FAQ Episode 79: Your Best Workout despite Migraine

Frequently Asked Questions about Natural Migraine Relief

Preview

• You need to improve your physical conditioning, but having a headache or the fear of getting one can be a major obstacle to regular exercise.

• Exercise can make migraines better, or worse. The focus of this article is the discussion of 12 migraine → exercise related factors that may apply to you.

• We will finish with specific action steps to consider as you develop your own best exercise prescription.

If you’ve done much reading about migraine, you’ve no doubt seen a mix of opinions about the role of exercise in causing or preventing migraines. Clearing this confusion requirers understanding which provocative root cause factors provoke your version of migraine, and how exercise can either calm or aggravate each of the root cause factors that apply to you. You may want to reference my more in depth FAQ Episode 17 & FAQ Episode 19 on Exercise and Migraine: preventive, provocative or both? Parts I & II.

Its rare, if not unheard of, to need to address only one of the several factors we will discuss, each of which can promote exercise induced migraines. The more of these factors you can address, the better you’ll do. Both on any given day, and specifically for days where you’ve planned a focused exercise session.

Twelve exercise related factors to consider when you have migraines:

1. State and rate of conditioning

Here’s a pretty safe prediction: if you have migraines, you’re probably “out of shape” compared to where you would like to be, and what would be a healthy best for you. If you have suffered migraine with exercise in the past, its best to ‘start low and go slow’ as you return to or work at progression in your regular exercise. Make small but consistent steps forward. Take a short walk. Use small hand weights. Consider limiting your peak heart rate to only ~65% of your maximum the first few months. (for this you can use the: 220 minus your age = max HR formula. So if you’re 40, 65% of 220-40 would equal a maximal heart rate of ~120 beats per minute.) Migrainuers who are restoring fitness should start easy and then taper up.

2. Energetics for both brain and body

Optimal response to exertion, as well as your recovery between workouts requires requires efficient cellular energy production. One of the root cause problems that allow migraine expression is a suboptimal production of cellular energy, both at rest and also under situational stress. This can be due to genetic shortfalls as well as reduced dietary intake or lack of absorption. Its an extensive and important topic, and one I address in my Natural Migraine Relief course (see ‘Action Considerations’ below.) I will also write an upcoming FAQ Episode to address this topic with a specific focus on maximizing cellular energy for exercise, general quality of life, and migraine management.

3. The role of cyclic hormones

As we discussed in FAQ Episode 76: What common element promotes PMS and provokes migraines?, hormone imbalances during the latter 1/3 of your cycle can reduce your reserves and make you more migraine prone at that time of the month. See the advice in Episode 76, and work on the other factors in this article to minimize the headache risk often seen for this phase in your cycle.

You may also produce more uterine prostoglandins near the onset of menses. If so, a post workout dose of a NSAID (ibuprofen 600 mg or naproxen 440 mg) may help reduce migraines or menstrual cramps in that day or two nearest to the onset of menstrual flow when they are related to excess prostoglandin levels.

4. Sleep

Sleep is where you replenish brain chemistry and repair the wear and tear of daily activities + exercise on the musculoskeletal system. If you plan to stay with and progress into an exercise program, deep restorative sleep is essential. Over the course of a week, consider adding 30-60 minutes of sleep time for each exercise session.

5. Overheating during exercise

A rapid change in core temperature can change blood flow patterns and promote a migraine. Ease into a workout with a warm up routine, and temper your intensity when in a warm exercise setting. Commonsense advice, but easy to ignore when you’re feeling fine! Monitor your migraine history to see if this factor has played a previously unrecognized role.

6. Hydration

Water provides the framework for efficient exercise by:

• acting as a solvent for biochemical reactions

• functioning as a reactant in many metabolic processes

• transporting of nutrients and waste products into and out of cells

• regulating body temperature.

Having sufficient water on board also helps the body burn fat. Studies show that drinking 17 ounces of water during and after an exercise session can increase the metabolic rate by 30% in both men and women. Even mild dehydration can slow down your 24-hour metabolic rate by 3%.

Plan to drink at least 15-20 oz before and during your exercise. It should be enough volume to require at least one bathroom break by the time you’re done (!)

7. Is there a “typical time of the day” for your migraines?

If you journal your migraine events, you may find that your headaches may have a more dominant time of the day to occur. 50% of migraineurs have a circadian rythym pattern as to when their headaches are more likely. Knowing if such a pattern applies to you would help to avoid exercising during the 2-4 hour time frame going into that time frame. So, for AM migraines, aim for an aftrnoon exercise session, and vice versa.

8. Recognize and dismiss peer pressure

This is especially true if you have workout buddies or are in a class exercise. While its tempting to let our peers dictate the exercise intensity, forget what other people are doing and listen to your body. Pace yourself, and when in doubt, underperform. You can always do more later or tomorrow! Slow but steady wins the race.

8. Exposure to glare and bright lights

You already know where you stand on this one. You may benefit from wearing glasses with an FL-41 tint or blue light-blocking lenses during exercise sessions, especially in a group class setting. The pounding rythym of music in these sessions can be provocative, as well. Use discernment in choosing a group exercise setting.

