The Recommendation

So, your doctor has told you that it's important to get regular exercise, both for maximizing your overall health, and for helping to manage your migraines.

Are you skeptical? You're not alone.

Many migraineurs have a hard time with exercise. Some find that vigorous exercise can trigger a migraine attack. Others just feel so lousy so much of the time, they have a hard time finding the energy to do something that requires physical exertion. But this topic is worthy of a bit of exploration, to find out why exercise has been recommended, and how you can be successful in using it to your best advantage.

The Research

Previous studies have shown that around 22% of migraineurs report exercise as a trigger for their migraines.¹ Another study shows that people with migraines tend to be less aerobically fit, and less flexible, than those without headaches.² There is also some evidence that an adequate warm-up can help prevent exercise-induced migraine,³ and some preliminary studies that suggest regular exercise can help reduce headache frequency.^4,5,6

But a recent study published in the medical journal Headache sheds some light on the type, amount, and intensity of exercise that seems not only well-tolerated, but possibly quite beneficial for headache sufferers.⁷ The following information details that study.

Exercise Intensity

The RPE Chart (Rating of Perceived Exertion) was developed in 1998 by Dr. G. Borg to describe a person's perceived exertion during exercise. A person can look at this chart while exercising, and rate how hard they feel they are working.

Exertion	RPE
no exertion at all extremely light very light light somewhat hard hard (heavy) very hard extremely hard maximal exertion	6 7 8 9 10 11 12 13 14 15 16 17 18 19 20

In this study, the subjects were instructed to do warm-up exercise for 15 minutes at an RPE of 11-13 (light to somewhat hard). This was followed by aerobic exercise at an RPE of 14-16 (hard) for 20 minutes. The exercise could be any form of continuous aerobic exercise (biking, jogging, swimming, Nordic walking, etc). Exercise was followed by a 5 minute cool-down phase, at RPE of 11-13. The subjects exercised 3 times per week.

The Results

The investigators were hoping to find that the subjects of their study were able to exercise enough to increase their fitness level, without increasing or triggering headaches.

What they actually found was even better than that. The subjects not only showed improved aerobic fitness by measuring the amount of oxygen used during aerobic exercise, but they also showed significant decrease in the frequency of their migraines, severity of migraines, and amount of headache medication used. There was also a significant increase in their Quality of Life score, as measured by a Migraine Specific Quality of Life questionnaire.

Types of Exercise

Exercise is indeed important. However, if you are dragging yourself, kicking and screaming and finding every excuse in the book not to go because you HATE it-well, how therapeutic is that? But if you can find some sort of exercise that you actually enjoy doing, or if you can make the exercise enjoyable with the addition of music, a friend, a spouse, beautiful scenery, the therapeutic value will increase, because now in addition to the aerobic benefits of exercise, you are participating in a recreational activity that brings you pleasure. Open your mind to the types of exercise you might find yourself enjoying: fast walking, cross-country skiing, water aerobics, belly dancing--anything that gets your heart rate up and holds it there. Check out your local YMCA or Rec Center and see what classes they offer-you might find yourself inspired.

Getting Started

Getting started is always the hardest part. But take it day by day. Find something you want to try. Look at the Borg scale of Perceived Exertion, and give yourself a similar warm-up, exercise, and cool-down pattern. Realize that you don't have to work out at maximal exertion in order to get benefit. And then just do it! And keep doing it. And then, 6 months from now, revel in amazement at how much stronger, healthier and energized you feel.

MHNI Physical Therapy Division

References

1. Kelman L. The triggers or precipitants of the acute migraine attack. Cephalalgia. 2007;27:394-402.
2. Neususs K et al. Physical activity and fitness in patients with headache disorders. Int J Sports Med. 1997;18:607-611.
3. Lambert RW, Burnet DL. Prevention of exercise induced migraine by quantitative warm-up. Headache. 1985;25:317-319.
4. Lockett DM, Campbell JF. The effects of aerobic exercise on migraine. Headache. 1992;32:50-54.
5. Koseoglu E et al. Aerobic exercise and plasma beta endorphin levels in patients with migrainous headache without aura. Cephalalgia. 2003;23:972-976.
6. Narin SO et al. The effects of exercise and exercise-related changes in blood nitric oxide level on migraine headache. Clin Rehabil. 2003;17:624-630.
7. Varkey E et al. A study to evaluate the feasibility of an aerobic exercise program in patients with migraine. Headache. 2009;49: 563-570.