken sufficient fluids before and during exercising so your body becomes dehydrated.
- You start a strenuous ‘keep fit‘ programme at the same time as ‘healthy’ new diet . If not managed properly, these changes to your lifestyle can act as an additional trigger.
- You undertake strenuous infrequent exercise which causes stiff, aching muscles which can then act as a trigger.
- You experience a minor blow to your head during sport, for example you may be hit by or head a football. This can trigger an instantaneous migraine aura.
- A headache can be brought on by and occur only during or after strenuous exercise. This is called exercise headache (previously referred to as exertional headache) and may last from 5 minutes to 48 hours after the exercise. It tends to occur in hot weather or at high altitude.
Choosing the right type of exercise
Previous studies have suggested that mild regular aerobic exercise offers the most benefits to those with migraine. Remember, it is important to choose an exercise activity that you enjoy. It could be:
- Brisk walking.
At the start of your new exercise regimen it is best to avoid activities which are too strenuous or competitive until you are fitter, but moderate intensity (equivalent to brisk walking) is fine.
You should try to exercise for at least 30 minutes of moderate intensity, 3 times a week. Give yourself at least 6 weeks to see if there is any beneficial effect.
You may find your local gym offers short introductory classes and can also give advice about what exercise is right for you and the types of warm up exercises you could try.
You don’t need to join an expensive private gym as most places have local leisure centres with discounts for people on low incomes, students and people over 60.
Keeping a diary
It is worth keeping a migraine and exercise diary, recording both your migraine attacks and exercise you have undertaken. This will give you an idea of the affect aerobic exercise has had on your migraine and any steps to take to help ensure that exercise is not a trigger for you. It will also act as a record of whether you are decreasing or increasing migraine medication. Details to record include the date and time of your exercise, how you prepared, and the type and duration of exercise. Further information on keeping a migraine diary can be found here.
Preparing to exercise
Preparing for exercise is as important as the exercise itself.
If you have any concerns about your health, or if you have not exercised for a long period of time you should inform your GP who can give you a basic health check prior to starting your program.
You should begin your exercise program gradually, building up the momentum over several weeks. It is best to do short, frequent sessions.
You should always:
- Eat – at least an hour and a half before exercising, leaving time for your body to digest the food – this will avoid a low blood sugar level which can trigger a migraine. You could also take glucose sweets to maintain blood glucose levels prior to exercising.
- Drink – fluids before, during and after exercise. You not only lose fluid through sweating but also as water vapor in the air that you breathe out. If fluid is not replaced quickly you will become dehydrated – and this is a major migraine trigger. You should always have a bottle of water available. You may also find isotonic drinks help. Isotonic drinks are widely available in health shops. They are drinks in which the mineral salts and glucose are equal to those in the blood. Therefore they will help keep your body in balance.
- Warm up – this is really important and should be done before and after exercise.
You should never stop or start your session suddenly. Stretching exercises for at least 5 – 10 minutes at the beginning and end of the session will prevent muscle tension which may then act as trigger.
- Wear the correct clothing – the right footwear is also important so it is worth a visit to a sports shop for some basic trainers. Other clothing depends on the sport you are doing, but the main thing is that you feel comfortable in the clothing you wear.
- Remember – if at any stage during your exercise program you feel uncomfortable – stop. There is always another day. Note it in your diary so you can see the triggers.
- Plan ahead – set a regular routine so that you can ensure that exercise is built in to your lifestyle along with regular meals and regular bedtimes. In this way you will also be able to monitor the affect it is having on your migraines.
I have headaches when I exercise. What should I do?
If you get a headache when you exercise, or shortly after exercise, you should see your GP. It would be useful to bring a headache diary to the appointment to describe your headache. Your GP may refer you to a neurologist especially if:
- You don’t normally experience headaches or have migraine and develop or new headaches that start during or directly after exercise.
- You start experiencing headaches or migraine attacks when you don’t normally experience headaches or migraine attacks during or after exercise.
- You experience a new and different headache, not just different in severity or intensity, from your usual headache or migraine during or after exercise.
- As well as experiencing headache during or after exercise, you also develop a headache with coughing or sexual activity.
- You also experience chest discomfort or shortness of breath in association with headaches that begin during or after exercise.
You may need further investigations. You may need a heart tracing or electrocardiogram (ECG). You may be referred for brain imaging such as an MRI, which may include injection of additional dye known as contrast.
If you do not experience the above but are concerned about your headaches or they impact your day-to-day life, you should see your GP.
Always consult your doctor before taking or changing any treatments. The information should not be a substitute for your doctor’s advice.