Aerobic exercise is Jane Fonda type aerobics, jogging, cycling, swimming, rowing, cross-country skiing, elliptical equipment, and stair-stepping.  It is not walking, lifting weights, stretching, yoga, Pilates, or playing most games, like tennis, golf, or racquetball. 

Fast walking may be classified as low-level aerobic exercise.  Tennis, golf, and racquetball are too slow, and the exercise is intermittent.  Because of the running, soccer and basketball would be considered aerobic exercise.

If you are already exercising and still have bad headaches, consider increasing your exercise program.  Exercise is something you can do for yourself to take control of your headaches, but it takes determination, time, and effort.

I know exercise is good for health, but does it help Migraines?

Let’s start out right, read my article on “What is Migraine?” on my website, www.doctormigraine.com.

This is an article by Britt Talley Daniel MD, retired member of the American Academy of Neurology, the American Headache Society, migraine textbook author, and blogger.

Multiple studies and literature reviews through the years have favored aerobic exercise as therapeutic for migraine.  Exercise may decrease the frequency, duration, and intensity of migraine.  Exercise for migraine then is like, a drug, a very helpful drug that is good for you, that reduces tension, promotes sleep, and helps Migraine.

Read my mini book on Migraine.

Related Questions.

1.What are the other benefits of exercise?

Aerobic Exercise is good for reducing the risk of atherosclerosis, so the patient may get a double bonus-exercise reduces migraines and helps the heart.  Although migraine with aura carries a slight, 6% risk for stroke, migraine headaches don’t usually kill anyone.

However, the ravages of atherosclerosis are the main entries on death warrants—myocardial infarction (or heart attack) and cerebral infarction (or stroke.)  The American Heart Association has warned that the number 1 cause of death over age 50 is heart attack and the number 3 cause of death is stroke.  This fact is important.  It’s why the American Heart Association has suggested that “level of activity” is one of the risk factors for atherosclerosis.

The other risk factors are genetics, overweight, cigarette smoking, elevated cholesterol, and diabetes.  The American Heart Association has suggested that everyone exercise aerobically for 20-30 minutes 3-4 days a week.  Aerobic exercise is defined by the heart rate.  There are different heart rates recommended by age to qualify for being aerobic exercise.

One has to then do the exercise and obtain and keep that heart rate for the required time for the work out to be “aerobic.”  Work out machines at health centers usually can calculate the required heart rate after obtaining the person’s age.  Aerobic heart rate per age can also be obtained at the YMCA, an exercise store, or over the internet.

Several years ago, a Mayo Clinic cardiologist reported that “Sitting is the new Smoking,” and said that even if someone is doing the 3-4 days of aerobic workout as suggested, that if they sit all day, then they have a risk of heart disease.  That’s when I got a Desk Cycle from Amazon and put it under my desk at my office.

2.Does playing basketball help migraine?

Kinart, et al, writing in 2002 in Headache on “Prevalence of Migraines in NCAA Division I Male and Female Basketball Players,“ used the International Headache Society’s criteria for migraine to determine the first prevalence study of migraine in college athletes.

A validated headache survey was mailed to 791 Division I men and women basketball players representing 51 colleges and universities.  The results were 2.9% of the group was classified as having migraine.  (Recall that 25 % of women and 6% of men in the US have migraine.)  Caucasians had a rate of 3.3% and African Americans of 3.1%.  The prevalence in the athletes was .9% in men (3/332) men and 4.4% in women (20/459).  Kinart, et al, concluded:

…it was found that the prevalence of migraines in National Collegiate Athletic Association Division I men's and women's basketball players was generally less than in the general population, that women showed an increased prevalence of migraines when compared with men, and that Caucasians and African Americans did not differ in prevalence of migraines.

3.What about change in blood nitric acid level and migraine?

Narin, et al, writing in 2003 in Clinical Rehabilitation on “The effects of exercise and exercise-related changes in blood nitric oxide level on migraine headache” studied 40 women with migraine attending the neurology clinic at Dokuz Eylül University in Turkey.

Comparing an exercise group undergoing aerobic exercise for 1 hour three times a week and a non-exercise control group for 8 weeks, they found a decrease in pain relief and quality of life measures in the exercise group.  Blood nitric oxide level rose in the exercise but not the control group.  Narin, et al, concluded:

The study showed that regular long-term aerobic exercise reduced migraine pain severity, frequency and duration possibly due to increased nitric oxide production.

4.What about exercise and endorphin levels?

Koseoglu, et al, writing in Cephalalgia in 2003 on “Aerobic exercise and plasma beta endorphin levels in patients with migrainous headache without aura” evaluated the effect of plasma beta endorphin level and exercise on migraine.

They studied 40 patients with migraine without aura who exercised for 6 weeks on a treadmill.  They looked at pre and post exercise plasma beta endorphin levels.  Koseoglu, et al, reported: “Exercise was found to have beneficial effects on all migraine parameters and to increase beta endorphin levels after the treadmill practice….”  The study: “…emphasizes the beneficial effect of exercise on migrainous headache, especially in patients with lower basal beta endorphin level.”

5. Does all the literature about migraine favor exercise?

Not all the migraine literature is supportive of an ameliorating effect from exercise.  Busch and Gaul writing in Cephalalgia in 2003 on “Exercise in Migraine Therapy—Is There Any Evidence for Efficacy?  A Critical Review,” investigated whether recommendations of exercise for migraine are “based on sufficient data to cope with requirements of an evidence-based modern migraine therapy.”

