The benefits of regular exercise for heart, brain and general body health are well known. Aerobic exercise is good for your heart, lungs, muscles and your whole body. It can help lower your risk of developing cancer, type 2 diabetes, depression, and heart disease along with many other benefits 1. For people living with migraine this is really important - it can help us avoid further chronic diseases that are often comorbid with migraine. There is also some research suggesting that working out could help your migraine, but I’ll get to that in a moment.
Generally, it is recommended that adults aim for at least 150 minutes of moderate intensity, or 75 minutes high intensity aerobic exercise each week 2. To break that down, this means approximately 30 minutes of an activity like walking, five days a week, or just over 20 minutes every day. Moderate intensity means exercising to a point where you feel like you are at about 60-75% of your maximum. You can hold a conversation but you are a little puffed out, and your heart rate would be high but not really thumping. High intensity means you go flat out, you can’t chat while working out and your heart rate is climbing towards maximum.
What is aerobic exercise?
Aerobic means ‘with oxygen’ so it is exercise that pushes your body to rely on oxygen for energy. Aerobic, or cardiovascular (or ‘cardio’), exercise involves repetitively moving the biggest muscles of the body. As you start to move more these big muscles require more oxygen so you start to breathe more quickly and your heart pumps faster, rapidly delivering more oxygen from the air to the muscles. Over time your heart muscle will become more efficient at this task, and it will strengthen along with all the other muscles in your body that you use while working out. These changes (along with a whole host of other complicated enzymatic and metabolic changes) help the body function better, resulting in a healthier you.
Exercise as a migraine trigger
Many people report anecdotally that working out can bring on a migraine attack. Personally, I have found high intensity exercise can trigger an attack for me which is really disappointing. That said, sometimes I find working out can stop an attack in the very early stages, so ultimately we are all unique and incredibly complicated!
A few large studies suggest somewhere between 20-40% of people living with migraine report exercise as one of their attack triggers 3. This means for a large number of people living with migraine, meeting the recommended exercise guidelines can be a struggle. The science around why this happens and how movement might trigger an attack is still uncertain. This makes it difficult to give suggestions about how to avoid triggering an attack with any real certainty. Some doctors will suggest taking medication prophylactically if this is a problem for you, but if you want to start working out regularly this isn’t a particularly sustainable option. I’ve read extensively on this, experimented with myself and talked to a number of people living with migraine. My personal theory is (not science, my opinion!) that we can gradually increase our threshold, our tolerance for exercise, over time. Here are my best suggestions for how to avoid triggering an attack while exercising based on what I know at this stage:
- Stay hydrated
- Keep sessions shorter than you might think, especially to begin with
- Keep your blood sugar stable (eat within 1 ½ hrs before exercising and ½ hr after)
- Consider the environment you are working out in - avoid the midday sun, fluorescent lights, or other environmental factors that you know are triggers for you
- Increase your session length and frequency very gradually
- Find activities you enjoy (don’t start running if you can’t stand running!)
- Experiment with working out at different times of the day to find what works for you
- Bring down the triggers in the rest of your life too - lower stress, sleep regular hours, eat a healthy diet
- Keep it fun! If you want a sustainable exercise routine it has to be something you enjoy doing
How to start exercising
If you are newly diagnosed with migraine and you have been avoiding exercise because you are worried it might make things worse, I get it. In 2018 when I was diagnosed with chronic migraine I stopped moving too. I stopped doing anything that I thought might bring on another episode. To be honest I think this exacerbated my slide into more and more frequent attacks, as we know that lower levels of physical activity are tied with a greater migraine burden overall 4. I started moving again really gradually and began with gentle 10-15 minute walks around the neighbourhood. Eventually over a period of months I was able to extend this to 20-30 minute walks a couple of times a week, and I joined a gym.
The key thing to remember when starting out is to take it slow! Sometimes when you have finally mustered the enthusiasm to get started, you want to do it all at once. Maybe you bought new gear, fancy shoes, a big hat and you just want to start getting on the bike every day. I get it, but hang back a little. Keep something in reserve and don’t go all out straight away. You have your whole life to move and enjoy being active, pace yourself for now.
Exercise for Migraine
When it comes to aerobic exercise we have fairly good evidence now to show that it might help lower suffering for people with migraine5. If you can build to a point where you are able to workout (walking, running, cycling, swimming) for 40 minutes three times a week (including warm up and cool down) then this could help you as much as taking a prophylactic drug such as Topiramate 5. That is pretty remarkable. We still need to do more research into this area, but exercise is certainly a promising non-pharmacological intervention for migraine. Aerobic exercise can reduce the frequency of attacks, pain intensity and improve quality of life 6. Given that it can also help improve so many other areas of your health, I really recommend trying to increase the amount of exercise you do each week overall. Find something you enjoy, even if it seems simple like using mini pedals at home or going for a walk around the block. Start small, progress gradually and hopefully you will come to enjoy the way exercise can make you feel.
If you have any questions about this, head over to our brand new Facebook Group! Movement with Migraine on Facebook is a place for tips, inspiration, success stories and links to the current research news as it happens. As always you can come say hi on Instagram too.
Vina, J., Sanchis‐Gomar, F., Martinez‐Bello, V., & Gomez‐Cabrera, M. C. (2012). Exercise acts as a drug; the pharmacological benefits of exercise. British journal of pharmacology, 167(1), 1-12. ↩︎
WHO (2020), Physical Activity and Adults: recommended levels of physical activity for adults aged 18 - 64 years. Retrieved from: https://www.who.int/dietphysicalactivity/factsheet_adults/en/ ↩︎
Amin, F. M., Aristeidou, S., Baraldi, C., Czapinska-Ciepiela, E. K., Ariadni, D. D., Di Lenola, D., … & Linde, M. (2018). The association between migraine and physical exercise. The journal of headache and pain, 19(1), 1-9. ↩︎
Varkey, E., Hagen, K., Zwart, J. A., & Linde, M. (2008). Physical activity and headache: results from the Nord-Trøndelag Health Study (HUNT). Cephalalgia, 28(12), 1292-1297. ↩︎
Lippi, G., Mattiuzzi, C., & Sanchis-Gomar, F. (2018). Physical exercise and migraine: for or against?. Annals of translational medicine, 6(10). ↩︎
La Touche, R., Fernández Pérez, J. J., Proy Acosta, A., González Campodónico, L., Martínez García, S., Adraos Juárez, D., … & Paris‐Alemany, A. (2020). Is aerobic exercise helpful in patients with migraine? A systematic review and meta‐analysis. Scandinavian Journal of Medicine & Science in Sports, 30(6), 965-982. ↩︎