In the previous post, I talked about the important lifestyle factors and strategies of hydration, diet and sleep. In this post I will discuss exercise/physical activity. Again these are basic lifestyle strategies that are appropriate for all headaches, but can be particularly important to migraineurs.
Exercise or physical activity is vital to healthy functioning for everyone. For some of our patients, it can be challenging to get active. And if you have a migraine, the last thing you want to do is exercise. But getting exercise on a regular basis is an excellent way to prevent migraines. It physiologically improves your cardiovascular system, provides stress relief and releases endorphins, and when done with others, exercise can be a positive social experience. All of these aspects contribute to a healthier lifestyle with fewer migraines.
Our basic recommendation is 30 minutes of vigorous activity, 3 times per week. This can be sports practice or games, dance class, going to the gym or a run, or playing outside with the family dog. Kids can be encouraged to make the active choice. That can mean taking the stairs instead of the elevator, walking up and down every aisle at the grocery store, or parking (or encouraging their parent) the car far away from the store entrance to sneak in some extra steps. We all need more exercise, and the more the family participates, the easier it is for the teen to join in. No teen wants to be the one who is singled out for exercise. Families or friends can get activity monitors and set up challenges- see who can get the most steps in a day, weekend or the whole week. There are endless possibilities and options. The key is to just get started.
For those kids who are inactive, this might seem daunting. They may have stopped doing their sports or activities because of migraines, and are worried that activity will make them worse. This is a situation where pacing is really helpful. Basically activity pacing is the slow return to exercise, working toward being able to tolerate increased intensity and time in a vigorous activity. Often, I will ask a teen to start to get more active and describe how to do it, slowly and methodically. On the next visit, he report that they ran a mile once, had worse headaches and stopped. (Not exactly what I recommended!) It’s a hard concept to explain. I found some excellent You Tube videos, done by a teen girl with chronic pain, with great explanations. The series of 5 videos is called Pacing: Your Superpower against chronic pain, and here’s the link: YouTube videos on activity pacing. I encourage my patients to check them out and while not every suggestion will apply to them, they can gain better understanding of the concept and make an appropriate plan for themselves.
One of the keys to establishing an exercise habit is convenience. Whatever activity is chosen, participation has to be easy to achieve: going to a neighborhood gym rather than the one across town; walking around the block or to and from school; carpooling with a friend to exercise/dance class, etc. The strategy of convenience makes it easier to establish and keep a good habit, and then it just becomes a part of daily life. (Read more about strategies for establishing good habits in the book “Better Than Before” by Gretchen Rubin.)
Finally, I am always asked about what is the best exercise to do. My answer is always the same: Do the activity that you like and that you will actually do. Of course, there are a few things to avoid, like doing inversions in yoga during a migraine. And I am biased against high impact sports, where it is more likely to result in concussion (a potential disaster for migraineurs). But any activity that brings you joy, satisfaction, a good feeling, a hit of endorphins, is the right exercise. Just put the phone down and get moving!