1. Exercise seems to trigger my attacks. What can I do?

This is a common situation and there is no single answer that works for everyone.  The first thing to keep in mind is that just because a migraine starts to come on or increase during exercise doesn’t mean that it will always stay increased for the whole duration of the exercise session.   At the same time you don’t want to train your body to have a prolonged increase in pain (2/10 or more increase in pain from your starting pain level) while doing exercise.

The first step is becoming aware of the possible migraine triggers that can occur during exercise: eg. Increased temperature, change in body and head orientation (elevation of treadmill), initiation of a moving platform like a treadmill belt, increased blood flow, dehydration, low blood sugar; or a change (especially sudden) in posture, movement pattern, or energy demand.

If you suspect a particular cause then you can try and address that issue as follows:

  1. Drink water before, during and after exercise to prevent dehydration.
  2. Eat a meal with protein in it 1.5 – 2.0 hours before a workout or have a carbohydrate snack (eg. piece of fruit) 20-30 minutes before the workout.
  3. Do a gradual warm-up and cool-down especially if you are sensitive to sudden changes.  This includes changing your posture and work demand gradually in either direction of posture and intensity. eg. while inclining and declining the treadmill – for some people this means only pushing the incline or decline button on a treadmill once every 40 seconds to a minute.
  4. If you don’t handle heat well and prefer cold when you have a headache, wear loose shorts and a loose neckline tank top to let your groin, arm-pits and neck breath.  Also, have the room temperature on the cooler side and/or be near a fan, and if you still feel warm then spray your body lightly with a water mist – especially if you don’t tend to sweat much.
  5. If you don’t do well on a moving surface – try a different surface or mode of exercise.
  6. If you don’t do well with elevation or when your head is not on a completely vertically oriented body – find a machine where your posture feels more comfortable.
  7. Note that although a headache may come on or increase during the warm-up, it may start to subside during the more intense portion of the workout when your natural body endorphins kick-in.
  8. To curb a rebound headache after exercise, you may find it helpful after completing a gradual cool-down to lie in a restorative position (eg. On your back with your knees up and feet flat) for a couple minutes before going back to your usual activities.
  9. If back or neck tension and pain is a factor during exercise and acts as a migraine aggravator, seek advice from a Physiotherapist or Kinesiologist to help minimize this tendency through posture, technique, or preparatory exercises.

Remember too, that you should begin your exercise program very gradually, and increase the intensity and duration of your exercise gradually.  You may find that your body is more sensitive to activity if you are just coming off of an intense migraine attack of a long duration.  As your body gets into better physical condition, you will likely find that it will take more and more exercise to trigger a migraine attack.  Try to stay below that threshold as you gradually increase your exercise.  Also, if you don’t go to a gym, walking outside and other physical activities and chores can also be a useful form of exercise.

An example of a pre-exercise tension release and post exercise restorative position:

  • Have shoulders a little toward the ears and feet and knees a little outside the hips comfortably and relaxed on the mat/floor.
  • Do before and/or after exercise for 1.5 minutes or more with either one or a few (thicker) mats under the torso.

This document was originally created in March 2015 for the website of the Canadian Headache Society.