Available information on exercise and migraines can appear to be conflicting and can lead to confusion about the role that physical activity plays in the onset of symptoms for migraine sufferers. Fear of triggering a migraine from engaging in exercise has led to many sufferers avoiding physical activity, and consequently, missing out on its associated health benefits. And, indeed, for a minority of sufferers, exercise does bring on a migraine attack. This type of migraine is known as an "exertional migraine/headache" and usually occurs with the initiation of sudden, intense exercise.

In general, however, exercise can be beneficial in the management of migraine symptoms. The release of endorphins (the body's natural painkillers) from exercise can reduce the severity and frequency of migraine attacks. Exercise also helps to manage stress, which can be a trigger for some migraine sufferers. A study published in the September 2008 issue of Headache, found that subjects who underwent an aerobic training program (indoor cycling) 3 days/week for 12 weeks were able to significantly improve their maximal oxygen uptake (a measure of aerobic fitness) without a concomitant worsening of migraine symptoms. In fact, participants experienced significant decreases in the number and severity of migraine attacks, the length (in days) of a migraine, as well as a significant reduction in the amount of headache medication needed.

It is thought that those individuals who experience migraines may have a nervous system that is more "vulnerable" or sensitive to abrupt changes either within the body or in the surrounding environment. Because of this, care must be taken in the approach to exercise.

Exercise Tips for Migraine Sufferers:

• Engage in a prolonged warm-up of 15 minutes
• Avoid abrupt increases in intensity
• Participate in moderate-intensity activities, avoid strenuous; vigorous exercise
• Choose low impact workouts such as cycling
• Exercise on a regular basis to maintain internal physiology
• Exercise in the morning or early afternoon; avoid evening exercise which may interfere with sleep patterns, and subsequently, trigger a migraine
• Stay adequately hydrated
• Do not skip meals, especially prior to exercise, which could lead to low blood sugar levels which can precipitate a migraine
• Avoid exercising in environmental extremes (e.g., high altitude and excessively cold or hot/humid settings)

In general, engaging in a regular exercise program is safe for migraine sufferers. If you experience frequent migraines, it is suggested that you keep a "headache" journal in which you record precipitating factors, associated symptoms, and methods of relief so that you may discuss your situation with your health care professional. Anytime that you experience a sudden onset of head pain with exertion, a worsening of symptoms, or new symptoms associated with an attack, consult your physician. Likewise, individuals who suffer from exercise-induced or exertional migraines need to discuss their personal exercise plan with their physician.

Note: Before beginning an exercise program or increasing the intensity level of a current routine, a physician's approval should be obtained, especially for older adults and those at risk for or who currently have chronic health conditions.

Resources:

"Exercise Can be a Pain in the -- Head," Sorgen, C.

Guide to Managing Migraines - Migraine Overview

Exercise and Migraine Fact Sheet

Headache 2009;49:563-570, "A Study to Evaluate the Feasibility of an Aerobic Exercise Program in Patients with Migraine," Varkey, E., et al