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Twenty minutes and two miles into Liz Carroll's fifth 10K race, the 34-year-old found herself slumped on the sidelines, a blur of runners passing her by. With a stabbing pain in her left temple and a wave of nausea weakening her resolve, she couldn't take another step. That initial twinge of pain she'd felt at the starting gun wasn't jitters after all: It was a migraine.
Approximately 45 million people in the United States suffer from chronic headaches, including migraines, and a surprising number -- 70 percent -- feel the pain while exercising, says a recent National Headache Foundation survey. How is it that exercise, a universal pathway to well-being, can also trigger one of the most common health problems -- a headache?
Actually, the impact exercise has on pain works both ways. "Most headaches develop when blood vessels around the brain are inflamed, which stretches the nerves within and sends shock waves of pain," explains Merle Diamond, MD, codirector of the Diamond Headache Clinic in Chicago. Regular cardio usually lessens this reaction, thanks in part to a boost of endorphins, the body's natural painkillers, which are released during exercise. Working out also improves blood flow to the brain and reduces muscle tension and fatigue -- all of which minimize blood vessel inflammation. What's more, physically inactive adults are at least one and a half times more likely to suffer from recurring headaches and migraines than those who exercise vigorously at least three times a week, a recent Swedish study found.
But sometimes the type of activity you're doing -- or the way you're doing it -- can lessen the healing effects of exercise, says David Buchholz, MD, associate professor of neurology at Johns Hopkins University in Baltimore. Understanding what sets off your occasional workout ache is essential to keeping your health and fitness on track.
Holding your breath is smart only when plunging under water. Do it during intense activity, like strength training or a sudden spurt of running, and you're likely to give yourself a head splitter. A piece of the puzzle: Straining your core can temporarily and rapidly push your blood pressure up and cause headaches, explains Douglas McKeag, MD, director of the IU Center for Sports Medicine at the Indiana University School of Medicine in Indianapolis.
Let it out. "No matter what exercise you're doing, if you must grunt to get through it, you need to focus on your breathing or take the intensity down," says Michael Esco, PhD, assistant professor of exercise science at Auburn University at Montgomery, Alabama. Maximize the flow of oxygen to your muscles during strength-training by exhaling when you lift and inhaling when you lower the weight. "To find an appropriate amount of weight, which is what you can comfortably lift for up to 15 reps, start with higher reps, lower pounds," Dr. McKeag says. "The heavier the weight, the more likely you'll want to hold your breath."The Trigger: Sudden Sprinting
One minute you're cooling your heels at your company's softball game; the next you're hightailing it around the bases without so much as a stretch. You may not connect the dots between your afternoon cardio burst and the throbbing that sneaks up at dinner, but skipping your warm-up may be partially to blame for your pain. Easing into your workout with low to moderate intensity helps your body adjust to the increased blood flow that comes from exercise, and that may reduce your chances of getting a headache. (There has also been some speculation that people who warm up properly have lower blood levels of nitric oxide, a chemical in the brain linked to migraines, than those who don't. The chemical may prompt blood vessels to dilate quickly, which can bring on pain.)
Monitor your heart rate. The best 10- to 15-minute warm-up is the exercise you're about to do, just taken down a notch. If you're jogging, begin by walking and slowly build up to jogging, increasing your heart rate gradually every five minutes. With strength training, start with lighter weights and move on to heavier ones. "This slowly raises your heart rate and gives your blood vessels time to react to the increased demand for blood flow," Dr. McKeag says.The Trigger: Your Food Choices
Charging up with a pre-workout banana or smoothie is a healthy idea for many of us. "But people who are prone to migraines often find that the amino acid tyramine, which is sometimes found in soy, citrus fruits, bananas, yogurt, and nuts, can prompt a headache," Dr. Diamond says. (The naturally occurring amino acid is thought to play a role in the constricting and dilating of blood vessels in the brain.)
