FAQ Episode 19: Exercise and Migraine: preventive, provocative or both? Part II
FAQ Episode 19: Exercise and Migraine: preventive, provocative or both? Part II
FAQs for Natural Migraine Relief
I hope that you have had a chance to review last week’s FAQ, which was Episode 17 Exercise and Migraine Part I. We are in the middle of reviewing six root cause factors that affect how exercise can either prevent or promote migraine headaches. Last week we discussed:
1. Exercise, blood flow and the role of nitric oxide.
2. Exercise and the neurochemistry of migraine
3. Exercise and the role of rest and sleep
This week, in Part II we will consider the impact of three other potential root cause contributors that can modulate the role of exercise on migraines:
4. Exercise and metabolic factors in migraine
5. Exercise and female hormone balance
6. Exercise and your fitness level in migraine expression
As we did in Part I, I’ll include action plan ideas with each of them and then we’ll summarize them at the end of the article. Please keep in mind that we could easily fill each section with 15-20 pages of discussion and documentation. For the sake of brevity I will stay as focused, brief and as to the point as possible.
Let’s begin this episode, #18 Part II with:
4. Exercise and metabolic factors in migraine
By its nature, exercise puts a demand on the body to achieve a performance workload. Lets take a look at how this workload affects three factors that might affect migraine frequency or intensity.
a) Oxygen and lactic acid
Exercise can be described as either aerobic (with oxygen) or anaerobic (without oxygen). Exercise that exceeds our ability to bring the cell oxygen on demand can result in the production of lactic acid. Anaerobic exercise results in the an excess of the byproduct lactate. Magnetic resonance spectroscopy has shown higher migraine frequency is related to increased brain lactate level1 The bottom line here is that its best to stay within your aerobic range as you gradually extend your fitness capacity over time. The easiest definition of this it may be best to avoid getting too far into or staying in the “feeling acutely short of breath” zone with your exercise.
b) Hypoglycemia
While we would like exercise to melt fat directly and preferentially, most of the time our initial energy source in exercise is glucose. Since the preferential energy source in the brain is also glucose, low sugar levels often manifest there first. Fasting, skipping a meal, or having had a high carb meal 2-4 hours before an exercise session can drop your glucose level and may promote a migraine headache. Avoid the carb swing events noted above, and have a quick glucose fix of ~100 calories (sports drink, energy bar, etc.) available, especially if you are experiencing typical symptoms of hypoglycemia, such as irritability, low grade nausea, a feeling of ‘brain fog’ or lightheadedness, yawning or increased sweating as you go through your exercise session.
c) Hydration
Multiple studies suggest that dehydration can trigger a migraine. And if you are in a cycle of headache and nausea, the resulting dehydration can worsen the migraine. In dehydration, the brain meninges can be stressed, and the resulting signaling can overlap with the cortical spreading depression event that is a key part of the migraine process. If you are already low grade dehydrated before exercise, even a moderately intensive exercise session could contribute to a headache. It can be helpful to pre-hydrate with 10-16 oz of water before exercise, and then sipping another 10-16 oz through and after your session to stay hydrated and limit any fluid deficit contribution to a migraine event.
5. Exercise and female hormone balance
There are two considerations here:
a) where you are in your monthly cycle. An estrogen/progesterone imbalance can be a promoting factor in migraine, especially if the progesterone component is too low, allowing the estrogen to have ‘too dominant’ an effect. This is usually most prominent in the latter 1/3 of the cycle, in the 5-10 days prior to the next mendtrual flow. If you have PMS symptoms* in this phase you may be more prone to month end migraines, including those precipitated by exercise. If you note this connection, consider using additional daily topical progesterone on the at risk days. A physician can prescribe gelcaps of 50 mg or 100 mg, or a topical cream in the 20-100 mg range.
You can get USP pure progesterone over the counter (OTC), although you may need 2-4 cc per day of 15 mg/gram cream to get enough to meet your needs. This can be more expensive than getting it in a prescribed form, although the OTC form can allow you to begin a process of trial and elimination of progesterone for PMS and exercise induced headaches on your own. You may want to consult a practitioner who understands the use of bioidentical hormone support therapy. If you have a local compounding pharmacy available, the staff there will know who in your area knows what they are doing in this area of expertise.
