For many of us living with migraine, exercise can be a trigger. This is so unfortunate, as there is also evidence that exercise can help alleviate migraine - both the severity and frequency of attacks. So, how can we benefit from movement without bringing on the dreaded monster migraine?
Helpfully we already have suggestions online from places like The Migraine Trust and The American Migraine Foundation. They both recommend exercise as part of a lifestyle approach to managing migraine. The advice boils down to these four key points:
Warm up properly
Consider your blood sugar levels (eat beforehand)
Stick to low-moderate intensity
All of these ideas come back to a core principle of migraine care - we need to help our hypersensitive brains maintain stability. As I mentioned in a recent Instagram post, consistency is everything for the migraineur. Hormonal fluctuations, blood sugar rising and crashing and stressful ups and downs can all trigger an attack.
“We don’t want to shock our brains by jumping straight into an intense workout or into the deep end of a new regime.”
When we set out to start moving more, it serves us well to keep this in mind. We don’t want to shock our brains by jumping straight into an intense workout or into the deep end of a new regime. We also don’t want to become dehydrated, or hungry. Go slowly, create new habits and routine over time, and build gradually. We absolutely can enjoy exercise, we just need to consider how we approach it!
What might this look like?
Start With Something Simple
If you haven’t been moving much because of migraine or simply because you haven’t made time for it, start with something simple. I usually recommend walking or using a stationary bike for aerobic exercise and gentle yoga or pilates for some strength and flexibility.
“Incremental change will shift us slowly into a new way of living, gradually creating a healthier lifestyle”
Aim to set aside time 2-3 times a week that you can devote to moving more. Perhaps 15 minutes 3 times a week, you could go for a walk or sit on a bike and ride. Find something that feels good, and feels easy. I know I know, most of the messaging around working out and getting fit reminds us that change happens outside of our comfort zone, but I actually disagree here. Lasting change often begins with tiny incremental change that does indeed feel easy, or at least not terribly hard. Incremental change will shift us slowly into a new way of living, gradually creating a healthier lifestyle. Remember, these movement sessions shouldn’t feel like a shock or stress to the system, that way you can avoid an attack.
Pick a Time That Feels Good
Timing is another thing that has to suit you and your life, and your migraine. If you find that your migraine attacks often occur in the morning, then perhaps planning for a walk in the early evening might be something you can stick to more regularly. You will also want to make sure you move at a time that allows you to eat an hour or so beforehand. First thing in the morning sounds great, but for those of us prone to migraine attacks after exercise, the dip in blood sugar that comes from a workout is a common culprit. Morning after breakfast, or in the afternoon after lunch or a snack are great times to get going. Make sure you have digested your meal enough to feel comfortable, but don’t start out hungry.
Seek Out Things You Enjoy
Similar to what I said early, you need to find things that feel good for your body and that you find fun and enjoyable. If you don’t like running, don’t pick running as your new plan. Think outside the box here too - what did you enjoy doing as a child? Did you love to ride your bike? Or get on rollerblades? Perhaps you loved to dance and you could find an adult ballet class?
Keep the Intensity Down
I hate to be a bummer, but unless your migraines are well controlled (in which case congratulations! Enjoy all the exercise you like!) you might want to steer clear of the currently trendy high intensity interval training (HIIT) for a while. We don’t fully understand why, but at this stage the science indicates that higher intensity exercise can be a migraine trigger for many sufferers. It could be the build up of lactic acid (a waste product of exercise) or the sore muscles, or the rise in blood pressure that sets things off. We don’t know for sure. However, if you are worried about triggering migraine then you are best to stick to low to moderate intensity aerobic exercise.
What does that mean? Well, we can use two measures. Firstly, we use a scale called the RPE (rate of perceived exertion) which goes from 0-20. 0 being no effort at all (ie asleep) and 20 being the most effort you could put into moving ever, your upper limit. When you are exercising with migraine, you don’t want to head much past a 13-14. An occasional 15 is OK, but any higher and you may be working too hard. You can hold a conversation while you workout, even if its a little difficult. Instead of RPE we can also use heart rate, aiming for a heart rate below 70-75% of you maximum. You can calculate your approximate maximum heart rate using this formula: 220 - age. Then calculate 70% of this. So for a healthy 33yr old the max would be 187, and 70% 131. If you have a fitbit or other heart rate monitor then keep an eye on it and aim to workout around or below 130.
Set Up a Routine
Coming back to the core idea of consistency, creating a stable routine can really help. Stick to your yoga class on Mondays and go for that longer walk on the weekend. Choose a day that works with potential workout buddies or your partner’s schedule. Ideally it would be great to find a way to move every day of the week. Eventually! No rush, but eventually a walk or a gentle home stretching session or bike ride every day will give your brain something to rely on.
“If you want to build a healthy exercise routine into your current life, don’t rush.”
Build Over Time
Once you are walking or riding 2-3 times a week, and eventually also adding some strength and flexibility training into the routine, then you can start to build the intensity. The idea is is simple - keep going with what works until you are confident that it isn’t triggering migraine attacks for you. If you think it is, drop the intensity, go for a shorter session, find that baseline again. Once you are feeling good with your routine, step it up a little. Add 5 minutes, or 10, pick up another class, work a little bit harder. Gradual change shouldn’t trigger a migraine for you, once your body has adapted to the current load and your fitness has improved accordingly.
To summarise, I’m suggesting a slow burn approach to exercise as a way to avoid triggering a migraine attack. Before each session stay hydrated, eat regularly and always warm up before each session. More broadly, consider your approach to exercise in general. If you want to build a healthy exercise routine into your current life, don’t rush. Don’t risk putting yourself off or setting your progress back. Start small, move regularly, and build from there. As your fitness improves over time more and more options will become available, and won’t seem like such an effort either, but you might need to be patient. Choose activities you enjoy and celebrate the little wins! Exercise can be such a great way to lift your mood and improve your health overall, and if we approach it well then we don’t need to fear the migraine repercussions.