There Is Very Little Information Out There For Athletes With Migraine

By Jessica McWhirt

I’ve been researching for the past several weeks to find information for athletes with Migraine. But not only Migraine, athletes with fatigue and dizziness, and how to train and race while living with a chronic illness or disease.

There are plenty of lists of famous athletes and Olympians who have migraine: Amanda Beard, Steve Kerr, Ian Thorpe, Dwyane Wade. But these articles rarely go into the details of how these athletes manage the sometimes debilitating effects of Migraine. We just know that they have. It’s not helpful.

Jessica McWhirt

The Cleveland Clinic says, “an exertional headache occurs when an activity causes veins and arteries to expand to allow more blood flow. That expansion and increased blood pressure create pressure in the skull, which causes the pain.”

Without further ado, here are some recommendations by sites, my commentary on it, and some things I do in a vain attempt to reduce the severity of the exercise-induced headaches I get after hard efforts, long efforts, or races

WHAT MIGRAINE CANADA SUGGESTS

When I actually found an article with tips for athletes with Migraine, I’ve either been doing the suggestion already, I won’t do it, or it isn’t even applicable. Migraine Canada suggests the following:

  • Stick to a schedule
  • Eat and sleep at regular times
  • Exercise regularly
  • Eat a healthy diet
  • Find factors that are triggering the Migraine (light sensitivity = wear sunglasses; noise sensitivity = wear earplugs)

What I do

While these all make sense for even someone who doesn’t have Migraine, what happens if you already have a daily headache and strenuous exercise makes it worse? Because I do. What if exercise, is in fact, the trigger? Because it is for me. And when you are sticking to a schedule, eating regularly and healthily, and getting enough sleep, then what? Yes, I do these things.

I regularly go to bed around 9:00 PM and wake up around 5:30 AM. Lately, I’ve been trying to eat 6 small meals every 2-3 hours throughout the day. Before that, I’d eat 3 meals every 4ish hours. “Exercising regularly” varies between people, but I workout 6 days per week and one day is reserved for rest and yoga. I try to make sure my diet consists mostly of whole, real foods. So, food that doesn’t have a ton of weird ingredients listed or if you left it outside the fridge for too long, it’ll go bad.

If you also do all these things, and you still have headaches, there are more things to try, so keep reading.

WHAT NEW YORK HEADACHE CENTER SAYS

Another article (I emailed them about the misspelled title already) differentiates between exertional headaches and effort-induced headaches. Exertional headaches are caused by lifting, pushing, or pulling. They list sex, coughing, sneezing, or straining to shit as some of the triggers for an exertional headache.

Effort-induced headaches are caused by aerobic activities like running, swimming, cycling, etc. They think that if you’re dehydrated, hypoglycemic, or overheated, this can result in an effort-induced headache. The authors also believe if you’re low in Magnesium then this would also contribute to effort-induced headaches. Their recommendations were:

  • To take an NSAID an hour prior to the activity
  • Get a prescription for Indomethacin
  • Do a proper warm-up and cool-down

What I do

While taking an NSAID every once in a while won’t cause much harm, taking one every time before a strenuous workout will actually cause a rebound headache. This is when you essentially become dependent on the NSAID. When the pain-relieving effects wear off, you take another one and another one and another one.

This may make sense for someone who ONLY gets effort-induced headaches every once in a while, but for me, I have a headache every day—from the moment I wake up to the time I fall asleep. I can’t take an NSAID every single day otherwise I’ll destroy my insides. I tested taking  Tylenol before a race to see if that alleviates any post-effort-induced headache. It didn’t.

There’s the option of using Indomethacin, an anti-inflammatory drug that’s primarily used to “relieve moderate to severe pain, tenderness, swelling, and stiffness caused by osteoarthritis, rheumatoid arthritis, and ankylosing spondylitis.” If you Google this medication, you’ll likely see a warning sign telling you that if you take this on the reg’ you’re more likely to have a heart attack or stroke. So, I’m good.

For every hard workout or race I do, I warm up for at least 30 minutes. I also do a proper cool down to get my heart rate to about 100 bpm before getting off the bike to stretch and practice slow and deep breathing.

WHAT THE CLEVELAND CLINIC SAYS

The first thing the Cleveland Clinic recommends is to avoid the activity that triggers your headache. For some of us who love cycling [insert your sport], that’s ludicrous. It’s one thing to have Migraine, it’s another to let it control your life. And especially rob you of one of the few things that bring you joy. I call bullshit.

