By Judy Foreman
A few weeks ago, on an otherwise uneventful Sunday afternoon, I got an urgent call on my cell phone from my daughter-in-law, Robin, a vigorous 42-year-old. She was calling from her health club, barely “10 minutes into a decent run” on the treadmill
Suddenly, she told me, she had gotten a “hole” in her vision in her right eye, and zig-zaggy lines like lightening when she closed her eye, a predictable sign, she knew from past experience, that a migraine headache was about to start.
An exercise-induced migraine was not a total surprise for Robin, who has had about a dozen such episodes over the years. “It does make me scared to exercise for a few days,” she told me later. “But then I just get on with my life. I only get four or five migraines a year, so it’s not as scary for me as for some people.”
For years, exercise has been believed to be a significant “trigger” for migraines, along with other triggers, or premonitory symptoms, such as food cravings, being very tired, mood changes, increased urges to urinate, muscle aches, stuffy noses – all part of what Dr. Carolyn Bernstein, a neurologist and migraine specialist at Beth Israel Deaconess Medical Center calls the “build up of what’s changing in the brain before migraine pain gets going.”
But in a recent study in the journal Neurology, researchers explored the exercise-migraine link in a novel way.
They gathered 27 people, good sports and brave souls all, who reported getting migraines with aura that were triggered by bright or flickering light or strenuous exercise. (Migraine auras are typically visual symptoms like Robin had, but can also be other sensory problems or even difficulty speaking.)
The researchers, from the University of Copenhagen, then deliberately exposed the 27 volunteers in the lab to light stimulation, strenuous exercise or both. For the exercise stimulus, patients either went for an intense run or used an exercise bike for an hour, reaching 80 percent of their maximum heart rate. They were also exposed to bright light for 30 to 40 minutes, then were monitored for three hours afterwards and told to report any symptoms of migraine or migraine with aura.
Surprisingly, hardly anyone did. Only three patients reported an attack of migraine with aura after being exposed to light or exercise; three others reported a migraine without aura. Nobody got a migraine with exposure solely to light.
The fact that these triggers for migraine were not as powerful as long believed has left researchers scratching their heads.
Perhaps, suggested two headache specialists in an editorial accompanying the research, the triggers that people believe are harbingers of migraines are not so much triggers that lead to migraines as symptoms of a migraine already in progress.
“Are patients driven to exercise as a premonitory symptom and could their migraines be the cause, not the consequence?” they wondered. “Is the association with light simply reporting photophobia during the premonitory phase?”
Good questions, of course. But here’s an even more important one: What is a migraine patient – most of whom are young women like Robin – to do? Exercise? Not exercise? Avoid other supposed triggers as well?
“It’s a delicate balancing act,” the study’s lead author, Jes Olesen, said in an email. “People with migraines are often told to avoid triggers, including exercise, but exercise is a valuable health activity, and it doesn’t make sense to tell people with migraines to avoid all exercise.”
The solution, in other words, becomes a juggling act. If pounding up and down while running on the pavement or a treadmill brings on migraines, said Bernstein, perhaps exercising on a stationary bike or elliptical machine might help, though Robin has gotten migraines on elliptical machines, too.
If ramping up your heart rate triggers migraines, “you might walk for a while but not increase your cardiac rate.” If getting hot and sweaty brings on an attack, staying cool by swimming might be the solution.
Be vigilant, Bernstein said, and keep a diary of when migraines occur, noting exactly what was going on prior to the attack, including stress level, sleep loss, mood changes, exercise patterns and so on.
But don’t let migraines become an excuse not to exercise. “The idea is to understand how exercise affects your migraines, but don’t think it’s a license to say, ‘Okay, I won’t exercise.’ ”
Robin agrees: “If I think I’m close to getting a migraine,” she said, “I won’t exercise. But otherwise, I do.”
Judy Foreman, a health reporter in Boston, just completed a book about chronic pain: “A Nation in Pain: Healing Our Biggest Health Problem