Migraines and Exercise

Question:

Could you tell me a bit about exercise-induced migraines? What are some common causes and also ways to prevent them? My client gets them occasionally after a Spin class.

Answer:

Migraine is a complex and multifactorial syndrome, that affects between 10 to 20 percent of the population. More women than men are affected due to the hormonal link, and the frequency of migraine may be associated with the menstrual cycle. Migraine is defined as “an often familiar symptom complex of periodic attacks of vascular headache.” A variety of triggers for migraine includes hormonal changes, sociodemographic factors, lifestyle including dietary intake and sleep pattern, psychological correlates, medication administration, vigorous activities and external stimuli. Exercise-induced attacks are usually related to one of two preceding headache conditions: exertional headache and effort headache.

Exertional headache may result from straining, or a Valsalva-type maneuver (breath holding) precipitates the acute onset. Exertional headaches are thought to be vascular, but this is unproven. According to the theory, exertional headache occurs because exertion increases cerebral arterial pressure, causing the pain-sensitive venous sinuses at the base of the brain to dilate.

Effort headaches are the most common type of headache in athletes and are associated with a variety of sports, especially in hot weather. Effort headaches are clinically distinguished by mild-to-severe throbbing pain brought on by maximal or submaximal aerobic exercise. The patient may have prodromal "migrainous" symptoms; the headache will be of short duration (four to six hours). These vascular headaches are more frequent in hot weather and tend to recur with exercise.

Treatment for migraine suffers includes drug therapy and/or physical therapy. As with all drug therapies there is a risk/benefit factor that needs to be considered and this should to be discussed with a medical practitioner. There are a variety of non-drug treatments available with several studies on the effects of relaxation and biofeedback treatment currently in progress. Treatments such as meditation, yoga, massage, acupuncture and swimming may all be of benefit.

With regard to your client in the Spinning class, here could be some predisposing factors to consider:

1. What gear was she in?
2. Were there many extended climbs in the class resulting in holding her breath (Valsalva-type maneuver)?
3. What was her riding form like (tense = upper thoracic hypertonicity)?
4. What was her nutrition and hydration state?
5. At what phase of her menstrual cycle?

I believe you are heading in the right direction. I suggest that you encourage her to maintain an exercise log, food diary and a menstrual cycle diary in order to pinpoint stress, nutritional or hormonal changes that may alter the occurrence or intensity of attacks. If you are not already, start monitoring exercise intensity with a heart rate monitor and/or RPE scale. Finally, remember, sometimes we need to train smarter and not harder. Quality of health is the key.

References:

1. Barrett E: Primary care for women: Assessment and management of headache. J Nurse Midwifery 1996; 41(2): 117–124.
2. Kanner RM: Headache and facial pain. In: Pain Management: Theory and Practice, 4th ed, Portenoy RK, Kanner RM (editors). Davis, 1996. pp 51-77.
3. Lin, J. ( 2001). Overview of migraine. J. Neurosci. Nur. 33 (1): 6-13.
4. McCrory, P. (10 Nov. 2002). Recognizing Exercise-Related Headache. J Physician Sports Med. 25 (8). February 1997. (online). http://physicaltherapy.about.com
5. Mountier, B. (1994). Migraine Control: The Food Connection. Hyland House: South Melbourne, Australia.
6. Prendergast, m. (1992). Understanding Migraine. Text Publishing Company: East Melbourne, Australia