SEPTEMBER  1999 MEETING
TOPIC:  “EXERCISE AND HEADACHES”

The September 14, 1999 meeting of the East Bay Headache Support Group featured Lynne Eilers, M.F.C.C., who presented a talk on exercise and headaches.  The meeting was held in the Ball Auditorium at John Muir Medical Center with 26 people in attendance.

Ms. Eilers is a family therapist who works with high-risk obesity clients, as well as families, couples and adolescents; and facilitates groups focusing on a variety of topics, including eating disorders, women’s issues, and couples issues.  When asked to speak to our group, she researched the topic of headaches and exercise, and began her presentation with good news for people who dislike exercise:  most of the information she found about exercise and headaches seemed to conclude that exercise is problematic for people who suffer from headaches.  Therefore, she stressed that we have to be careful when exercising.  Ms. Eilers admitted that she doesn’t suffer from migraines, and only periodically has head pain, so she felt guilty talking to us about headaches.  She said one day she worried about this so much, though, that the next morning she woke up with a whopper of a headache (laughter).

Ms. Eilers told us about exertional headaches, which are triggered by exertion (physical activity).  Originally it was thought that only weightlifting brought on these headaches, but actually running or pacewalking, etc. can trigger them.  She asked the audience, “Do your headaches start after exercise?”  One woman in the group responded that her headaches usually start 20 to 40 minutes after engaging in physical exercise.  Since January she has been getting a migraine with aura when she exercises, but before then she didn’t have migraines.  Another woman said she will be experiencing a headache and then start exercising, and the physical activity seems to aggravate the headache.  Another audience member said that she has headaches in phases—during her frequent headache phase, any exertion will intensify pain.

Dr. Michael Stein, medical advisor to the East Bay Headache Support Group, and a member of the audience, said that he has had patients tell him their pulse and heart rate increased with exercise, and then they got a headache, but without aura.

Ms. Eilers said she can explain to us what happens to the body when a person exercises, but there is no research to really explain why a headache starts soon after physical activity.  When you exercise, the heart pumps more blood into your muscles and body tissues.  With vigorous exercise, your heart rate will go to 150 beats per minute, whereas a heart at rest typically beats 70 to 80 times a minute.  With physical activity, nerve receptors in your muscles and joints begin to signal the sympathetic (involuntary) nervous system to release epinephrine and norepinephrine to go into the blood stream and speed up the heart.  Also, just before beginning exercise, the brain cortex gives the message that the heart needs to beat faster. 

So what does this have to do with headaches?  In a normal state, the heart pumps five liters of blood per minute through the body, but with vigorous exercise, the heart pumps twenty liters of blood per minute.  Blood flow is very rapid, which produces lots of constricting in the head.  Ms. Eilers mentioned a doctor in Charleston, WV who said that head pain is probably due to an acute forceful contracting of tissue in the head during exercise.  Blood pressure speeds the heart beat and the brain cortex speeds up the heart.  You will experience lots of pounding in the temple area, which has to do with the constriction of blood vessels.  Ms. Eilers went on to say that there is pressure on the cranial tissue, and depending on if you have problems with blood pressure, this could be dangerous.

The most important thing to consider before embarking on an exercise program, as all doctors will tell you, is that you need to make certain of the state of your health before exercising.  High blood pressure is serious.  Is your heart in good shape?  Do you have a history of heart problems in your family?

In her research for this talk, Ms. Eilers read about a study of competitive athletes, where it was determined that some got headaches because of the restrictive headgear they wore in competition.

Eyestrain is also a possible cause of headaches while exercising.  If you go out for a run, but don’t wear sunglasses to protect your eyes, you may develop a headache from eyestrain.  Remember that your eyes change as you get older.  And pay attention to other changes as you age.

Dehydration can trigger a headache.  Be certain you drink enough water as you exercise to keep yourself hydrated.  Use common sense.  To learn more about this, talk to your doctor.

But we know that exercise is important for good health.  What exercise can you do if you typically get headaches from a real workout?  Ms. Eilers suggested Yoga as a good exercise to try.  She passed out a handout (attached) to the audience listing many beginning Yoga resources, including books and Web sites.