9. Use of alcohol

Even moderate use of alcohol can promote migraines. One version of this occurs within 30 minutes to 3 hours of drinking, although most of us don’t feel like exercising during this time frame! Another more insidious version doesn’t manifest itself for 10-12 hours. Known as a delayed alcohol-induced headache (DAIH), this version may not show up until the morning after you drink. This is due to downstream alcohol detox metabolites, secondary dehydration, and enhanced histamine formation (oh yeah, that’s also called a hangover. Even a small version can spill over hours later to promote a full-on migraine.) If you see that pattern, either drink less, or avoid scheduling a workout session for the next morning.

As a related issue, thiamine, also known as Vitamin B1, is a key nutrient in energy production, especially in the nervous system. A thiamine deficit has also been linked with migraines. Thiamine can be depleted or low with regular alcohol use, even at ‘social drinking levels’. If you have the DAIH as described above, or if you drink regularly, you may benefit from taking daily thiamine in the form of Benfotiamine, a more absorbable form of B1. Usual support dosages are in the range of 300-600 mg/day.

10. Mix and combine strength, flex and cardio

Although its probably true that you will make faster progress if you can place more focused intensity on a single system, this can also magnify migraine promoting factors. So rather than just a hard 3 mile run, or a chest and back only weight session, or a prolonged yoga only session, it may serve you better to combine a little of all three in a session: something cardio, something for strength and a warm up or warm down with some body weight only flexibility work.

11. Cerebral blood flow

For some migraineurs, an intense exercise session can result in an exaggeration of increased cerebral pressure and blood flow. For some this can be a promoting factor for a migraine, and in general, you should consider:

a) for cardio, staying within an aerobic threshold, meaning a heart rate no higher than 60-80% of your ‘predicted maximum’ (see #1, above.)

b) for strength training, using less weight but perhaps with a few added reps, with good form and a breathing technique where your long, easy breath out is during the exertion phase of the lift.

12. The CGRP factor

If you fall in the group where exercise precipitates or promotes your migraine, consider this: exercise increases the release of the calcitonin gene-related peptide (CGRP) that is known to provoke migraines. Around 1/3 of those with migraines find that exercise can be a precipitating factor. We don’t yet know if the two are related, but it is interesting to note that roughly 1/3 of those with migraine respond well to CGRP-blocking medications. It would be reasonable to consider that if your exercise leads to a headache, you may be a good candidate to try one of the newer drugs that block the CGRP pathway and allow you to engage exercise without headache pain. If this sounds like your story, check out this option with your primary care or neurology physician.

Taking CoQ10 can also limit CGRP impact, and I advise everyone with migraine to take 100-200 mg of CoQ10 daily, especially if you are using one of the CGRP blocking meds (see more details on this at FAQ Episode 40: Vitamin Deficiencies predict migraine risk and the first free portion of Lesson 6: Integrative Therapy for Migraines: Using the Migraine Action Plan to make this course work for you.)

Action Considerations:

-plan for a slow but steady progression in exercise. Transform your enthusiasm for quick results into the patience needed to develop long term consistency.

-paid subscribers should review the Natural Migraine Relief course Lessons 9 & 10 on Cellular Energy deficits as a Migraine Root cause: Part I Basic Concepts & Part II Practical details for implementing Therapy. Also look for my next FAQ #80 on “Maximizing brain energetics for migraine managment.”

-late cycle migraines, especially if precipitated by exercise may benefit from late cycle daily topical progesterone or a dose of post exercise NSAID (ibuprofen or naproxen) on the one or two days right before menses begin.

-whenever possible, consider adding 30-60 minutes of sleep time for each serious exercise session in your week.

-ease into any workout with a warm up routine, and temper your intensity or duration when in an especially warm or humid setting.

-plan to drink 15-20+ oz of water before and during your exercise, enough to require at least one bathroom break by the time you’re done.

-if you have a circadian pattern to your migraines (mostly AM, for instance), avoid an exercise session in the 2-4 hours leading into this time frame. Yes, seemingly obvious, but often ignored. Do you ever play the “I’m feeling lucky today” card? Me too. But just like poker, its best not to draw to an inside straight…very often.

-forget what other people are doing and listen to your body. Pace yourself, and when in doubt, underperform until you’ve reached a comfortable baseline. Then push your fitness forward at a sustainable pace.

-consider the lighting where you exercise. Bright or pulsating lights can be provocative for migraine. Wearing FL-41 blocking glasses may be helpful, even with indoor exercise.

-be aware of alcohol use and exercise related headaches, including the DAIH version. If you use alcohol on a regular basis, consider supplementing benfotiamine 300 mg/day to compensate, and to optimize brain enegetics.

-when you can, diversify your training. Integrate some strength, some endurance and some flexibility work into each session.

-avoid intense exertion during either cardio or strength. If you dial up your level of fitness gradually, you will be ready to move to the next level of exertion without it being intense enough to provoke a headache.

-if, despite the above measures, your exercise still leads to a headache, talk with your doctor about a CGRP blocking medication. Also consider adding CoQ10 100-200 mg to your daily nutrient regimen.

Through my 40 years in medicine and 70 years in life I’m increasingly convinced that regular exercise, and the multiple short and long term benefits it confers is ‘the best insurance you can buy’ for general vitality, day-to-day quality of life and long-term extension of your health-span (more high quality days rather than just latter-life days where a persisting heart beat defines your best moments.)

Let’s find a version of exercise and conditioning that works for you, while not provoking those activity quenching migraines!

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