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Migraine, Comorbidities, and Exercise - A delicate balance


"Lack of activity destroys the good condition of every human being, while movement and methodical physical exercise save it and preserve it." -Plato

A number of recent studies have shown aerobic exercise may yield positive outcomes for migraine and consequently regular exercise is recommended as an intervention for migraine management and prevention. However, for those of us with migraine disease, the reality is exercise can be a "damned if you do and damned if you don't" situation. For example, if we have pain and exercise, we may aggravate our pain. If we are pain-free and exercise, we may trigger a migraine attack. On the other hand, if we don't exercise because of pain or fear of a migraine attack, we deny ourselves the option of a preventive treatment for migraine.

In addition, given the role of exercise in the preservation of health and promotion of wellness, lack of exercise deprives us of the health benefits regular activity provides for a number of diseases and disorders shown to be comordid with migraine, including obesity, cardiovascular disease (heart disease, angina, high cholesterol, high blood pressure, stroke), circulation problems, arthritis, chronic pain disorders, anxiety, and depression (Buse, Manack, et al, 2010). This is important for us to know because:

  • an increase in the frequency of our attacks is correlated with an increase in a number of these comorbidities and may contribute to our progression from episodic to chronic migraine; 
  • depresssion, anxiety, and chronic pain disorders have all been associated with chronic migraine at higher rates than episodic migraine (Buse & Silberstein, 2013); 
  • and, the effects of depression, anxiety, and obesity are additive (Katsarava, Buse et al, 2012). For example, related disability increases when obese individuals have comorbid depression or anxiety compared to non-depressed obese individuals.  

How, then, do we effectively incorporate exercise into our treatment plans?

"If we could give every individual the right amount of nourishment and exercise, not too little and not too much, we would have found the safest way to health". - Hippocrates.

Perhaps, for those of us with migraine, our answer lies in the words of Hippocrates. We find the right amount of exercise, not too little and not too much, to suit our individual needs. 

To help us find the right amount of exercise and tailor the activity to meet our individual needs, this article addresses:

  • the health benefits of exercise.
  • the types of exercise we should consider.

The health benefits of exercise

The health benefits of exercise are numerous. As you read through the following list, keep in mind your personal comorbidities and risk factors for progression from episodic to chronic migraine.

Regular exercise can: 

  • improve circulation to our extremities and warm up our cold hands and feet.
  • boost our energy and help with fatigue.
  • promote hormonal stimulation and enhance our sexual function.
  • increase our metabolism, burn fat, help us maintain a healthy weight, and prevent obesity.
  • balance our blood sugar, decrease insulin resistance, and help prevent diabetes.
  • improve our sleep by restoring normal body rhythms.
  • elevate our HDL (good) cholesterol and help protect us from heart disease.
  • decrease or normalize our blood pressure and help decrease the risk of stroke. 
  • improve our muscle tone, strength and endurance.
  • strengthen our bones, cartilage and ligaments and lower our risk for osteoporesis.
  • increase our serotonin and dopamine levels and help reduce anxiety and depression.
  • improve our mental function.
  • raise our endorphin levels (bodies' natural pain reliever).
  • reduce levels of our stress hormones, promote calmness and relaxation, and decrease the effects of stress on our bodies.

Types of exercise we should consider

To begin with, if you haven't exercised in a long time because of pain, fear of a migraine attack, or other health considerations, you should have a physical examination by your doctor or other health care professional. At your appointment, you might want to ask for a consultation with a qualified physical therapist to plan and initiate an exercise program that is best for your situation. Also, if you pick an exercise that is new to you, always seek guidance from a qualified instructor to learn the proper technique. 

Keep in mind, any form of activity that moves our bodies, increases the work of our heart and lungs, and burns calories is considered exercise. These activities include walking, running, gardening, climbing stairs, working out at the gym, sports, swimming, hiking, biking, dancing, yoga and tai chi.   

That said, for those of us with migraine, the type of exercise we choose, apart from the overall health benefits, may be significant in either reducing the frequency and severity of our migraine attacks or precipitating a migraine attack. Low - to moderate - intensity exercises such as walking, cycling, and yoga, as well as sports that rely on endurance rather than power like, swimming, jogging, and tai chi are thought to decrease the frequency and severity of our migraine attacks by:

  • increasing our serotonin levels.
  • raising our endorphin levels.
  • helping in stress reduction.

