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Exercising Without Triggering a Migraine or Headache

Regular exercise can reduce the frequency and severity of migraine attacks and other types of headaches… unfortunately, it can also trigger them. Finding the balance between enough and too much exertion can be difficult. I’ve tried a variety of ways of getting back in shape without triggering migraines. My current program, Couch-to-5k, is the most successful.

Couch-to-5k (or C25K) uses interval training to move people from being sedentary to able to run a 5k race in eight weeks. Exercising for about 30 minutes three times a week, participants start out walking more than jogging, then inverse the ratio until they can jog for a solid three miles. Even though I’m only walking and have no plan to do a 5k, this program is the most effective way I’ve found to increase the speed and distance of my walks without triggering a migraine.

Following a five-minute warm-up, I spend the next 20 minutes walking at intervals (guided by an app for my phone that tells me when to change speeds), then do a cool-down. Initially, my walking/walking-faster intervals were 2.3 MPH and 2.8 MPH; I’ve worked up to 3.3 MPH and 4 MPH. I now walk almost 2 miles per session in about 35 minutes. That’s my current workout, my goal is to walk at 4 MPH for 3 miles.

The program is intended for three exercise days a week. I’m trying to walk daily, which means I actually do about three times a week. Some weeks I don’t exercise at all and that’s OK, too. That’s life with chronic illness.

Whether you do a couch-to-5k program or your own exercise plan, the key is to increase your exertion v-e-r-y slowly. Say you walk for a mile at 2.5 MPH and you get a migraine or headache — slow down to 2.2 MPH the next time and see how that goes. If that speed is still a problem, slow down even more. When I first started exercising in the spring, I walked at 1.8 MPH, which felt like a crawl. But, even barely exercising was still more exercise than I was getting before and I was building the foundation for increasing the intensity in the future.

People put 26.2 and 13.1 stickers on their cars. I doubt I’ll advertise my 3, though it will be as big of an achievement for me as a healthy person running a marathon. On second thought, I might stick a 3 on my car. Can you imagine the looks on people’s faces when I say proudly that I can walk briskly for 3 miles without triggering a migraine?

Looking for other ways to avoid migraines or headaches while exercising? See these great tips on exercising with headache or migraine from ACHE.

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Pedometer Apps: Highlighting My Substandard Exercise Acheivements

Exercising outside is one of the most enticing parts of summer in Seattle. To avoid triggering a migraine attack, I wanted to keep my exertion level about the same as it has been on the treadmill at home, so I downloaded some pedometer apps for my phone.

How demoralizing! These apps are designed to encourage healthy people whose only obstacle is a lack of motivation to get moving. They aren’t intended for someone who desperately wants to exercise more, but has to be very careful not to overdo it. The app I used first has a preset goal of 10,000 steps a day with a scale indicating what my level of fitness is.* After 2,200 steps, that scale still declares me “sedentary.” Trust me, I KNOW I’m sedentary and that walking a 20 minute mile doesn’t constitute impressive exercise. I don’t need an app to remind me that the best I can do right now is substandard.

Instead of feeling good about the one mile that I walked — and the beautiful view of Lake Washington that I glimpsed — I came home nearly in tears. I want to be physically fit. I want to walk 10,000 steps a day. I want to leave a yoga class with my muscles aching. I want to run for miles. Yet, what I want and what my body can currently handle are not in alignment.

Couch-to-5k? A hardcore seven-minute high-intensity interval workout? I’m there. Well, I would be if my body didn’t react with a migraine that would lead to at least three days on the couch. Trying harder, exerting more is a perfectly fine option for a lot of people. For me, it’s counterproductive.

I’ve (mostly) let go of the belief that having chronic migraine means my body is broken. Carrying around that sense of betrayal constantly highlighted what was lacking in my life and my body. Rather than dwell on what I can’t do, I try to revel in what I can do. That works most of the time. Then I use an app that reminds me that even though I’m exerting myself at my current maximum, my effort — and perhaps my very self — is deficient.

*I know these apps are intended to count one’s total daily steps and I’m only using them for active exercise. If I carried my phone around with me constantly and saw the steps around the house add up, I’d either be pleasantly surprised or even more dismayed. I choose ignorance.

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Ritalin Three Weeks In: A Turbulent Relationship

Like so often happens with love at first sight, the spark I initially felt with Ritalin has faded. That first week, I had energy and a clear head even when I had a migraine. Week two began with a five-day migraine full of fatigue and head fog. Since that attack let up, I’ve had intermittent bursts of vigor and mental wherewithal, but also daily migraine attacks, during which I’m back to physical and mental blah.

Despite my freakout, I don’t think Ritalin is directly making the migraines worse. I’m pretty sure the five-day migraine was the result of unwittingly (or half-wittingly) reintroducing salicylates to my body. Since then, the weather has been erratic. My sleep is off, too, which could definitely be a Ritalin side effect.

