Corina Froese had her first severe headache when she was 11. “I had never experienced that kind of sensation before. I remember realizing, ‘Oh, this must be what a headache is,’” she says. By the time she was 14, she was vomiting and sensitive to light, sounds, and smells whenever an excruciating migraine ruined her night.
As she entered her twenties the migraines became more frequent (five times a month) and intense, to the point where all she could do was lay down in complete darkness. She tried to identify and avoid her triggers, but nothing seemed to help. She also started working out, eventually finding a high-intensity group fitness class she took once a week. “Within about three classes, I started to notice that, like clockwork, later that afternoon, I’d have a migraine,” says Froese, who was 26 at the time.
She loved the endorphin rush, so the Clearwater, Florida resident managed the resulting pain with a combination of ice on her head, over-the-counter migraine medication, and sleeping. After three years, though, the post-workout migraines were too much. “I have never liked any workout as much as that class, but I just couldn’t continue,” she says. Froese switched to indoor cycling, which, to her surprise, actually helped her migraines.
Like Froese, many of the 39 million Americans who experience migraines report that working out can induce intense head pain, oftentimes causing them to give up sports and activities they love. Migraines are the sixth-most disabling illness in the world, causing throbbing, pulsing head pain, often accompanied by nausea and sensitivity to light, sound, and odors. In the past, researchers believed the dilation and constriction of blood vessels in the head caused migraines. However, “the pathophysiology of migraine is very complex and is far more so than we once thought,” says Kevin Weber, MD, a neurologist at the Ohio State University Wexner Medical Center. What experts do know is that several things can trigger a migraine, including stress, hormonal changes in women, alcohol, changes in sleep or weather, certain foods, and, as Froese experienced, physical exertion.
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In a 2013 study published in The Journal of Headache and Pain, 38% of migraine sufferers reported exercise-induced migraines, with more than half saying they stopped the offending sport (most often running or racket sports) as a result. A few chemicals in the body may explain this connection, namely increased levels of hypocretin, calcitonin gene-related peptide (CGRP), or lactate, Weber explains.
Hypocretin is a chemical signal in the brain that helps regulate sleep. But many of the functions regulated by hypocretin are impaired in those who have migraines, and some believe hypocretin may cause symptoms such as yawning or fatigue that can occur before a migraine, Weber says. What’s more, intense exercise can impair sleep, and poor sleep can be a migraine trigger. CGRP is another neuropeptide that’s associated with migraines — to the degree that the FDA has approved drugs comprised of anti-CGRP antibodies to prevent the headaches. Lastly, lactate (or lactic acid) is a byproduct of anaerobic exercise the body produces for energy purposes. Increased lactate levels have been found to be associated with increased migraine attacks, Weber says, but whether lactate causes migraines or is a byproduct of migraines is still unclear.
But there may be other factors too, which all come down to your body trying to maintain homeostasis, says Carolyn Bernstein, MD, a neurologist at the Brigham and Women’s Hospital who specializes in headache medicine. “The brains of people who have migraines want things to be the same all the time,” she explains. “And when things change — such as rapid changes in body temperature, getting the heart rate up by jumping around, bright lights in a gym or outside, or changing position quickly — it can trigger a migraine.”
Additionally, dehydration can lead to migraines. “Most of us don’t drink enough water,” Bernstein says, “so sweating can exacerbate the problem.” And anything that involves pounding up and down is typically out of the question for migraine sufferers. “When I run, I feel like my head is shaking at the same time — it’s like a head earthquake,” says Claire Lee, 24, of Houston, Texas. “I can’t be hard on myself. Running rigorously, jumping, burpees, or lifting heavy weights puts too much stress on my body and does not help at all.”