Living With Migraines
Anyone who has googled, “How to stop migraines from happening” has probably read that exercise is good for migraine prevention.
It makes sense: Research shows that exercise is a great way to reduce stress hormones and stimulate endorphin production. Unfortunately, it can also be migraine triggers—meaning the same movement meant to make you feel better can actually induce head pain.
The idea of doing anything that potentially increases the risk of headaches is unnerving for migraine sufferers, to say the least. But throwing in the towel on fitness all together isn’t the solution. Heart-pumping physical activity is essential for good health, and the American Heart Association recommends 150 minutes of moderate aerobic activity or 75 minutes of vigorous aerobic activity a week (or a combination of the two).
To help you better understand the relationship between migraines and exercise, and how to avoid exercise-related headaches without compromising your well-being, we talked to Dr. Philip Bain, Cove advisor and migraine expert, to answer some of your most pressing questions.
Unfortunately, yes. While there’s a lot of research suggesting a fitness routine can help mitigate migraines (one study even found that regular exercise is just as effective in reducing the rate of migraines as medication!), some people do get headaches during or after strenuous exercise. According to Dr. Bain, some of the most common triggers include high-intensity activities such as rowing, running, playing tennis, swimming, and weight-lifting.
Well, it depends. There are two main types of headaches that are triggered during or after exercise, Dr. Bain explains. The first, primary exertional headaches (also called benign exertional headaches), have no obvious cause, though doctors believe physical activity can dilate blood vessels in the brain, translating to pain.
Another possibility is that elevated blood pressure due to strenuous exercise can cause a headache or migraine. While exact reasoning behind primary exercise headaches is unclear, the good news is that these headaches, though painful, are relatively harmless.
As Dr. Bain mentioned earlier, more strenuous and high-intensity activities like rowing, running, playing tennis, swimming and weight lifting are prone to triggering headaches. However, a recent study found that high-intensity interval training, or HITT, is effective in reducing migraines in addition to moderate continuous exercise.
“My sense is that low to moderate intensity workouts do not precipitate headaches as much as high-intensity workouts, though the study seems to contradict this,” Dr. Bain says.
One reason behind Dr. Bain’s prediction include the fact that HIIT is associated with more significant increases in blood pressure and heart rate—two factors may contribute to head pain. Despite ambiguity on the matter, as with all triggers, the exercise that incites a migraine in one person may not trigger any pain in another. Therefore, it’s best to determine what fitness regime works best for you, personally.
Certain triggers can increase your risk of migraines, so it pays to be aware of them. Working out in extreme conditions—like very hot weather or at high altitudes—can increase your likelihood of getting a migraine, while dehydration and bad fueling are also risk factors.
Some experts believe those who already suffer from migraine headaches or have a close family member with a history of migraines are also at a higher risk for exercise-related headaches.
If you’ve been experiencing headaches after or during moderate or strenuous exercise, taking a medication like naproxen or indomethacin (both NSAIDs, or nonsteroidal anti-inflammatory drugs) before working up a sweat could help keep pain at bay. However, Dr. Bain recommends only going this route after the possibility of secondary exertion headaches has been ruled out.
A category of medication called beta blockers can also help reduce your chances of experiencing a primary exertion headache. Additionally, if planning activity at altitude (such as hiking), Dr. Bain recommends asking your doctor to prescribe a diuretic (a water pill) that can lower your chances of getting a headache.
Surprisingly, no. If you don’t already have a headache, music should have no effect on triggering a migraine.
While primary exertion headaches are frustrating, they’re totally normal and nothing to seriously worry about. A second type of headache associated with physical activity called a secondary exertional headache, however, is a more serious issue, Dr. Bain warns.
Secondary exertion headaches are typically indicative of a larger problem, like meningitis or a brain tumor, Dr. Bain explains. For example, exercise increases your blood pressure and heart rate, making a blood vessel rupture more likely if you’re already in a compromised health condition. In rare cases, exercise-related headaches can also be an unusual sign of heart artery blockages. While rare, these headaches require immediate medical attention.
It can be tricky to differentiate between a primary exertion headache that is essentially innocuous and a secondary exertion headache that can be potentially life-threatening, so Dr. Bain broke down the symptoms of each.
Primary exercise headaches often have a throbbing sensation, are felt on both sides of the head, occur during or after strenuous exercise, and generally, last anywhere from five minutes to 48 hours.
