Lifestyle Modifications and Migraine – Exercise

For anyone looking to improve their health, exercise is a universally recommended activity. Regular physical activity is associated with numerous benefits, including reduced risk of cardiovascular diseases, slower age-related cognitive decline, decreased likelihood of depression, increased resistance to chronic pain, and healthier dietary choices. It’s natural, then, to consider exercise a potential ally in combating recurrent, debilitating conditions like migraine headaches. However, in the realm of medicine, it's crucial first to distinguish between correlation and causation. While physically active individuals are generally less likely to experience chronic pain, it's not always clear whether this is due to the therapeutic effects of physical activity or because those in pain are less likely to engage in such activities.

The Dual Effects of Exercise on Migraines

The relationship between exercise and migraines is notably complex, as physical activity is often reported as a trigger by many suffering from headaches. Yet, some find that a more active lifestyle leads to better headache management. This article aims to delve into the existing research on how exercise impacts migraines.

Physiological Impacts of Exercise on Migraines
Exercise affects human physiology in several ways that relate to headaches. On one hand, physical activity increases the secretion of calcitonin gene-related peptide (CGRP), known for its role in triggering migraines. On the other hand, exercise also promotes the release of endorphins, our body's natural pain-relievers, which can significantly alleviate pain.

Most studies examining the impact of exercise on migraine patients have focused on aerobic activities like jogging, cycling, rowing, and walking, typically recommending 20-60 minutes per session, 2-3 times a week. The results, however, have been mixed. While most research indicates a decrease in pain intensity among active participants, the effects on migraine frequency remain unclear.

A notable study published in Cephalalgia in 2011 found aerobic exercise as effective as Topiramate, a medication used for migraine prevention, with a 66% response rate in the exercise group. Interestingly, the study noted that the responders were more likely to be more physically fit than the non-responders, and also to have less use of migraine medications at baseline. This goes into illustrating our point regarding the inherent  bias when studying the effect of exercises on migraine, as patients with severe migraine are unlikely to be able to participate in physical activities to start with.

Factors that complicate the Exercise-Migraine Relationship

1. Exercise-Induced Migraines:
Approximately 20% of migraine patients experience migraines triggered by exercise, with or without aura. While the exact mechanism is not fully understood, implementing a thorough warm-up routine and using preventive medications may help manage this trigger.

2. Primary Exercise Headache:
Recognized as a separate entity from migraines, primary exercise headaches occur exclusively after physical activity and are characterized by intense, throbbing pain without the hypersensitivity associated with migraines. These headaches are thought to result from increased blood flow and subsequent intracranial pressure during exercise. 

3. Neck Pain and Migraines:
As previously discussed on this blog (read more here, here and here), there is a significant overlap between neck pain and migraines. Patients with cervicogenic headaches might find that specific exercises, particularly overhead activities, trigger their symptoms. Conversely, strengthening exercises for the posterior chain and neck extensors may help prevent such headaches.

Conclusion: Personalizing Your Approach

The relationship between migraine and exercise is intricately complex, and the decision to incorporate physical activity into your migraine management plan should be personalized. If you suffer from exercise-induced headaches, it's crucial to consult with your physician to explore potential treatments that could mitigate these effects. Ultimately, integrating exercise into your routine requires careful consideration of its benefits and potential triggers, tailored to your specific health needs.

The complete series on lifestyle modifications and migraine

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