Busch and Gaul reviewed and discussed all available trials on the subject (eight studies and 4 case reports).  They felt that “some results are controversial regarding the efficacy of sports intervention in migraine.”  They found that the majority of studies did not find a significant reduction of headache attacks or headache duration, but only indicated a reduction of pain intensities.  Busch and Gaul concluded:

To further recommend exercise in migraine based on EBM-criteria, more studies are imperative.  Future studies should adhere to the rules for randomized clinical trials in pharmacological migraines prophylaxis. Implications for further studies are given.

6. How about a training program for migraine patients?

Darabaneaunu, et al, did just that and described their work in an article they wrote for International j Sports Med in 2011 on “Aerobic exercise as a therapy option for migraine:  a pilot study.”  They studied 8 migraine patients with no special physical training and compared them with 8 migraine patients who completed a 10-week aerobic running program which consisted of 3 workouts per week.  Darabaneanu, et al, found:

Migraine patients of the exercise group showed both a reduction in the number of migraine days per month (p=0.048) and the intensity of the attacks (p=0.028).

7. What do reviews of the literature on exercise and migraine reveal?

Koseoglu, et al, writing in J Sports Med Phys Fitness in 205 on “The role of exercise in migraine treatment,” studied scientific databases with keywords “exercise” and “migraine.”  The authors found that:

Patient population with low beta endorphin level in blood, high physical fitness and high motivation receives significant benefits from the exercise treatment. The action of exercise on migraine is in general related to neurochemical factors, psychological states and increase in cardiovascular and cerebrovascular fitness.

Considering its effectiveness and minimal side effects, migraine patients should often be encouraged to practice physical exercise with intensity, frequency and duration that should be carefully instituted to achieve the most beneficial outcome while preventing potential injuries and side effects.

Amin, et al, wrote in J Headache Pain in 2018 on “The association between migraine and physical exercise.”  Amin, et al, thought there is “an unmet need of pharmacological and non-pharmacological treatment options for migraine patients.  They performed a Pub Med review using the search words “migraine” and “exercise.”  Amin, et al, concluded:

In conclusion, it seems that although exercise can trigger migraine attacks, regular exercise may have prophylactic effect on migraine frequency. This is most likely due to an altered migraine triggering threshold in persons who exercise regularly. However, the frequency and intensity of exercise that is required is still an open question, which should be addressed in future studies to delineate an evidence-based exercise program to prevent migraine in sufferers.

Kroll, et al, wrote in Cephalalgia in 2018 on “The effects of aerobic exercise for persons with migraine and co-existing tension-type headache and neck pain. A randomized, controlled, clinical trial.”  Kroll studied 53 persons in an aerobic exercise group performing bike/cross-trainer/brisk walking for 45 minutes three times/week and a control group doing no exercising.

Kroll, et al, concluded:

Exercise significantly reduced the burden of migraine and the ability to engage in physical activity because of reduced impact of tension-type headache and neck pain. Exercise also reduced migraine frequency, pain intensity and duration, although this was not significant compared to controls. These results emphasize the importance of regular aerobic exercise for reduction of migraine burden.

Lemmens, et al, wrote in J Headache Pain in 2019 on “The effect of aerobic exercise on the number of migraine days, duration and pain intensity in migraine: systematic literature review and meta-analysis.”

The authors conducted a systematic review and meta-analysis of five pervious studies and one controlled trial. Participants exercised by walking, cross-training, jogging, or cycling 30-45 minutes 2-3 times a week for 10 weeks.  All training was in the aerobic area. Results showed significant decreases in the number of migraine days per month with aerobic exercise.

A study by Yarkey, et al, in 2011 writing in Cephalalgia entitled “Exercise as migraine prophylaxis: a randomized study using relaxation and topiramate as controls,” suggested that exercise may provide similar reductions in headache days per month as topiramate.  Santiago, et al, writing in 2014 in Arq Neuropsiquiatr found that exercise with amitriptyline was more effective than amitriptyline alone.

How about learning about “Lifestyle Issues For Migraine Prevention,” an article on my website, www.doctormigraine.com?

8. What about work out headaches?

Some migraine patients get a “work out headache” if they get hot.  If this happens with exercise, then change to work out in a cool environment so you don’t get so hot.  Exercise inside in front of a fan or in air conditioning to jog on a treadmill rather than running out in the hot July sun.

Take ibuprofen, Excedrin, or a half of a Triptan drug only 2 days a week to avoid overtreating before you work out.  If you still get a work-out headache, then try a sport that doesn’t raise the body temperature like swimming.

A general rule regarding exercise is that if a migraine has already started then exercise should be avoided.  However, in some patients, migraine may be stopped by exercise.

Aerobic exercise is good for migraine, anxiety disorders, panic attacks, depression, tension-type headache, and sleep problems.  There are many articles in the last 30 years on the value of aerobic exercise for migraine.

In Summary.

You can read the data.  Now, all you migraine patients know what you have to do.  Set aside some time, call your gym, get your water bottle, and let’s go for it.

Exercise is Great for Migraine.

Check out my big book on Migraine.

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All the best.

Follow me at:  www.doctormigraine.com, Pinterest, Amazon books, Podcasts, and YouTube.

Britt Talley Daniel MD