Secondary exercise headaches can mimic symptoms of primary exercise-related headaches, but often include more drastic symptoms like nausea and vomiting, loss of consciousness, double vision, and severe neck stiffness. They can also last multiple days—tipping you off that something might be seriously wrong.
If you suspect you have a secondary exertion headache, Dr. Bain recommends seeking medical attention ASAP.
Unfortunately, some pain is inevitable for those who experience exercise-related headaches. However, it’s important to recognize when your condition may pose a serious threat to your health, and when to call a doctor.
If your headaches are new or different than usual, or if they last longer than an hour or two, Dr. Bain recommends talking to a doctor, especially if you’re over 40 years old. More immediate medical attention is required in the case of symptoms like nausea and/or vomiting, and unusual neurological symptoms like double vision, a droopy face, slurred speech, or weakness of an arm or a leg.
“If your headache comes on suddenly, like a clap of thunder, you should go to the emergency room quickly,” Dr. Bain says. “If you have a seizure around the time of your headache, you should seek evaluation as soon as possible.”
Due to the overlap between both primary and secondary exercise headaches, it’s never a bad idea to seek professional advice, Dr. Bain says.
Your doctor can facilitate a scan of your brain tissue via computed tomography (CT) scan or magnetic resonance imaging (MRI), or administer another test called a magnetic resonance angiogram (MRA) that specifically looks at your blood vessels to see if your arteries have torn.
It’s impossible to completely avoid all types of fitness that spark migraine pain, as there’s no real way to predict which exercise routines will negatively affect you. Yet there are precautionary measures you can take to enhance your well-being through exercise without the threat of a headache.
“Staying well hydrated, making sure that you have eaten before exercising—especially food that has a lot of protein in it—and taking it easy the first few days that you are at a higher altitude can lessen the chance that you will get a headache,” Dr. Bain says. “Also, warming up and easing into your exercise routine can help.”
The American Migraine Foundation recommends awalking for five minutes at a leisurely pace before jogging or running, stretching, and gently lifting lighter weights before doing more intense resistance training.
Individuals can take other preventative measures, like taking their workout indoors during extreme conditions like hot weather, and properly eating and hydrating post workout.
If you notice headaches consistently with one type of exercise, Dr. Bain recommends switching to another type of workout. For example, if you’ve been exerting bursts of energy with a strenuous exercise regime like CrossFit, it might be time to try a low-impact workout, like swimming or yoga, or aerobic exercise like running or cycling.
As you know, exercise boasts countless benefits that are essential to our well-being. Physical activity releases the body’s natural feel-good hormones (endorphins), minimizes the frequency and intensity of pain, reduces stress, and in many cases, improves sleep. (We don’t have to tell you twice that lowering your stress levels and getting more sleep also reduces migraine frequency.)
It’s possible that one or two specific types of exercise are precipitating your headaches. So if you do experience exertion headaches, Dr. Bain encourages individuals to use trial-and-error—and the guidance of a medical professional!—to find the workout that works for you.
The information provided in this article is not a substitute for professional medical advice, diagnosis, or treatment. You should not rely upon the content provided in this article for specific medical advice. If you have any questions or concerns, please talk to your doctor.
Naproxen is an oral medications used to ease pain, swelling, and fever. This drug may raise the chance of heart and blood vessel side effects like heart attack and stroke. If these happen, they can be deadly. The risk of these side effects may be greater if you have heart disease or risks for heart disease. However, the risk may also be raised in people who do not have heart disease or risks for heart disease. The risk of these health problems can happen as soon as the first weeks of using this drug and may be greater with higher doses or with long-term use. This drug may raise the chance of very bad and sometimes deadly stomach or bowel side effects like ulcers or bleeding. The risk is greater in older people. The risk is also greater in people who have had stomach or bowel ulcers or bleeding before. These problems may occur without warning signs. If you are pregnant or you get pregnant while taking this drug, call your doctor right away. Tell your doctor if you are breast-feeding. You will need to talk about any risks to your baby. You can read more about naproxen’s side effects, warnings, and precautions here. Full prescribing information for naproxen is available here. You are encouraged to report negative side effects of prescription drugs to the FDA. Visit MedWatch: https://www.fda.gov/Safety/MedWatch/default.htm or call 1-800-FDA-1088.
Photo by Jacob Postuma on Unsplash.