Exercise and Migraines: What Helps and Hurts

You probably know that regular aerobic exercise, the kind that raises your heart rate and uses large muscle groups, is good for your health overall. It may also help if you have migraines.

Several studies have shown that regular aerobic exercise can help make migraines come less often and make them less severe, says Nada Hindiyeh, MD, a clinical assistant professor of neurology. She specializes in headache medicine at Stanford University.

Still, some people say exercise can bring on familiar migraine symptoms. There’s not a lot of research on that, but some of the findings point to sudden bursts of intense activity, or in hot weather or other stressful conditions. And those might be “exertional” headaches, rather than migraines, and the pain may go away as your body gets used to working out, some researchers say.

A key benefit of a regular exercise routine of any type is that it relieves stress, which is often a trigger for migraines. Releasing this tension through activity may cut down on the number of migraines you get, says Urvish K. Patel, MD, a research associate in the Department of Neurology at the Icahn School of Medicine at Mount Sinai in New York City.

A Smart Strategy

You may want to stay away from exercise because you’re worried it can cause an attack. But the benefits are too important for you to avoid activity. Here’s how you can help prevent a workout from causing a migraine.

Hydrate. You may trigger a migraine if you don’t have enough fluids in your system. “You want to stay hydrated before, during, and after exercise,” Hindiyeh says. The color of your pee can tell you if you get the right amount of water. A darker color is a sign you need to drink more. You’ll know you’re hydrated if it’s light yellow or clear.

Fuel up. Starches and sugars from the foods you eat break down into glucose, also called blood sugar. That is what gives you energy. Exercise can make your blood sugar level go down.

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“There are many studies that show the correlation between lower blood sugar level and triggering a migraine,” Patel says.

You can help prevent this and make sure you have enough fuel beforehand by eating 1-4 hours before your workout. You should opt for complex carbohydrates and protein, Hindiyeh says. Nuts or a protein bar are both good options.

Start and end slowly. Take the time to warm up. Then raise the intensity gradually. Sudden or hard activity can lead to a migraine or exercise headache.

“Doing some whole-body movements at a very low, comfortable pace can serve as that warmup. For example, if you’re going to go for a jog or a run, maybe you walk for about 4 or 5 minutes. Then, gradually start to jog at a very slow pace for another several minutes. Then, after about that 5- to 10-minute period of walking and slowly jogging, you get to your exercise pace,” says Cedric X. Bryant, PhD, president and chief science officer of the American Council on Exercise. “With strength training, you want to do some whole-body aerobic activity, then perform a warmup set, and then your exercise training set.”

Once you’re done with exercise, take about 5 minutes to cool down. “Do some walking and gentle stretching to lower your heart rate and blood pressure to help reduce the odds of having a post-workout migraine episode,” Bryant says.

Be careful of your environment. Workouts in the heat can make you dehydrated and cause a headache. High heat alone can make you have a migraine. Head pain can also happen at higher altitudes.

Take notes. Use a journal to document things like sleep, meals, and hydration to figure out what helps you stay active without causing a migraine.

Get Moving

Whether you’re starting a routine or getting back on one, use a low and slow approach. “Start with 5 or 10 minutes of activity. See how your body adapts and tolerates it,” Bryant says.

You may also want to talk to your doctor before you start an exercise plan if you take medication to treat or prevent your migraines. “Preventive medications can alter blood pressure and heart rate,” Hindiyeh says.

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If you know that going above a certain threshold triggers a migraine for you, Hindiyeh suggests you ease your way past it. For example, if one of her patients says they can’t run longer than 20 minutes, she says, “I’ll have them do a significant warmup and cool down. Then the part where their heart rate is elevated and they’re actually running, we may just start with 5 minutes a day doing that, and then every week increase it by a few minutes until they can tolerate past the 20-minute point that was their maximum before.”

When it comes to the best exercises for people with migraines, “lower-impact exercise -- where you’re really not jostling the body too much -- tends to be better tolerated,” Bryant says. If strength training is part of your plan, stick to proper form to avoid straining your neck, back, and other areas. At the very top of Bryant’s list? Find an activity that you enjoy. That way, you’ll want to do it and stick to it.

WebMD Feature Reviewed by Brunilda Nazario, MD on November 09, 2020

Sources

SOURCES:

Nada Hindiyeh, MD, clinical assistant professor of neurology specializing in headache medicine, Stanford University.

Urvish K. Patel, MD, research associate, Department of Neurology, Icahn School of Medicine at Mount Sinai, New York City.

Cedric X. Bryant, PhD, president and chief science officer, American Council on Exercise, San Diego, CA.

Mayo Clinic: “Aerobic exercise: Top 10 reasons to get physical,” “Exercise and stress: Get moving to manage stress,” “Migraine,” “Dehydration,” “Exercise headaches.”

SleepFoundation.org: “How Exercise Impacts Sleep Quality.”

Cleveland Clinic: “Migraine Headaches,” “Carbohydrates.”

CDC: “Benefits of Physical Activity.”

American Migraine Foundation: “Top 10 Migraine Triggers and How to Deal with Them.”

Kaiser Permanente: “10 warning signs of dehydration. And staying hydrated while wearing a mask.”

American Diabetes Association: “Blood Sugar and Exercise.”

The Migraine Trust: “Hypoglycaemia.”

National Health Service (U.K.): “Causes -- Migraine.”

Eat Right: “Timing Your Pre- and Post-Workout Nutrition,” “Exercise Safely in Hot Weather.”

Migraine Canada: “Can travelling to a higher altitude trigger migraine attacks?”

The Journal of Headache Pain: “The association between migraine and physical exercise.”

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