On top of those issues, whenever one migraine dissipates, I have enough oomph to do something that triggers another migraine. That energy is a positive effect of the Ritalin that I have yet to figure out how to manage. I unintentionally over-exert during yoga or on the treadmill as I try to find the balance point of good exercise without triggering a migraine. Or I go to a place that I don’t know will be perfumed. Or I have sex (damn those orgasm-triggered migraines!).

Could it be that if I went two days in a row without a migraine, the next attack would be less debilitating? As if I need to recharge between migraines to get back that lovin’ feeling even when I have an attack. I also wonder if my body is acclimating to the medication and it is becoming less effective.

Ever a romantic, I still believe Ritalin and I can work through these difficulties and create a loving, supportive long-term relationship. Maybe we’re not meant to see each other every day, but would be better off having fun together a few times a week. I’m sticking with daily for now as I try to manage all the other triggers. That’s always hard work, but not as exhausting as it was before Ritalin came into the picture. Every relationship has its tradeoffs, but the good ones are worth the effort.

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Exercise-Triggered Migraine Attacks

A half mile in 10 minutes on the treadmill, a gentle yoga class and dancing at a wedding. What do these three activities have in common? They’ve all triggered migraine attacks in the last month. It seems so unfair to get a migraine when I’m doing something good for my body — especially when that’s celebrating at a wedding! Alas, dwelling on what’s fair can only lead to a pity party. Time to figure out how to cope.

Following Diana Lee’s recommendations for coping with exercise as a migraine trigger, I plan to start with a slow 10 minutes a day on the treadmill, then increase my speed and duration gradually each week. Of course, this assumes an upward trajectory of migraine improvement. The reality of life with chronic migraine will probably intervene. (Is that pessimistic or merely realistic?)

A friend gets exercise-induced migraines whenever she starts running again after falling out of her routine. She just puts up with them for three weeks and then they stop. Although my general philosophy is to avoid migraines as much as possible, I might use her strategy for yoga. First, though, I’ll try backing off a bit in class tonight. I felt so good at my last class that maybe I just pushed too hard.

Once again I appear to be in need of balance. Why is that such a difficult lesson to learn?

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Finding (and Missing) My “True Sanctuary”

Though my migraines have been better in the last couple months — except for last week, when I accidentally halved my dose of magnesium — I’ve been feeling kind of blah. Not depressed, but not motivated or energetic either. This, I’ve discovered, has in large part been because I haven’t been able to practice yoga, which generally boosts my health and my mood. Beyond providing exercise, yoga occupies the all-important third space for this migraineur.

Migraine didn’t keep me away this time, at least not directly. Instead, I developed joint pain as a result of my sedentary life. After a year of taking only gentle yoga classes, I moved to all-levels classes. I felt like I’d developed some stamina and was ready to start building some muscle. I expected a lot of muscle aches — the good, I-can-tell-I’ve-been-working-out kind of soreness. It never came even though I was going all-out in class. It turns out that my natural flexibility (which hasn’t waned) was working against me. My muscles aren’t strong enough to support me when I’m splayed out in a pose, so my joints took the brunt of my workouts. I kept going to classes for awhile, thinking I’d work through it. Nope. So I tried only gentle classes, but the pain persisted. I had no choice but to stop and heal.

I bought an ancient treadmill so I could exercise without leaving the house. I’m one of those weird people who doesn’t mind exercising on a treadmill, but “exercise” and “yoga” are not synonymous experiences for me. Walking on a treadmill and listening to podcasts is fine; yoga classes are a time of (almost) pure enjoyment for me. I’d rather follow my bliss. Engaging in a third space, which is a meaningful activity outside of work or home, can reduce stress and social isolation. In A Third Space for Migraine Patients, headache specialist William Young writes:

I think that finding a good third space can be very hard for a person with bad migraine, but that finding something is truly important. I think it works best when it requires interacting with people outside of work or home and consumes someone in such a way that it becomes very hard to focus on pain.  I don’t think it needs that much time, and if an hour a week is all you can find, that is fine, if you have found a true sanctuary. Find something, try it on and if it doesn’t fit, keep trying until you find something meaningful. Fight for one tiny, special activity that takes you away from the places in your life that the pain resides. Keeping a seed of contented normalcy somewhere in one’s world is critical, and provides hope in the darkest times.

I will spare you the poetic waxing. Suffice it to say that classes provide me with much pleasure, which I have missed. While I don’t talk to a lot of people at the studio (how outgoing I am depends on how migrainey I am), I appreciate seeing different people than my friends and family. The studio I go to has a strong community feeling and I like the support implicit in that. People notice when I’m gone and ask how I am when I return.

I have described yoga as a lifeline before. Until this forced hiatus, I didn’t know how true that was. I’ve been back for a few gentle classes and have felt great emotionally and migraine-wise afterward. My joints were OK with one class, but they are complaining a bit after classes on consecutive days. Next week I will get suggestions from a physical therapist/pilates instructor/massage therapist for improving muscle tone and protecting my joints.

The work required to regain muscle strength is daunting, especially knowing that migraine will continue to interrupt my attempts to exercise. I fear that I will never come out ahead. At which point I have to remind myself to be mindful of the present moment, not lost in the past or anticipating the future. One step — whether forward or back — at a time.