Here, it is interesting to note, "A Study to Evaluate the Feasibility of an Aerobic Exercise Program in Patients With Migraine", (Varkey et al, 2009), demonstrated moderate-intensity exercise (indoor cycling), including warm-up and cool-down periods, was well tolerated by the patients. Patients were reminded to consider stress, proper sleep, good nutrition and hydration during the study. 

Another study aimed to evaluate the effects of exercise in migraine prevention (Varkey et al, 2011) showed exercise (based on indoor cycling) was found to be equal to the well-documented methods of relaxation and topiramate with regard to the reduction of migraine frequency. The report goes on to say this non-pharmacological approach may be a treatment option for patients with migraine, who do not benefit from or do not want to take daily medication. And, adds "from a wider health-based perspective, it should be stressed that patients with migraine are less physically active than the general population, and that exercise has positive effects in terms of general well-being and the prevention of disease."

In addition, a pilot study, "Aerobic exercise as a therapy option for migraine," (Darabaneanu et al, 2011), showed migraine patients in the exercise group (running program) had both a reduction in the number of migraine days per month and the intensity of attacks. As well, the increase in fitness level resulted in a lowered stress level. 

At this point, we need to know that strenuous and high-intensity exercises such as running, jumping rope, and heavy weight lifting, as well as sports that include short bursts of speed alternated with periods of moderate-intensity like singles tennis, basketball, and soccer, are believed to precipitate or aggravate our attacks because: 

  • although they increase our endorphins, they also increase our epinephrine levels heart rate and blood pressure.
  • if prolonged, the increase in our epinephrine levels may propel our bodies into the "fight or flight response" and decrease our serotonin levels.
  • some exercises, like heavy weight lifting, may cause muscle tightness or spasms in our upper body.

In a recent study that investigated the lifetime prevalence of exercise-triggered migraine (ETM) attacks and if patients with ETM experienced specific prodromal or ictal migraine symptoms (Koppen and vanVeldhoven, 2013), results included

  • life time prevalence of ETM attacks was high regardless of migraine type (with or without aura) or gender.
  • possible rise in cardiac output and systolic blood pressure triggers ETM attacks.
  • those experiencing ETM attacks more frequently had neck pain as the initial symptom explained by activation of upper cervical nerve fibers and release of neuropeptides.
  • higher brain lactate levels were associated with higher migraine frequency and could explain the triggering of migraine attacks by high-intensity exercise.
  • the majority of patients stopped practicing high-intensity exercise, but were able to continue other low-intensity exercise.  

"Movement is a medicine for creating change in a person's physical, emotional, and mental states."  - Carol Welch

Holding on to the delicate balance of migraine, comorbidities, and exercise, in this article, we have learned lack of movement because of migraine attacks deprives us of a valuable health activity, along with participation in the sports we enjoy, and negatively affects our physical, emotional, and mental states. On the other hand, low-to -moderate intensity exercises may decrease the frequency and intensity of our attacks and help us enjoy the benefits of better overall health and quality of life, including enhancing our self-efficacy for migraine management (capability and confidence).

A few other things to keep in mind include

  • if we feel a migraine coming on, a short walk in the fresh air might help.
  • exercising during a full blown attack may be extremely painful and is probably best avoided.
  • *if we can't talk without stopping for a breath during any form of exercise, then the activity it is too strenuous or intense.
  • exercising in the heat is not wise as the activity may trigger a migraine from heat intolerance.
  • stay hydrated, and avoid hypoglycemia.
  • wear a hat and sun glasses when exercising outdoors.
  • should not exercise close to bedtime as it may interfere with sleep.
  • pick something fun.
  • set realistic goals and, given our unique situations, do what we can do to achieve them.

*Aerobic (cardiovascular) recommendations for moderate-intensity exercise include at least 30 minutes of the activity per day, repeated 5 days a week, along with strength and stretching exercises twice a week for flexibility and stamina. However, we can break up our activities into fifteen minute periods, three times a day, and achieve the same benefits. Then, increase the time as we get stronger. As well, walking is a great way to start. 

