OsteoVIf a hard run or a sweaty class has ever been followed by a migraine, it is easy to decide that exercise is simply not for you. That is a very reasonable conclusion to reach, and it is also one worth revisiting, because for most people with migraine regular, well-paced movement turns out to be more ally than enemy.
Why exercise gets a bad name
Exercise can set off an attack in some people, usually when it is a sudden jump in effort, when it happens on an empty stomach or a dry mouth, or when it is stacked on top of a poor night and a stressful week. Bright, noisy gyms and hot rooms do not help either. So the problem is rarely movement itself and much more often the way it arrives, which is why one hard session after a long gap can feel so punishing while a steady routine does not.
The trouble is that avoiding exercise out of fear tends to make the body less tolerant of it, so the next attempt feels worse and the avoidance deepens. The Migraine Trust describes this cycle directly, and it is a common one among the people we see.
What the evidence says
A 2019 systematic review and meta-analysis in The Journal of Headache and Pain looked at aerobic exercise in people with migraine. It included six studies and 357 participants, and when four of those studies were pooled, exercise over 10 to 12 weeks was linked to about 0.6 fewer migraine days per month, from a starting average of 9.4. The authors rated the evidence as moderate for that outcome, and they were candid that the clinical size of the effect was small. They also noted that it could be worth having alongside usual care.
That is a modest result and it deserves a modest description. Exercise is not a cure, and it will not replace preventive medication where that is needed. What it does offer is a low-risk addition that may also help sleep, mood and stress, which is part of why it earns its place in a whole-body plan.
A gentler way to begin
Consistency matters more than intensity, so the aim is to start lower than feels necessary and build slowly over weeks.
- Start small. A ten-minute walk, an easy cycle or a gentle swim is plenty to begin with, and it is far better to finish feeling you could do more.
- Eat and drink first. Have something to eat an hour or two beforehand and sip water before, during and after.
- Warm up gradually. A slow first five minutes lets your heart rate rise gently rather than spiking.
- Pick your conditions. Cooler rooms, natural light and quieter times can all lower the load, and so can avoiding exercise on a day you are already running on empty.
- Keep a note. A line in your diary about what you did and how you felt afterwards will show you your own pattern within a few weeks.
Neck and shoulders count too
Many people with migraine carry a lot of tension through the neck and shoulders, and that can make some movements feel risky. Gentle mobility work and strengthening for the upper back are often a sensible part of getting going again, and this is somewhere an osteopathic assessment can help, because the right starting point depends on what your neck and shoulders can comfortably do. It is a matter of professional judgement rather than a fixed rule, so it should be tailored to you.
When to stop and when to get checked
If an attack begins mid-session, stop, rest somewhere calm and treat it as you normally would. And if you get a headache that comes on with exertion for the first time, or that feels different from your usual pattern, please have it assessed by a doctor, since some exercise-related headaches need their own investigation.
When to seek urgent care
See a doctor promptly, or call 999, if you have a sudden, severe "thunderclap" headache, a headache with fever and a stiff neck, new weakness, numbness or confusion, or a headache after a head injury. New or changing headaches always deserve medical assessment.
If you would like help working out where to begin, a full assessment can look at your neck, your pattern of attacks and what is realistic for you right now. You are welcome to book an appointment or get in touch.
- Lemmens J, De Pauw J, Van Soom T, et al. The effect of aerobic exercise on the number of migraine days, duration and pain intensity in migraine: a systematic literature review and meta-analysis. The Journal of Headache and Pain, 2019. doi:10.1186/s10194-019-0961-8
- The Migraine Trust. Migraine and exercise. migrainetrust.org
- National Institute for Health and Care Excellence (NICE). Clinical Knowledge Summaries: Migraine. cks.nice.org.uk