Ms. Eilers also mentioned biofeedback as being a powerful tool for the headache sufferer.  She suggested to the audience that we talk to our doctor about biofeedback therapy, and then go for it.

In her research, Ms. Eilers read mainly about persons who didn’t have a headache prior to exercising, then developed a headache during exercise, and the headache stopped once physical activity was discontinued.  She knows, however, that this isn’t the case for many people who suffer from headaches.

She suggested that we keep a journal of our headaches—something happens when you journal on a daily basis.  

Ms. Eilers then concluded her presentation and asked for questions from the audience.  Donna Johnson mentioned that because of the medications she takes for her headaches (both prophylactic and abortive), she has a hard time journaling—she can’t concentrate.  She asked if Ms. Eilers had seen anything during her research about serotonin and endorphins.  Ms. Eilers answered that with exertion headaches, the researchers weren’t interested in serotonin.

After researching this topic, Ms. Eilers concluded that most doctors say that a steady, consistent exercise plan is good for a person who suffers from fairly frequent headaches.  She added that, since her research, she has a whole new respect for headache sufferers and also has new knowledge of headaches.

Dr. Michael Stein commented that the International Headache Society set up a diagnosis criteria for migraines, and one of the criteria is that the headache is worsened by physical exercise.  Dr. Stein asked if anyone in the audience had experienced a headache dissipating during exercise.  One woman said that her headaches get better during Yoga exercises, and another said that once after a 36-mile bike ride her headache went away.  And another said that she exercises frequently, but if she goes a number of days without exercising, she will develop a headache.

Endorphins are androgynous morphine in the brain.  How are endorphins and serotonin connected?  Dr. Stein said they are not related.  Endorphins lower the pain level.  When serotonin is released, it may turn off pain.  Endorphins and serotonin are both substances that reduce the perception of pain.  Dr. Stein added that the brain itself doesn’t feel pain—it is pain insensitive, but the coverings and blood vessels are pain sensitive.  Ms. Eilers added that serotonin gives us a sense of well-being, while endorphins are more of a physical feeling.

In Ms. Eiler’s research, she read that one doctor believes that soft tissues are damaged from heavy pumping of blood, which may cause pain.

Ms. Eilers was asked, “If active exercise exacerbates migraines, what would you recommend?”  She answered that she learned from her sister about the powerful effect of Yoga.  Apparently her sister’s body changed almost entirely from doing Yoga.  She mentioned another powerful form of exercise that is not aerobic—Tai Chi.  When asked, “Which one would you recommend?  Tai Chi or Yoga?,” she answered, “Yoga, as you can do a multitude of poses, it’s more common, and you can probably get more out of it.”  She added that Yoga works on glands.

Dr. Stein said that a person who gets headaches from exercise should tone down his/her exercise program.  “We should exercise to get the heart rate up about 110-120 beats per minute, and then keep it at a certain level, rather than getting it up to 160 beats per minute,” he said.  Ms. Eilers agreed.  Dr. Stein suggested five minutes on the treadmill until you get to 120 beats per minute, and then slow to a walk, and then go on.  Don’t attempt to go fast for thirty minutes.

The term anaerobic was defined as “not burning fat any longer, but burning sugar.”  If you feel hungry after exercise, you’re anaerobic.  On the other hand, aerobics is the word for sustained exercises designed to stimulate and strengthen the heart and lungs, i.e., you’ve got to go steady for a period of time.

Ms. Eilers said that if you’re headache prone, your exercise program should include a longer warm up period and longer time to cool down.  And stretching is always beneficial.  Dr. Stein added that you should go slowly up to speed, plateau, then cool down.

To conclude the evening, Ms. Eilers gave us an example of how hard it is for North Americans to develop a sensible exercise routine:  Covert Bailey developed the Health Rider, which is probably the best exercise machine because it exercises every part of the body.  He tells people to start out using the machine three minutes per day, and work up from there.  Unfortunately, however, many people get gung ho and overdo it in the beginning, and end up not using it on a routine basis.

The intention of the East Bay Headache Support Group is to provide information and resources.  It does not provide medical advice, which should be obtained directly from a physician.