Exercise for migraine is a topic that comes up frequently. Does exercise help migraine? Or does it cause exercise induced migraine symptoms? Is there a best exercise for migraine? How to avoid headache after exercise? Is working out with a migraine attack recommended? The answer to all of these questions is, it depends. Let’s delve in and explore this topic!
Exercise as migraine prevention treatment?
People with frequent, chronic or daily migraine attacks often have difficulty finding the energy to exercise. The more debilitating the migraine symptoms, the harder it is to even contemplate planned movement, especially if it feels like a trigger. There are studies that show increased movement of 30-45 minutes a day, at least 3 times a week, can help reduce the frequency of migraine attacks (1). According to the American Migraine Foundation, ’The President’s Council on Physical Fitness recommends a minimum of 150 minutes of exercise per week. This can be broken down into five sessions of 30 minutes. You also can meet this goal by doing ten minutes of continuous exercise for three times per day.’ (2)
One of the benefits of exercise is the release of endorphins which act as a sort of natural antidepressant and pain killer which generally leaves us feeling good. (3) While an antidepressant medication might work more quickly as a preventive, some people with migraine would like to (or have to) avoid medications. Adding exercise to a migraine treatment plan is a good option. This practice will take several weeks to help reduce the frequency and severity of migraine attacks. And researchers do acknowledge the limitation of not also studying the effects of exercise on those who have chronic migraine or even daily attacks. (3)
** While Migraine Strong writes about the latest in migraine treatments, this is not medical advice. We are patient educators and all information you read should be discussed with your doctor.
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Exercise as an acute treatment for migraine
Most of the studies available about treating an acute attack with vigorous exercise (like running) are case studies. Meaning one person was studied and found that running could abort an attack when exercise was started during the prodromal or aura stage. (4) This is one of those try it and see what happens situations. I have been able to reduce the severity of an attack when taking a walk at onset. Whether this was from the exertion or distraction, I don’t know. But I’m willing to give it a try more often to see how well it works for me.
Exercise induced migraine symptoms
Is exercise a trigger for most people with migraine? Or could they be ‘primary exertional headaches (PEH)? This is a relatively uncommon primary headache disorder which occurs particularly in hot weather or at high altitude, lasting within 48 hours brought on exclusively during or after strenuous physical exertion. PEH and migraine seem to be a common comorbidities in middle aged adults. (4)
The jury seems to still be out on this topic. Anecdotally, we have spoken to many people over the years who feel that exercise is a trigger for them. Some studies have found there to be little evidence of exercise induced migraine symptoms and attacks. (3)
Of the patients studied in a Dutch headache clinic, ‘those experiencing exercise-triggered migraine attacks, more frequently had neck pain as initial migraine symptom during normal life attacks.’ (5)
Whether we are part of the subset of the migraine community that deals with PEH or not, using our best judgment and tracking skills could help us come to our own individual conclusions. Some of us have exercise induced migraine symptoms, no matter what a study might or might not say. Challenging ourselves to see if exercise is really a trigger is a worthwhile endeavor. The benefits might outweigh the risks of an attack being triggered.
What is the best exercise for migraine?
The word exercise seems to connote HIIT classes, CrossFit or a couch to 5K program to name a few. These can be wonderful options for those who find vigorous exercise to be helpful in their migraine treatment plan. But they aren’t the only options. And I encourage you to not be discouraged if you aren’t ready to jump into these higher energy classes. What’s most important here is simply to move. Heavy weights, formal classes or gym memberships are not required.
As I mentioned up above, increased movement starts with getting up off the couch or out of bed to move about your home. This is a great way to start adding more movement to your day. Set a timer and walk around the house for 5 or 10 minutes at a time and gradually increase until you are at the 30 minutes daily, 5 days a week recommendation. There is no predetermined amount of time that you have to achieve this task. We are all so different and we need to be gentle with ourselves when trying to make this change. Take your time. And definitely don’t compare yourself to what others are able to do.
Tips for exercising with migraine and avoiding exercise induced migraine symptoms:
Start low and slow
Just like with medications, the start low and go slow (intensity and time) are keys to being successful with exercise for migraine. It’s hard to hold back when we decide to try something new. I know I like to jump right in with both feet! With exercise, that will often lead to sore muscles or head pain which can lead us to give up before we really even get started. If you haven’t done exercise for migraine in a long time, start with walking around the house, out in the yard or around the block and work up to a more dedicated type of exercise.
When I made the decision to add exercise to my routine back in 2015, I was still daily, chronic and intractable and had been for about 18 years. This was HARD, I’m not going to lie. My plan was to make an appointment with myself to get on the treadmill at the same time each day. I chose 9:00am because our kids were off at school by then. Often, I would have to stop to deal with nausea, but I would get back on and continue until I had finished my 30 minutes. I was walking at about 2 miles per hour in the beginning. Low and slow. It did end up being one of the strategies that helped me overcome 18 years of chronic, intractable migraine. I’m not suggesting that you adopt this type of plan, we all need to approach this as individuals. Just an example of how I adopted this strategy from a daily, intractable place.
