Sports and exercise are fairly common Migraine triggers. That can present a conundrum for us. We need exercise to maintain our health, and it's been shown that exercising regularly can help reduce the frequency, duration, and severity of Migraines. Exercise becomes a problem, however, when it triggers a Migraine or headache.
Migraines and headaches can become an additional problem for athletes, some of whom depend on sports for college scholarships and even their careers.
Dr. David Kernick and Dr. Peter Goadsby, on behalf of The Royal College of General Practitioners and The British Association for the Study of Headache have published a very comprehensive article on this subject in Cephalalgia. This article identifies the types of headache disorders most frequently a problem during exercise and sports and outlines options for treatment and prevention.
It's important to recognize the difference between primary and secondary headache disorders:
- A primary headache disorder is one that is not caused by another illness or disorder.
- A secondary headache disorder is one that is caused by another illness or disorder.
Kernick and Goadsby defined four categories of Migraine and headache to provide a logical and efficient organization for doctors:1
1. A recognised headache syndrome (Migraine, tension-type headache, cluster headache) coincidental to sporting activity.
2. A recognised headache syndrome (Migraine, tension-type headache) induced by sporting activity.
3. Headache arising from mechanisms that occur during exertion. These can be primary where the exact mechanism is not understood, or secondary where a direct causal factor can be demonstrated:
3a. Headache related to changes in cardiovascular parameters (increase in cardiac output and raised venous pressure).
3b. Headache related to trauma.
3c. Headache arising from structures in the neck.
4. Headache arising from mechanisms that are specific to an individual sport.
1: recognized headache syndrome coincidental to sporting activity
Tension-type headache (TTH) is the most frequently occurring headache disorder. TTH is usually bilateral, a steady ache, and often described as feeling like a band around the head. TTH is usually improved, not worsened, by exercise. In the event of TTH brought on by sports, simple analgesics such as acetaminophen are usually sufficient for relief.1 However, analgesic use should be limited to two or three days per week to avoid medication overuse headache (MOH). You can read more about TTH in Tension-Type Headaches - The Basics and about MOH in Medication Overuse Headache: When the Remedy Backfires.
Exercise and Migraine present a bit of a paradox. Although regular exercise can help reduce the frequency, duration, and severity of Migraine attacks, exercise can also be a Migraine trigger. Migraine is likely to be the most common primary headache to occur coincidentally during sports. Migraine is often unilateral, pulsing or throbbing and accompanied by other symptoms such as neck pain, nausea, vomiting, or increased sensitivity to light or sound. Migraine occurs more frequently in women than men and usually lasts two to 72 hours. For acute treatment of Migraine, triptans (Imitrex, Maxalt, Zomig, etc.) are the main form of treatment. Due to concerns about coronary vasoconstriction (constriction of blood vessels), the use of an NSAID with or without an antinausea medication maybe preferred by some doctors. If triptans are used by athletes during participation in sports, coronary issues such as ischemic heart disease and cardiomyopathy should be ruled out with a cardiac workup including an exercise EKG. As with TTH, use of triptans and NSAIDs should be limited to no more than two or three days per week to avoid MOH. If athletes are experiencing three or more Migraines a month, preventive measures may be considered. Beta blockers such as propranolol are often the first choice. Where beta blockers cannot be used, topiramate, sodium valproate, gabapentin, and cyproheptadine are reasonable alternatives.1