Why I Get Exercise-Induced Migraines, According to Neurologists

woman exercising

Stocksy

As soon as the pandemic revealed itself in March, I jumped on the Peloton bandwagon and snagged my beautiful bike. After my first ride, I was drenched in sweat, my legs ached—and I had the worst headache ever. I crawled into bed, telling my kids and my husband to stay away. I assumed I had COVID-19. After all, I had the headache, the body aches, and I was exhausted. But I didn’t have a fever, and after popping a few migraine pills, I felt fine.

The next day, I tried another ride on my fancy bike, only to have the same ridiculous migraine return. This time, I phoned my neurologist. I may not have COVID-19, but perhaps I had a brain tumor? Or maybe I was having a brain aneurysm from all that shaking I was doing while spinning?

Nope, my neurologist said. But it turns out, I’m one of the unfortunate people who is basically allergic to exercising. In other words, I get exercise-induced headaches. I’ve always suffered from migraines, but a mix of Topamax and Imitrex has helped me live my life relatively pain-free. Until now, at the age of 40, when I learned a totally new trigger as I attempted to seriously work out for the first time. 

The Symptoms

For me, the exercise-induced headache only occurs when I do a really strenuous workout: something that’s at least 45 minutes on the bike at a very high intensity. According to the Mayo Clinic, the exercises most often associated with these types of headaches and migraines are running, rowing, tennis, swimming and weightlifting. 

The pain begins toward the end of my workout on one side of the front of my head, and it becomes more intense throughout the day, despite the fact that I usually spend the rest of that day sitting in front of my computer, motionless. 

What’s Going on Inside Your Brain 

During an exercise-induced migraine—and even during a workout—there’s a ton of stuff going on inside your brain, says Thomas Pitts, a board-certified neurologist with Hudson Medical & Wellness in New York. Exercise increases the stress hormone output, increases your blood pressure, your heart rate and your respiratory rate—all of which can contribute to migraines. Especially, Pitts says, if you’re exercising without eating first or if you aren’t hydrated. “Exercise and the rapid augmentation of metabolism, gut speed, heart rate, blood pressure, respiratory rate, stress hormone output, dehydration, and glucose consumption can induce a migraine state, and this pathway is referred to as exercise induced headaches,” Pitts says. It’s common, he says, for patients with headaches to notice that exercise worsens or even provokes them. 

Fantastic. What makes this even worse is the studies on the topic are super limited. One study reports extensive information on the sports-triggered attacks and the patients experiencing these attacks is lacking. The study looked at migraine patients who were asked if exercise had ever triggered an attack. Apparently, 38 percent of those studied had exercise-triggered migraines, regardless of gender and regardless of migraine type.

Neck pain as the initial migraine symptom was the most frequent symptom for those with these types of attacks, and more than half of those who had exercise-induced migraines abandoned the offending sport. 

Do You Have to Stop Exercising Altogether?

I just spent thousands of dollars on a bike that goes nowhere. I love that bike that goes nowhere. I really don’t want to give it up, nor do I want to stop exercising. I spoke with Carolyn Zyloney, a headache specialist and neurologist at Unity Rehabilitation and Neurology at Ridgeway (Rochester Regional Health), who explained the type of exercise leading to these migraines varies from person to person. But, she says, it’s usually brought on by and occurring only during or after strenuous physical exercise. “People do not necessarily need to stop exercising entirely, but may modify their workouts to reduce the risk of a recurrent headache,” Zyloney says. “For example, they may reduce the intensity of their workout.”

That’s no fun, though. I love spinning, and the intensity is what gives me the exercise high—along with the headache. I want one without the other. “Sometimes,” Zyloney says, “I will prescribe a medication such as Propranolol or Indomethacin to take prior to exercise to reduce risk of an exertional headache.” 

Prevention 

I already take a handful of pills a day, so I don’t want to pop another one every single time I hop onto the bike. I looked into what I could do to prevent these migraines without additional medicine. According to the May Clinic, these migraines happen more often during hot, humid weather—or if you’re exercising at high altitudes. So I added a fan to my workout space, and have it pointed at my head. 

“A warm-up prior to strenuous exercise also can help prevent exercise headaches,” the Mayo Clinic recommends. I set aside time for a five-minute warm up so my blood vessels wouldn’t go from zero to 100 in a matter of seconds. In one study by Varkey and colleagues, they attempted to see what would happen if the migraine sufferers increased their oxygen uptake prior to the intensive workout. The participants did a 15-minute light warm-up followed by a 45-minute difficult workout, and found the warm-up prevented the exercise-induced headaches. 

Dehydration is also a key factor in exercise-induced migraines, or any type of headache. So I try to drink water before, during and after my workouts. 

Results 

I’m not going to lie and say I never get exercise-induced migraines anymore. But with the slight tweaks to my day, I only get them once a week. And that’s much better than daily exercise migraines. Plus, the tweaks are so minor, I barely notice them: I drink more water, I do a warm-up, I do a cool-down post-working out and I always exercise with a fan. No biggie. Also, and even better, no big headache. 

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