Choose something you like to do
What will motivate you to stick with this planned exercise for migraine? A few years ago I tried to do a couch to 5K program. I loved the idea of working through something that was essentially all set up for me. Unfortunately, I had forgotten how much a HATE running. LOL Choosing something that ‘sounds good’ isn’t the same as choosing something that you actually enjoy. I found that walking the dog with my husband was an easy form of movement to stick with. Not only does the dog expect us to do it and reminds us each morning, but I also get to walk with one of my favorite people. Almost like an exercise date!
Other options that are inexpensive or free are YouTube videos that will help you to walk a certain distance while in your house, chair yoga for those who are unsteady on their feet, workouts that are done completely while standing and even guided weight training. Of course you can always find a class that appeals to you as well. Sometimes having the time commitment of being somewhere at a certain time will help us to stick with it. Or having a buddy (in person or online) who will commit to working out with you and being an accountability partner.
Hydrate
We know how much you hate to hear about hydration and migraine. Drinking more water will not cure migraine, but it can help to limit dehydration as a trigger for an attack. Having some water before and after exercise is super important. And if you are involved in a longer, high energy type of exercise or out in the heat, make sure to take breaks to hydrate in the middle of the workout.
Regulate blood glucose levels by snacking before exercise
We know that skipping meals can be a migraine trigger for some. A hangry head is nothing to trifle with when it comes to avoiding migraine attacks. If you fall into this category of triggers, the American Migraine Foundation recommends eating a snack containing some protein about 90 minutes before exercising for migraine. We are looking to regulate blood glucose with this technique. If you get cramping during your workout because of eating beforehand, reduce the size of your pre-workout snack. Depending on my day, I sometimes have a latte or some eggs before my walk. That works for my level of exercise, but everyone needs to play around with this a bit to find the right fit.
Stay cool while exercising
Depending on where you live, heat can be a real problem to manage while exercising. If you have significant heat and humidity, refer back to #3 about hydration. Also, we have found that using a Koldtec Ice Towel (get $10 off with link and code MIGRAINESTRONG10) can be super helpful in regulating body temp while outside in the heat. This is one of our favorite tools to use when the heat and humidity is just too much. The best part is that the engineered ice inside the towel doesn’t sweat and can be switched out with reserve strips that are left in the freezer. If you can manage it, working out in the early morning or after the sun goes down can also help to reduce the effects of heat.
Warm up and cool down with some stretches
I am guilty of skipping this step! Stretching before and after a workout can help to reduce the soreness that we sometimes feel after exercising. Stretching is also a good way to get the blood moving in the large muscle groups. The cool down helps to clear out any lactic acid that builds up during the workout and reduces soreness. (6)
Medication and exercise
Speak to your doctor to see if you can take medications that affect your blood pressure before you exercise. If you are definitely triggered by an activity you can’t avoid, talk to your doctor about premedicating with your acute medication.
When my son was younger, he was always triggered by any exercise that involved bouncing/jumping. With doctor’s advice, we would premedicate him with ibuprofen and caffeine before the activity to help avoid the attack. This worked well because it wasn’t an every day occurrence. If you or your child participate in regular sporting activities which trigger attacks, talk to your doctor about options to help.
Is there a best exercise for vestibular migraine vs migraine without vestibular symptoms?
When we experience dizziness, it’s most important to find an exercise that you feel safe doing. If something you try is making you dizzy enough to fall, put that one on a ‘try later’ list.
We always recommend Madison Oak, DPT, an expert in vestibular physical therapy. She has a lot of amazing information on her Instagram account @thevertigodoctor. You can also read her excellent article on tips to overcome dizziness which is incredibly informative.
Some exercises that are preferred for our vestibular migraine members are: restorative yoga, swimming, using a balance pad while standing on one foot and passing a ball around the body, walking and cycling on a stationary bike.
For those with migraine without vestibular symptoms, many of the same forms of exercise are preferred. Walking, hiking, cycling, swimming, in person classes and those online. It really comes down to what you are most comfortable doing and working your way up to the recommended levels. Emily Cordes of @movementwithmigraine can be found on Instagram for all kinds of great tips for exercising with migraine.
How to manage migraine attacks that are triggered by exercise
If you are infrequently performing a physical task that you know will trigger an attack, it is possible to premedicate prior to the activity. However, this doesn’t work if you are regularly triggered by exercise. The are common suggestions for activity that triggers you daily. They include choosing something else, mitigate symptoms when possible through management (drink water, sunglasses for light sensitivity, manage blood glucose with a snack etc.) or start at a lower intensity that doesn’t trigger you and then work your way up. If you used to love running, but it is a triggering activity for you, try walking briskly to see if you can tolerate that intensity level. For me, keeping my heart rate under 135-140 beats per minute is helpful in reducing exercise induced migraine symptoms. Maybe you have a heart rate threshold to discover.
It is also a good idea to discuss exercise induced migraine symptoms with your headache specialist or primary doctor. Preventive medication ‘is recommended if headache is present more than 8 days per month, disability is present despite acute medication, headache is present more than three days per month when acute medication is not effective”. (1)
We would love to hear from you about how exercise affects you and your migraine disease. Please drop a comment below! Or come discuss it with the Migraine Strong Community in our private facebook group.
References:
1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6734345/
2. https://americanmigrainefoundation.org/resource-library/effects-of-exercise-headache-migraine/
3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4813301/
4. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6134860/
5. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3880028/
6. https://www.medicalnewstoday.com/articles/326521#prevention
