The benefits of regular exercise are hard to overstate: it helps you to control your weight; it helps prevent or manage chronic health problems like heart disease, diabetes, and depression; it improves your mood; it boosts your energy, and it improves your sleep.
However, getting exercise may not be as straightforward as it is for other people with migraine. The World Health Organization recommends getting at least 150 minutes of moderate to vigorous activity per week.
But according to study findings presented at the American Academy of Neurology's annual meeting in 2021, over two-thirds of people who have migraine do not get this much exercise. Those who didn't get the recommended amount of weekly activity showed higher rates of depression, anxiety, and sleep problems.
However, the researchers also found that those who got at least 150 minutes of regular weekly exercise could reduce the frequency and intensity of their migraine.
Besides the usual hurdles that can make exercise difficult, such as a lack of time, many people with migraine may not be active for other specific reasons. Richard Lipton, MD, a neurologist, and director of the Montefiore Headache Center in New York City, told the Migraine World Summit that the following challenges could come up:
It's hard to find the motivation and energy to exercise when feeling fatigued, which can be a common problem for people with chronic pain conditions, such as migraine. Fatigue itself can also be part of the early stages of a migraine attack.
Especially if you're exercising in a hot room or when it's hot outside, you're more likely to get dehydrated. About one-third of people with migraine report that dehydration is a trigger, according to the American Migraine Foundation (AMF)—and for some, even a slight amount of thirst can bring on an attack.
According to Migraine Canada, to stay adequately hydrated, an easy rule to remember is to have 2 liters a day or half a gallon of water, which means 2 cups per hour if you're awake 16 hours a day.
A study published in 2018 in the Journal of Headache and Pain found that for 38 percent of people with migraine, exercise could trigger an episode, causing participants to stop their physical activity. This might be because of the elevation of blood pressure during practice or the release during physical activity of a neuropeptide called calcitonin gene-related peptide (CGRP), which causes intense inflammation in the coverings of the brain, often leading to the pain of a migraine attack.
If you're already in pain, exercise may amplify it because of the increase in your blood pressure.
However, the same 2018 Journal of Headache and Pain study found that regular exercise could have a neuroprotective effect against migraine. Researchers suggest this may be because of an altered migraine-triggering threshold in people who exercise regularly.
In addition, a separate 2019 review of migraine studies published in the Journal of Headache and Pain found that regular aerobic activity could lead to fewer migraine episodes. The study participants who exercised regularly reported lower pain levels and a decrease of 0.6 migraine days per month.
It's essential to exercise regularly when you live with migraine—but finding the right kinds of exercise that won't trigger an attack or make existing pain worse is crucial.
Very vigorous, high-impact activities may not be a good idea when you have a migraine. Dr. Lipton told the Migraine World Summit that he recommends gentle aerobic exercise. Also known as cardiovascular exercise or cardio, aerobic exercise gets your heart pumping and strengthens your lungs. This can include walking 30 minutes most days of the week or doing other activities such as dancing, swimming, or yoga.
Start with a moderate intensity, which means you can still talk while performing an activity. During vigorous exercise, it's hard to speak, and you may need to stop to catch your breath. You can incorporate other activities, such as lifting weights as you gain more strength. You can do flexibility exercises by stretching before and after your workout or yoga or Pilates.
As your body gets more used to working out, you can also increase exercise intensity and see how that feels.
The keys to sticking with exercise over the long term are to find activities you enjoy and that you can fit into your schedule (or change your plans to accommodate). People who like to socialize when they exercise may enjoy in-person exercise classes, walking clubs, tennis, or other group activities.
Those who prefer to go solo might want to go on a walk or jog by themselves or do in-home exercise videos. If you like being outdoors, biking and hiking might be your preference.
Some people like to schedule exercise simultaneously each day to stick with it more easily (and sticking to a routine can be beneficial for people with migraine to avoid attacks).
You might enjoy exercising first thing in the morning or right after work. Suppose you know you will not go to a gym several times a week or exercise outside when the weather is terrible. In that case, you might invest in equipment you can use at home, like an exercise bike or just inexpensive items like hand weights.
You can help to avoid exercise-related migraine by taking steps before, during, and after your workout. These include:
Talk to your doctor if you're consistently experiencing migraine when you exercise, despite following the outlined prevention steps. Preventive migraine medications may be helpful, so you can still reap the benefits of regular physical activity.
Migraine during exercise is a cause for concern. In rare cases, a migraine during exercise is a sign of an emergency. According to the AMF, if any of the following scenarios apply to your migraine, call 911 and go to the nearest emergency room:
There are so many benefits to regular exercise—don't let migraine pain, or fear of exercising, inducing a migraine, keep you from being active.
Exercise is just one of the many triggers that can impact people with migraine, and every person with migraine is different. Other common triggers can include stress, changes in your sleep schedule, menstrual hormones in women, and bright light. It's hard to know what triggers a migraine for you, especially if your triggers seem different from one episode to the next.
Working with a Mable headache specialist can help you pinpoint your triggers—including exercise—and provide you with a customized migraine treatment that's more likely to help lessen the frequency and severity of your migraine.
Our specialists can also monitor your condition over time—meaning you'll have the support you need to prevent migraine even more effectively, so you can exercise, work, and engage with family and friends like you want to.
1. Mayo Clinic, “Exercise: 7 benefits of regular physical activity.” https://www.mayoclinic.org/healthy-lifestyle/fitness/in-depth/exercise/art-20048389
2. American Journal of Managed Care. “Study Finds Low Exercise Rates Among Migraineurs Despite Associated Benefits.” https://www.ajmc.com/view/study-finds-low-exercise-rates-among-migraineurs-despite-associated-benefits
3. Migraine World Summit, “Moving Through the Pain: Exercise and Migraine.” https://migraineworldsummit.com/talk/moving-through-the-pain-exercise-and-migraine/
4. American Migraine Foundation, “Top 10 Migraine Triggers and How to Deal With Them.” https://americanmigrainefoundation.org/resource-library/top-10-migraine-triggers/
5. Migraine Canada, “Hydration and Migraine.” https://migrainecanada.org/posts/the-migraine-tree/branches/self-care-lifestyle/hydration-and-migraine/
6. Amin FM, Aristeidou S, Baraldi C, et al. The association between migraine and physical exercise. J Headache Pain.2018;19(1):83. Published 2018 Sep 10. doi:10.1186/s10194-018-0902-y
7. Lemmens, J., De Pauw, J., Van Soom, T. et al. Theeffect of aerobic exercise on the number of migraine days, duration and pain intensity in migraine: a systematic literature review and meta-analysis. JHeadache Pain 20, 16 (2019). https://doi.org/10.1186/s10194-019-0961-8
8. American Migraine Foundation, “Effects of Exercise on Headache and Migraine.” https://americanmigrainefoundation.org/resource-library/effects-of-exercise-headache-migraine