* commonly reported PMS symptoms: fluid retention, breast fullness or tenderness, increased appetite, abdominal bloating, mood swings and irritability, fatigue, problems sleeping and headaches, notably migraines.
b) where you are in your ovaries’ life cycle. If you are in perimenopause, you are most likely having an ongoing year to year decline in the previous baseline of all three major hormones in play: estrogen, progesterone and female appropriate testosterone. This can cause weight gain and blunt your response to exercise. Working out harder and getting less results is not usually a formula for sticking with the program. If you find that you are not only getting less out of your workouts, but are also finding that exercise is provoking your migraines you may benefit from daily support hormone therapy, even if you are still having periods. See the advice in 5 a) above about seeing someone knowledgeable in prescibing individualized bioidentical hormone support therapy.
6. Exercise and Fitness level in migraine expression
Where you are in the ‘getting fit’ spectrum may play a role in how exercise may provoke, or prevent a migraine. It has been shown that as one progresses to a higher level of fitness, exercise can actually reduce the incidence of migraine. In the process of ‘getting fit’ however, there are two common exercise related triggers for migraine to avoid:
-insufficient warm up: some degree of progessive aerobic warm up allows a graduated increase of blood flow and blood pressure response to exercise. Those who want to go straight to the weights might want to first go to 5-10 minutes of aerobic warm up (treadmill, elliptical, etc.) that raises the heart rate and blood pressure before going to your usual strength training routine.
-high intensity exercise: as we discussed previously, pushing too hard against the boundaries of our fitness level can allow deficits in oxygen, glucose or hydration to elicit our migraine weak links. Apart from migraine, you could and probably should press your limits on intensity from time to time. However, it can be very hard to know exactly when you cross the high intensity line that could potentiate a migraine…until you cross it and pay the price. I would encourage you to make up in frequency and consistency of exercise what you might have to surrender in terms of intensity.
Action Plan:
Summary of Part II: Factors to consider about exercise and migraine:
warm up before more intense exercise. If you do weights first, consider 5-10 minutes of aerobic warm up to gently raise the heart rate and blood pressure before going to your usual strength training routine.
stay within your aerobic limits as you gradually extend your fitness capacity over time.
it can be difficult to know exactly when you cross the high intensity line that could potentiate a migraine. It may be wise to make up in frequency and consistency of exercise what you might have to surrender in terms of intensity.
be extra aware that fasting, skipping a meal, or having had a high carb meal 2-4 hours before an exercise session can drop your glucose level and may promote a migraine headache.
have a quick glucose fix of ~100 calories (sports drink, energy bar, etc.) available, especially if you are experiencing typical symptoms of hypoglycemia.
avoid dehydration by pre-hydrating with 10-16 oz of water before exercise, and then sipping another 10-16 oz through and after your session to stay hydrated and limit any fluid deficit contribution to a migraine event.
if you have monthly, cyclic PMS symptoms and are prone to end of month migraines, including those precipitated by exercise, consider using additional daily topical progesterone on those at risk days.
if you are in perimenopause, the gradual drop of all three major hormones in play: estrogen, progesterone and female appropriate testosterone can cause weight gain and blunt your response to exercise. This situation can also exaggerate exercise provoked migraines. Seeing someone knowledgable in prescibing individualized bioidentical hormone support therapy can make a world of difference for MANY of the symptoms seen in this time frame, incluging migraine and also exercise provoked headaches. If you have a local compounding pharmacy available, the staff will know who in your area knows what they are doing in this area of expertise.
If you did not read Episode 17 Part I of this series, I would go back and review that so that your cumulative Exercise related Migraine Action Plan can be as complete as possible.
If you would like to understand the broader range of root cause factors that drive your migraines and then individualize your therapy options, you may want to take my comprehensive Natural Migraine Relief for Women course and its unique Migraine Action Plan system. See www.naturalmigrainerelief.online for more details.
Watanabe H, Kuwabara T, Ohkubo M, Tsuji S, Yuasa T (1996) Elevation of cerebral lactate detected by localized 1H-magnetic resonance spectroscopy in migraine during the interictal period. Neurology 47:1093–1095