How not to miss workouts or good times out

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If you spent yesterday lying quietly in a darkened room, you’re not alone: At least 18 million Americans experience migraines, 13 million of them women. According to the National Headache Foundation, a Chicago-based nonprofit organization, migraine sufferers lose more than 157 million workdays to headache pain each year – and for athletes and people who exercise regularly, that translates into a slew of training days as well.

Fortunately, research suggests that physically active women are less likely to get migraines than the average couch potato, or at least may have them in less-severe form. In one study, migraine sufferers who improved their cardiovascular fitness. with aerobic workouts reported milder headaches. When the trial period ended, the participants who stopped exercising experienced the return of the old debilitating pain.

Researchers think that a migraine results from a temporary fluctuation in the level of serotonin, a chemical that maintains tension in the brain’s blood vessels. When the amount of serotonin in the brain dips, the blood vessels alternately tighten and relax, sending pulsating pain messages to the nerves.

Exercise appears to stave off headaches by thwarting that pain: During moderate to heavy exercise, the brain secretes large amounts of enkephalins and endorphins, the famed chemicals that give rise to “runner’s high”, which act as natural pain blockers. What’s more, such activity sweats away a lot of the stress that contributes to migraines.

Exercise: Cure or Spur?

In general, however, the exercise connection hasn’t been well studied. For example, it’s thought that like other known environmental triggers (such as certain foods, hormonal changes, stress, bright light, high-pitched noise and strong odors), some sports may actually bring on headaches. So common is this phenomenon that it has resulted in nicknames like “swimmer’s migraine” and “runner’s headache.” Weight lifting, cycling and hockey have been identified as other possible culprits.

Explanations for the sports connection vary, but researchers believe that strained neck muscles or increased pressure on the head often are the cause. The pain can be heightened by dehydration or fatigue. Some athletes can avoid attacks by carefully warming up before exercise, which can keep blood and oxygen levels steady, and by making sure that goggles, sunglasses, helmets or other headgear don’t fit too tightly.

Physical activity at high altitudes – cycling, climbing or skiing, say – is another source of migraines. When the 1968 Summer Olympics were held in Mexico City, 7,000 feet above sea level, some participants were unpleasantly surprised by searing headaches. High altitude can trigger a migraine anywhere from six hours to four days after your arrival in the clouds, so it’s important to allow the body a couple of days to adjust before engaging in intense exercise.

Whatever you do, don’t exercise after a migraine strikes. Most doctors agree that strenuous activity will only increase blood flow to the brain and worsen an already-agonizing headache. Do, however, try to pinpoint what’s inciting the riot inside your skull. “As the patient, you’re the best person to figure out what causes your migraines,” says Robert Smith, M.D., who directs the Cincinnati Headache Institute at the University of Cincinnati’s Drake Center. “Pay attention to the circumstances surrounding your headaches. You may be able to find the trigger.”

More Immediate Relief

The good news is that the crippling headaches are being studied more intensely than ever. According to the Food and Drug Administration (FDA), several new medications that can stop migraines once they start have been or are about to be submitted to the agency for approval. “As we learn more about the mechanisms of migraines, we’re developing more specific drugs to treat them,” says Smith. “There’s a tremendous amount of new research in on.”

These latest drugs follow in the wake of sumatriptan succinate (brand name: Imitrex Tablets), which arrived on the market in 1992. A prescription medicine, it restores order to the blood vessels by mimicking the action of serotonin in the brain. But because of its side effects, sumatriptan can’t be taken by people with cardiac disease, high blood pressure or even family histories of heart trouble. The new medications are expected to improve on it by working faster, lasting longer and producing fewer side effects. Look for the first of this latest generation of drugs to be available to the public sometime next year.

Another potential source of relief is lidocaine, a local anesthetic commonly found in such over-the-counter products as sunburn sprays and hemorrhoid preparations. According to a study published in the July 24, 1996 issue of the Journal of the American Medical Association, 55 percent of a group of migraine sufferers reported relief from headache pain just five to 15 minutes after using lidocaine nose drops. Though the migraines returned within an hour in 42 percent of those who got relief, sumatriptan users experience a similar rate of relapse. The study’s authors point out that lidocaine isn’t commercially available in nose-drops form and that large-scale studies would be needed before the FDA would consider approving it as a treatment for migraines.

Aside from prescription medication, deep breathing or a hot bath can sometimes ease migraine pain, says Andrew M. Elmore, Ph.D., a clinical psychologist in New York City. When it first strikes, stop what you’re doing and take 10 deep breaths. “Oxygen relaxes the muscles and increases blood flow, which is just what you need during a migraine,” he notes. “Better yet, get outside to some fresh air.”

A hot bath “which shuttles blood away from the brain to the body’s muscles, may also help. But Elmore warns that other folk remedies – including ice packs and caffein – can backfire. “Both of those add to the constriction-dilation cycle in the blood vessels, so they may make you feel better for a minute and then rebound you into a headache again.”

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