Migraine is a complex chronic debilitating condition, far more than just a headache. There are multiple types and no clear cause and effect, with multiple potential triggers and multiple treatment/management options. There are still many theories floating around but they still do not understand exactly what is going on during a migraine attack which is ultimately why there is no cure.
Everyone’s experience of Migraine is different which is why no one form of exercise will be right for everyone and for some exercise can increase symptoms. However research has shown that exercise can be beneficial for some of us who suffer with migraines. Although there are no forms of exercise specifically contraindicated with migraines, the main forms that are recommended include walking, swimming, cycling, yoga, pilates and Tai chi.
What does the research say?
- Touche (2020) completed a systemic review of the randomized controlled trials and found there was low to moderate quality evidence that in patients with migraine, aerobic activity can decrease pain intensity, frequency and duration of migraine and also increase the quality of life
- Lemmens (2019) also did a systemic review and found moderate quality evidence that in patients with migraine, aerobic exercise therapy can decrease the number of migraine days. However opposing the above study, they found that no conclusion on pain intensity or duration of attacks can be drawn from the research
- Amin (2018) showed in their systemic review that low levels of regular exercise can have a prophylactic effect on migraine attacks. Although noted more research was needed on the frequency and intensity of the exercise
- Machado Oliveria (2020) tried to look at narrowing down the parameters of what kind of intensity or type or frequency of exercise was beneficial, however although they again found exercise was positive, the studies presented inconclusive data about specific exercise parameters.
- Gil-Martinez (2013) looked at the effects of therapeutic exercise and physiotherapy interventions and found that this was a safe and effective treatment option for migraine. It lowered the intensity, frequency and duration of pain in patients. However they agreed that more research was needed to clarify these results.
The main thing clear with most of the current studies is the lack of clear guidelines on the type of exercise, the frequency, intensity and duration is required to have a beneficial effect. All things that as a patient you kind of need to know when trying to introduce exercise as a management tool. This often leads to people worsening their symptoms due to the following issues with exercising:
Confusion of not knowing what exercise is best, so follows the advice of either non-sufferers or other migraine sufferers and try to exercise at the wrong intensity for you
Starting something new and doing more than your body is ready for, overdoing it and risking injury or causing muscles to be overloaded trigger pain, inflammation and stiffness
Working with an exercise professional that isn't trained or knowledgeable about migraines so is unable to safely advise how best to exercise with migraine
Not looking out for yourself when exercising. Not hydrating enough before, during and after leading to dehydration or not eating enough around exercising causing changes in blood sugar levels
Not including an adequate warm up, triggering a migraine attack due to a sudden increase in oxygen demand
Working out in challenging conditions e.g. hot, too cold, high altitude
Pushing yourself too hard during the session leading to an attack which can lead to a fear of exercising again and fearing movement
How to exercise with a migraine?
Generally our bodies like to try and stay as steady as possible, so it's likely you are already trying to include a steady routine with your lifestyle to keep your body in a steady state. Things such as sleep hygiene, regular meals, hydration, pacing of activities etc all help to manage this balanced approach. This carries over to exercise too, you want to ease your body into a low-moderate form of exercise and go for a little and often approach to reduce the body from having a reaction.
Warm up and Cool Down
A warm up is key, no matter how low a level you think you are training, even if it is a gentle walk. I always advise doing a few dynamic stretches or postural activation warm up exercises first to ease into a strength session. Or with aerobic activity, to ease into whatever activity you are doing by starting with a slow pace on a flat terrain as your warm up. Equally important to include a cool down too, it doesn't have to be anything special. Just consciously bringing your body back down slowly to it's resting state again by slowing the pace or intensity, and adding in some stretch or breath work.
Little and Often
The research leans towards a regular approach to exercise, so 3 times a week for about 30 minutes at a time would be ideal. However with regular migraine attacks something this is challenging, plus many of us have other conditions that limit our activity too so my usual phrase of 'do what you can, when you can' applies - see this blog for more information on this. Aim for little and often at a manageable sustainable level, rather than a boom and bust approach of overdoing it and needing to rest.
Planning is key, both in terms of managing on what your exercise session will involve and how this will fit in with your day in terms of pacing. As well as planning when you will eat and drink to manage your blood sugar levels and level of hydration. General advice is to eat an hour before exercise, and hydrate before, during and after - with the addition of electrolytes if required.
If you are completely new to exercising with a migraine my number 1 advice is to start smaller than you think you can manage. So say you think you could manage a 30 min walk, try a 15 min walk. It is important you track your reaction both during, after and the day after exercise to notice any triggers and patterns related to exercising. Once you notice that the activity you have chosen is not adding to your migraine symptoms, you can consider increasing the intensity or duration.
If you feel like no matter what you seem to try it may be worth seeing a physiotherapist to look at how you are exercising. It may be something as simple as neck pain which is aggravated during physical activity which once addressed can make exercising less of a trigger. Or perhaps the modality you have chosen e.g. yoga does not suit you or the type of yoga e.g. yin is not right for you. We are lucky to have so many options of gentle ways to exercise these days, its just about finding out what suits you and your physiology! A health professional can help work with you to help you a find a way to move.
For more personalised advice, I offer an exercising coaching service specially for those with chronic illness and have worked with many clients with different types of migraine. I work with you to create a program for you to safely move your body without flaring your symptoms. For more information click here or email me on firstname.lastname@example.org
Would love to know your thoughts on how you manage to exercise with chronic illness?
Lots of love,