There are a few things you can typically expect after a great workout—an energy boost, some sweet endorphins, maybe a little soreness—but a debilitating migraine shouldn't be one of them. Unfortunately for some people, working out can actually be a migraine trigger, which is basically the least motivating news ever.
If you get exercise-induced migraines, being laid out in bed with the lights off probably feels like the opposite of the healthy life you were trying to maintain with working out. So, why does this happen? And how can people whose migraines come on with exercise still get the movement their minds and bodies need? We spoke with migraine specialists to find out why this happens and what you can do about it.
First things first: What exactly are migraines?
You may think of migraines as wildly painful bouts of sharp, throbbing head sensations. That’s true for some people, but not everyone, Nauman Tariq, M.B.B.S (Bachelor of Medicine-Bachelor of Surgery), assistant professor of neurology and director at John Hopkins Medical Center, tells SELF. The pain can present as a debilitating, dull, steady ache as well, and it can strike one side of your head or both. You may also deal with symptoms like nausea and vomiting, along with sensitivity to light, sound, and other sensory input, the Mayo Clinic says. For some people, migraines can even come on with no pain—just visual disturbances and other annoying symptoms.
One thing many people don’t realize about migraines is that the pain and its accompanying symptoms are sometimes only one part of the package. Before the pain sets in, you might experience the prodrome, which is essentially your body’s warning that a migraine is on the horizon. Symptoms include constipation, food cravings, mood changes, neck stiffness, feeling very thirsty and peeing more often, and frequent yawning, according to the Mayo Clinic. You may also experience aura, which is those sensory changes that can take hold before or during a migraine. Aura typically causes weird visual effects, like seeing flashes of light or zig zags, but it sometimes involves other senses as well. You might feel pins and needles, hear noises, and more. Then comes the pain, and once it’s receded, you may experience what’s known as a migraine hangover, or post-drome. This is when your body recovers from the exhaustion of a migraine, so you might experience residual symptoms like confusion, mood issues, dizziness, weakness, and some sensitivity to light and sound.
All told, a migraine can last for hours or even days. As anyone who’s tried to function with one can tell you, a migraine can make it incredibly hard to live your life as usual.
Experts don’t know the exact cause of migraines, but they have some theories, ranging from genetics to misbehaving brain chemicals.
Like many other health issues, the medical world hasn’t yet pinned down one specific cause of migraines. Genetic and environmental factors are a possibility, as are changes in the interaction between your brainstem and trigeminal nerve, which sends your brain signals about pain in your face and head.
Imbalances in brain chemicals also may play a role. Serotonin, for example, declines during migraine attacks. This might prompt your trigeminal nerve to release neuropeptides (brain molecules) that affect your meninges (three protective layers of tissue around your brain and spinal cord), ultimately leading to pain, the Mayo Clinic explains. Specifically, calcitonin gene-related peptide (CGRP) has been top of mind recently. In May the Food and Drug Administration approved the first class of drugs designed to prevent migraines by blocking the activity of CGRP.
Experts are also investigating whether there’s a “cyclical pain generator” in the brainstem that kick-starts chemical changes involved in migraines, Dr. Tariq says.
Experts do know that migraines can have a ton of triggers, including hormonal changes, stress, and—you guessed it—exercise.
This is where things get kind of confusing.
Plenty of people experience exercise as a migraine trigger; in a 2013 study published in The Journal of Headache and Pain, 38 percent of the 103 participants reported having had a migraine they believed was caused by exercise. But exercise has also been linked with the power to reduce migraines. For example, a small 2011 study of 91 people published in Cephalalgia found that people who exercised for 40 minutes three times a week experienced a greater reduction in migraines than people who followed a relaxation program, and almost as much as those who took a daily preventive migraine medication (topiramate, an anti-seizure drug).
Experts aren’t quite sure why exercise may help ward off migraines in some people, but there’s a lot of curiosity around physical activity’s ability to modulate a person’s pain response through endorphins or other influences.
The reason why exercise is a migraine trigger for some people prone to head pain is also unclear. One theory is that exercise-induced migraines might be due to what is essentially pressure going from your chest to your brain via your venous (vein) system. This is known as internal jugular vein valve incompetence (IJVVI), and it may primarily occur during a phenomenon called the Valsalva maneuver, which can happen when you exercise. A Valsalva maneuver is essentially when you hold your breath while exerting yourself, creating pressure in your chest, Natalia Murinova, M.D., M.H.A., director of the University of Washington Medicine Headache Center and a University of Washington associate professor of neurology, tells SELF. Although you shouldn’t hold your breath when exercising, it can happen accidentally as you push your body through a really difficult move. You know how sometimes you squeeze your eyes shut with effort as you sweep to the top of that last weighted squat, only realizing when you exhale that you were holding your breath? That’s a Valsalva maneuver.
There may be other factors as well, like beginning a workout too suddenly without an adequate warm-up period, the Mayo Clinic says. Exercising in hot weather and at high altitude also seem to raise the risk of migraines for people who experience them, Dr. Tariq adds.
If you think you get workout-induced migraines, talk to your doctor to make sure you know what you’re dealing with.
There are lots of potential causes of head pain associated with exercise, ranging from a sinus infection to a much rarer but also more serious issue like abnormal brain bleeding, so you want to be sure of what’s going on before jumping into treatment.
If your first instinct after confirming you have exercise-induced migraines is to avoid working out for a bit, that may not be such a bad idea. Your doctor may want you to hold off on exercise (or at least the kind that triggers your migraines) until you get a treatment plan for your head pain, Dr. Murinova says.
Over-the-counter headache medications may be a good preventive measure for exercise-induced migraines, Dr. Tariq says, but it’s still smart to talk to your doctor before deciding which one to go with and how often to take it. You may be at risk for rebound headaches, also called medication-overuse headaches, which can happen when you take certain pain relievers more than a few days a week. Doctors are still figuring out the exact threshold for this admittedly bizarre side effect. In the meantime, the Mayo Clinic recommends avoiding using certain pain medications like triptans (often used for migraines) and some ergots (which are less effective than triptans, but still sometimes used for migraines) more than 15 days a month, so you really should talk to your doctor before loading up. (Also: Needing to rely on any kind of pain medication more than 15 days a month is something to bring up with your doctor.) Getting even more head pain because you’re trying to treat your migraines isn’t exactly ideal.
When it comes to prescription medications for migraines, you have a lot of options, ranging from triptans and ergots to the nonsteroidal anti-inflammatory drug indomethacin to calcium channel blockers that may work by preventing your blood vessels from fluctuating in size in a way that might cause head pain.
No matter which medicine makes the most sense for you, you should ask your doctor exactly when to take it in order to prevent exercise-induced migraines. And, once you start working out again, try to avoid other exercise-related migraine triggers, like pushing yourself at a dizzyingly high altitude or running around when it’s boiling outside.
Finally, Dr. Murinova notes that you may need to address any other lifestyle factors that may be making you susceptible to migraines, too. Are you working too much? Are you getting enough sleep? Just like exercise, these are often pieces in the migraine puzzle.
If your workouts trigger debilitating migraines, you’re not alone, and you don’t have to say goodbye to exercise forever.
Talk to your doctor or to a migraine specialist. They may be able to help your brain—and body—feel so much better.