Fuel up with fluids. Thirty minutes to an hour before getting your sweat on, have a 100- to 250-calorie snack. Since for some people liquids can be more easily absorbed before a workout, Kaley Todd, RD, a nutritionist in San Francisco, suggests loading up with an 8- to 12-ounce fruit shake made with rice protein powder. "It will provide carbs, protein, and vitamins to help fuel your muscles and assist with recovery." Try blending one cup of berries (or mango or kiwi), a half cup of nonfat milk, one scoop of rice protein powder, a spoonful of honey (optional), and one cup of ice. If you're not into drinking your boost, top some whole wheat crackers with low-fat ricotta cheese, 100 percent fruit spread, or hummus. "All these snacks will deliver the energy you need without tyramine," Todd says.The Trigger: Dehydration
If you have ever forgotten your water bottle on a steamy run, you know that dehydration can easily spark a headache. Why that happens isn't entirely clear, but experts suspect that too little H2O may lower the pressure inside arteries that supply blood to the lining around the brain, called the meninges. "That dip seems to stimulate pain," says neurologist Alexander Mauskop, MD, director of the New York Headache Center.
Know your water weight. An hour before hitting the gym (or bike path or yoga studio), drink at least 8 ounces of water. If you exercise for at least 30 to 45 minutes, down another 8 ounces halfway through your workout, Esco suggests. And when it's hot, say above 90 degrees, and humid, consider taking your workout indoors with the AC on, or wait until the evening, when it's cooler. How to tell for sure that you've replaced enough of the fluid you lost through sweat? Weigh yourself pre- and post-workout, and keep drinking until the scales even out.The Trigger: Weak Muscles
Running, aerobics, and power walking can sometimes jostle the brain and set off throbbing, especially if your neck muscles are underconditioned. "When worked beyond their capabilities, weaker muscles can spasm," Esco explains, "and that spasm can trigger headache pain."
Focus on your form. This type of ache usually strikes newer exercisers who are still building muscle strength and stability. Targeted neck exercises are key to maintaining proper form, which can help eliminate the jarring of your head and ease pressure on the muscles that stabilize it, Dr. Mauskop says. Try this one, courtesy of Gwen Lawrence, a sports yoga instructor in Westchester, New York: Lie facedown, hands by your sides, palms facing up; lift your head and feet off the ground a few inches and hold for five to 10 breaths, keeping your neck straight and staring down at the mat (locust pose). Do this 3 to 10 times, depending on your fitness level.The Trigger: Poor Posture
Crunches are supposed to focus on your abs, but incorrect form can shift the stress to your neck, setting off a chain reaction of pain that can eventually morph into a headache. Some experts estimate that up to 75 percent of all tension headaches arise from muscle strain in the neck due to problems with posture. "I see improper technique a lot at the gym, and one of the biggest issues is the way people do crunches," Esco says. "Exercisers tend to cross their arms over their chest, which can severely strain head and neck muscles." If you're unaccustomed to crunches, it's better to place only your fingertips lightly behind your neck and keep your elbows out, in line with your ears. "People also often jut their head forward instead of keeping them parallel to the floor when doing push-ups," he says. Weight machines can be a headache hazard too, especially the lateral shoulder raise, chest press, and seated rowing machines. "People frequently drop their head forward, causing neck strain. They need to keep their neck and back straight," Esco says.
Go "om." Researchers at the University of Rajasthan in Jaipur, India, found that just three months of yoga can reduce the frequency and overall intensity of migraines by half or more. Notes Lawrence, "The skills you build with yoga translate to better form during other exercises as well and will give you more support, and therefore stability, in your neck and skull. The end result is fewer headaches." For added protection, she suggests doing this shoulder roll daily to help keep your spine and neck aligned: In a seated position, arms still and back straight, inhale as you raise your shoulders to your ears. Then exhale as you move your shoulder blades toward your spine, then downward. Do 5 to 10 times (feel free to reverse the movement). If you're headache prone, avoid doing resistance exercises like overhead presses, pull-ups, and pull-downs behind your head. Instead, do them in front, keeping a neutral spine.
Head still aches? Not sure if you should see a doctor? Go to headaches.org for more information.
If you're at risk for headaches, you may want to consider taking a preventive dose of aspirin before your workout, says Stuart Warden, PhD, director of physical therapy research at Indiana University in Indianapolis. While Warden would generally advise pro athletes against this practice (the medicine may slow the healing of injured muscles, ligaments, and bones), "for recreational exercisers with headaches, the benefits outweigh the risks, but aspirin should be used only temporarily," he says. "Remember that aspirin, as well as ibuprofen and naproxen, typically treat symptoms and not their causes." Bottom line: Serious exercisers and athletes should be assessed by a doctor for the cause of their headaches before using these meds as a common practice.
Originally published in FITNESS magazine, March 2010.