Exercise Can Be a Pain in the -- Head

Last Editorial Review: 1/31/2005

Body Gain But Head Pain

By Carol Sorgen
WebMD Feature

Reviewed By Charlotte Grayson

When it comes to exercise and migraines, you've got two sides of a coin, says Lawrence Newman, MD, director of the Headache Institute at St. Luke's-Roosevelt Hospital Center in New York. Exercise can be an effective preventive measure against migraines in some people, he says, but in others, it can actually cause them. "We think migraine sufferers have a heightened neurological system," says Newman.

"They're more apt to develop a migraine when anything is out of the ordinary -- when they get up too early, go to bed too late, skip meals, etc." For that reason, Newman suggests that people prone to migraines establish not only a schedule of eating and sleeping regularly, but also of exercising on a regular basis.

"Once you're exercising, no matter who you are," says Newman, "you're usually taking better care of yourself."

Exercise releases endorphins, the body's natural painkillers, Newman says, which can help lessen the frequency and/or severity of migraines. Almost all forms of exercising are good, from aerobics to yoga to stretching to swimming.

Gain No Pain

What Newman does suggest limiting, however, is strenuous workouts such as heavy weightlifting, which can cause muscle spasms in the upper body. These spasms can bring on headaches.

"Too much stress on the body can induce a migraine," agrees George DeJohn, a Dallas-based fitness consultant and author of Three Minutes to A Strong Mind and a Fit Body.

Before DeJohn sets up an exercise program for clients plagued by migraines, he advises them to see their doctor to determine what kind of migraines they are. "Some are caused by muscle spasms. Some are vascular in nature," says DeJohn. "It's important to know which kind you have so you can plan the most effective workout for your situation."

Since fitness consultants frequently work with their clients' eating regimen, too. DeJohn suggests that those with migraines keep a careful diary for one week of what they eat. "That will help us identify any foods that could be triggering the headache."

Two Headache Types

Exercise can help many people cope with their migraines, but in others it can actually trigger a crippling headache, Newman says. There are, he says, two types of "exertional headaches," one benign, and the other more serious.

"Certain medical conditions can cause severe headaches when exercising, coughing, even having sex," says Newman. "If someone comes in complaining of a sudden headache with exertion, then I suggest an MRI to rule out such conditions as a tumor in the back of the brain or a ruptured aneurysm."

Symptoms that warrant a doctor's attention, Newman advises, are:

  • The sudden, explosive onset of pain upon exertion.
  • A headache that gets progressively worse.
  • Headaches that begin after the age of 50.
  • Headaches accompanied by numbness and tingling in your arms or legs, weakness on one side of the body, or visual disturbances.

Heart of Matter

Headaches that begin during exercise and then go away might also point to heart disease, a group of New York researchers reported in a 1997 issue of Neurology. Led by Richard Lipton, MD, of the Headache Unit at Montefiore Medical Center in New York, researchers found that in a small group of patients, headaches that began during exercise were the only symptom of heart disease. The headaches disappeared after the patient was treated with drugs, surgery, or a combination of the two.

The report said that although this condition seems to be rare, many doctors -- as well as the general public -- are unaware of the possible link, and therefore may not check for heart disease. "Cardiac headache" should be investigated, reported Lipton, in people whose headaches began after the age of 50 and in those who have risk factors for heart disease, like hypertension, diabetes, smoking, or a family history of heart disease.

Sports Get to Your Head

Once serious conditions are ruled out, your doctor will likely say you have a benign -- meaning not dangerous -- condition frequently called "weightlifter's headache." "These kinds of headaches come on with a bang," Newman says.

"Many people get them every time they exercise and they're characterized by the sudden onset of throbbing pain. Nausea is also a common symptom, although vomiting usually isn't." These benign headaches usually disappear within 30 minutes of stopping the exercise, says Newman.

Other exercise-induced headaches, says Newman, include "swimmer's headache," which many people get from jumping into cold water, and "swim-goggle headaches," caused by goggles that are too tight. Stopping the pain is "very easy," Newman laughs. "Just take the goggles off. You'd be surprised, though, how many people don't think of that." "Footballer's headache," traditionally seen more in England and Europe, will likely be on the rise in the States, says Newman, as soccer becomes increasingly popular.

If you're prone to headaches while exercising, your doctor may prescribe an anti-inflammatory medication such as indomethacin (sold under many brand names), which is used primarily to combat arthritis. Indomethacin, which can be taken either before or during exercise, works on the blood vessels in the body, says Newman, and is thought to also act on nitric oxide -- one of the chemicals that can cause headaches.

Migraine sufferers don't have to give up exercising, Newman says. Just start slowly, he advises, and don't overindulge. "Ten minutes at a time should do it when you're starting out. Increase your time gradually and you should be fine."

Originally published May 1, 2000.

Medically updated Jan. 12, 2005.

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