They also suggest:

  • Avoid activity in extreme temperatures, too hot or too cold.
  • Don’t work out in altitudes you’re not used to.
  • Drink plenty of water so you are well-hydrated.
  • Wear sunglasses if it’s bright outside and moisture-wicking clothes if it’s hot.
  • Take Coenzyme Q10.
  • Take Feverfew.
  • Take Magnesium.
  • Take Riboflavin (vitamin B2).
  • Take Boswellia (a natural anti-inflammatory if indomethacin is not well-tolerated).

What I do

I haven’t raced outdoors in a while, so my races are situated inside next to a window with a giant box fan blowing on me, so I can easily avoid extreme temperatures. I also don’t wear a jersey to keep my body temperature low-ish. Wearing too many layers indoors is bound to overheat you.

I live in Colorado, so I’m automatically at a higher altitude. I could move to a lower altitude, but I love Colorado and I don’t love lower altitude more than Colorado. If you’re willing to move (or looking for an excuse to) for something like this, then by all means.

I drink my bodyweight in ounces of water (135oz) every day. I also make sure to have at least one glass of electrolytes per day, increasing that up to 2 or 3 on race days.

They also suggest a handful of supplements: Coenzyme Q10, Feverfew, Magnesium, Riboflavin, and Boswellia. I’ve taken all of them except for Boswellia for the past year and haven’t noticed a difference in my daily headaches nor my exertion headaches. I may look further into Boswellia and talk to my neurologist.

Here’s the summed up checklist from what was recommended earlier:

  • Stick to a schedule
  • Eat and sleep at regular times
  • Exercise regularly
  • Eat a healthy diet
  • Find factors that are triggering the Migraine (light sensitivity = wear sunglasses; noise sensitivity = wear earplugs)
  • To take an NSAID an hour prior to the activity
  • Get a prescription for Indomethacin
  • Do a proper warm-up and cool-down
  • Avoid activity in extreme temperatures, too hot or too cold.
  • Don’t work out in altitudes you’re not used to.
  • Drink plenty of water so you are well-hydrated.
  • Wear sunglasses if it’s bright outside and moisture-wicking clothes if it’s hot.
  • Take Coenzyme Q10.
  • Take Feverfew.
  • Take Magnesium.
  • Take Riboflavin (vitamin B2).
  • Take Boswellia (a natural anti-inflammatory if indomethacin is not well-tolerated).

These are the steps I take to try to prevent my headaches from getting worse after workouts:

  • Try to only drink caffeine 1 hour before I workout, no more than that because it’s a trigger for me (makes me dizzy). I also stick with matcha, black tea, green tea, or BCCAs.
  • I drink 1 glass of electrolytes when I wake up in the morning, another before and during the race, and then sometimes one more after the race.
  • I eat either eggs with veggies or oatmeal with fixins’ 1.5-2 hours before my race.
  • I make sure to drink my weight in ounces (135oz) throughout the day.
  • I do a 20-30 minute warm-up before a race or hard effort. This usually consists of 10 minutes of easy pace and slowly ramping up the effort over time. I’ll do a few sprints to get my legs ready for the hard starts in Zwift.
  • 10 minutes before the start of the race, I’ll usually have a Honey Stinger gel.
  • During the race or hard effort, I try to control my breathing as best as I can, which means trying to take deeper breaths to keep getting oxygen into my system.
  • I do a 15-20 minute cool-down after the race or strenuous workout. It really depends on my heart rate. I like to get it to drop to at least 100 bpm before jumping off the bike. I’ll ride longer if my heart rate remains high.
  • Then I stretch and try to slow down my breathing rate to about 6 breaths per minute, focusing on longer breaths out than in.
  • I’ll drink whatever’s left of my three water bottles (usually one has Flow Formulas Endurance Mix, one has Flow Formulas electrolyte mix, and one is just water).
  • I roll on Mary’s Medicinals THC muscle freeze roller along my forehead and temples.
  • I eat within 30-60 minutes after the workout or race.

So far, what I’m doing isn’t working, but maybe this can inspire someone else who gets exercise-induced headaches. Obviously, I’m not a doctor so don’t take my advice willy nilly. It’s best to see your doctor or your neurologist, or better yet, a headache specialist to see what else you can do.

 

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