Exercise Headache Triggers & Treatment - Lauren Natbony, MD
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Exercise Headache Triggers & Treatment

Exercise Headache Triggers & Treatment

Exercise headaches are headaches that occur specifically during or after any form of strenuous exercise. They typically last between five minutes and less than 48 hours and can get pretty severe. Hard exercise impacts blood flow to your brain and dilates the blood vessels there. We do know that they’re more likely to happen if you exercise in hot temperatures or at higher elevations,

Exercise headaches are more commonly associated with running, cycling, weightlifting (a.k.a. “weightlifter’s” headache), swimming, rowing, tennis, and many contact sports.

Naproxen or Indomethacin taken 30-60 minutes before exercise may prevent exercise headache in some cases. However, with indomethacin and naproxen, treatment should be monitored to avoid stomach irritation. It is also best to limit use of these medications to a maximum of 2-3 days per week. Beta-blockers such as nadolol and propranolol have also been reported to be effective for preventing exercise headache, and are reasonable options for people who cannot take naproxen or indomethacin or for those who exercise frequently. 

If you get migraines, you may find that intense exercise triggers this debilitating condition. In one study, 38 percent of participants experienced migraines as a result of or in association with exercise. Of those people, more than half stopped participating in their chosen sport or exercise to reduce or eliminate their migraines.

Although the reason is unclear, movement often triggers migraines. Actions such as rotating your body quickly, turning your head suddenly, or bending over can all trigger or aggravate migraine symptoms.

Exercise can also help headache in the moment. Cardiovascular exercise can activate multiple pain modulatory mechanisms, if not the underlying mechanisms that initiate the attack. Specifically, a synthesis of independent lines of recent research would indicate that exercise activates endogenous neurotransmitter signals that could be effective in reducing the intensity of migraine pain, though it may not have a direct effect on its overall frequency or duration.

Regular exercise can reduce the frequency and intensity of headaches. When one exercises, the body releases endorphins, which are the body’s natural pain relievers. An ideal exercise program should incorporate both cardiovascular exercise (brisk walking, running, cycling or elliptical work, swimming, rowing) and resistance training (weight lifting, yoga, pilates etc).  When starting an exercise program, consider these tips:

  1. Start slow and increase the intensity, frequency and duration over time as endurance improves. An increase in time per session of 5-10 minutes every 1-2 weeks is reasonable. After that, both intensity and duration can be gradually increased. To reduce migraine frequency, aim for 40-50 minutes of aerobic exercise three days per week. 
  2. Have a balanced snack with protein, fat and carbs about 60-90 minutes before exercising
  3. Stay hydrated, before, during and after a workout
  4. Warm up for at least 5 minutes to ease your body into exercise.  After a workout cool down for at least 5 minutes with gentle stretches to help lower your heart rate
  5. Exercise in a cool, temperature controlled environment if possible. Becoming overheated can trigger a migraine.