Finally, we should be aware in a recent publication, "Aerobic Exercise for Reducing Migraine Burden: Mechanisms, Markers, and Models of Change Processes," (Irby, Bond, Lipton, et al, 2016), the authors reviewed 9 studies that incorporated aerobic exercise for migraine. All studies reported a  reduction in headache frequency and/or intensity. Despite the apparent consistency, Irby, Bond, Lipton, et al, report it is a challenge to draw conclusions about the independent effects of exercise as published in most reports to date. The authors then proceed to explore mechanisms and pathways that reduce the frequency, duration, severity or associated disability with migraine in conceptual models linking aerobic exercise and migraine improvement. They articulate a variety of potential mechanisms and markers that could account for the effects of aerobic exercise on migraine; encourage and facilitate further research; and, hopefully benefit migraineurs, including the many who remain suboptimally treated, by providing a new therapeutic avenue to established interventions for migraine. 

*Note: "A systematic review and meta-analysis was performed to investigate the result of aerobic exercise on the number of migraine days, duration and pain intensity in patients with migraine...Read the full review, "The effect of aerobic exercise days on the number of migraine days, duration and pain intensity in migraine: a systematic literature review and meta-analysis", published January, 2019, in the Journal of Headache and Pain.


Buse, D.C., Manack, A., Serrano, D., et al. (2010). "Sociodemographic and comorbidity profiles of chronic migraine and episodic migraine sufferers." J Neurol Neurosurg Psychiatry. Apr;81(4):428-32. doi: 10.1136/jnnp.2009.192492. 

Buse, D.C., Silberstein, S.D., et al. (2013). "Psychiatric comorbidities of episodic and chronic migraine." J Neurol. Aug;260(8):1960-69. doi: 10.1007/s00415-012-6725-x.  

Darabaneau, S., Overath, C.H, et al. (2011). "Aerobic Exercise as a therapy option for migraine: a pilot study". Int J Sports Med.  Jun;32(6):455-60. doi:10.1055/s-0030-1269928.

Irby, Meghan, B., MS,  Bond, Dale, PhD,  S., Lipton, Richard, B., MD, et al. (2016). "Aerobic Exercise for Reducing Migraine Burden: Mechanisms, Markers, and Models of Change Processes". Headache. Feb;56(2): 357-369.

Katsarava, Z., Buse, D.C., et al. (2011). "Defining the Differences Between Episodic Migraine and Chronic Migraine." Curr Pain Headache Rep. February; 16(1):86-92.                 

Koppen, H., & van Veldhoven P., LJ., (2013). "Migraineurs with exercise-triggered attacks have a distinct migraine." The Journalof Headache and Pain. 14:99 doi:10.1186/1129-2377-14-99.    

Murray, S., M.S., R.N., Migraine; Identify Your Triggers, Break Your Dependence on Medication, Take Back Your Life - An Integrative Self-Care Plan For Wellness. San Francisco: Conari Press, 2013.

Ni. M., L.Ac., D.O.M., PH.D. Secrets of Self-Healing. New York: Avery, 2008.

Varkey, E., RPT, Cider, A.,RPT et al. (2009). "A Study to evaluate the feasibility of an aerobic exercise program in patients with migraine." Headache."  Apr;49(4):563-70. doi: 10.1111/j. 1526-4610.2008.01231.x. 

Varkey, E., Cider. A., et al. (2011). "Exercise as migraine prophylaxis: A randomized study using relaxation and topiramate as controls." Cephalalgia. October; 31(14): 1428-1438. doi: 10.1177/0333102411419681.

Sharron Murray MS, RN is an author and coauthor CaMEO Study, "Life With Migraine". Currently, Sharron is active in the migraine community as a writer, advocate, American Migraine Foundation Partner, moderator for the American Migraine Foundation "Move Against Migraine" Facebook Group, and member of the National Headache Foundation Patient Leadership Council.  

Follow Sharron on twitter @murraysharron, her Facebook page: Sharron Murray, MS, RN, and her website

This article is not intended as a substitute for medical advice. If you have specific concerns about your health or nutrition, please contact a qualified professional.

Updated, February, 2019.

Copyright 2014, Sharron E. Murray

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    sharron murray - Sharron's Articles - Migraine, comorbidities, and Exercise - A delicate balance
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    A good exercise is very important for a healthy life. As you also described the importance of these movements this is very nice from you. Those who are having the interest in this will be enjoying lots of the benefits.
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    Response: indoor workouts
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Reader Comments (2)

Good post. Migraine depends in our daily activities and can ruin our day. We should be aware of the things that may trigger migraine and enjoy things around.

November 24, 2014 | Unregistered Commenterbutalbital apap caffeine

Thank you for your kind comments. Our "migraine brains" definitely like routine :).

January 1, 2015 | Registered CommenterSharron E. Murray

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