Мигрень, головная боль и спорт: как тренироваться безопасно? Факты и мифы о мигрени

Neurologist Alyona Evdokimova explains safe exercise practices for migraine and headache sufferers, debunking myths and identifying triggers.

Key Takeaways

Most headaches related to exercise are primary and manageable with proper care.
Migraines require special attention as exercise can trigger or worsen attacks.
Identifying headache type is crucial to avoid dangerous conditions and optimize treatment.
Common myths about headaches can lead to underestimating their severity and improper management.
Gradual exercise intensity and professional guidance improve safety for headache sufferers.

What the video covers

Alyona Dmitrievna Evdokimova, a neurologist and pain management specialist, discusses the relationship between headaches, migraines, and sports.
Headaches are categorized into primary (independent diseases like migraines and tension headaches) and secondary (symptoms of other conditions).
Primary headaches account for 90% of cases and include migraines, tension headaches, and exertion headaches.
Migraine triggers include intense exercise, hunger, stress, sleep deprivation or excess sleep, alcohol (especially red wine), bright light, caffeine, altitude, and menstrual cycle.
Tension headaches are usually milder and can improve with exercise, unlike migraines which can worsen with physical activity.
Secondary headaches may indicate dangerous conditions and require medical evaluation to rule out red flags.
Common myths addressed include the belief that headaches are normal for everyone and that headaches always originate from neck problems.
The importance of gradual intensity increase in workouts and individualized physical therapy or fitness plans is emphasized.
Medication may be necessary if headaches persist and a neurologist consultation is recommended for proper diagnosis.
Special considerations for altitude-related headaches and distinguishing them from migraines are discussed.

Chapters

What are the main types of headaches discussed in the video?

The video explains two main types of headaches: primary headaches, which are independent diseases like migraines and tension headaches, and secondary headaches, which are symptoms of other conditions.

Can exercise trigger migraines?

Yes, intense exercise can trigger migraine attacks or worsen existing migraines, so it is important to manage exercise intensity carefully if you suffer from migraines.

Are headaches always caused by neck problems?

No, the video debunks the common myth that headaches always originate from neck issues, explaining that while neck muscle strain can cause local pain, it usually does not cause headaches radiating to the head.

Full Transcript — Download SRT & Markdown

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Great. My name is Alyona Dmitrievna Evdokimova. I am a neurologist, a specialist in pain management. I see patients at the Temichevogorkovsky clinic and the Chaika clinic. I am also an instructor for the educational project Physio Sapiens. Our topic today

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is a very pressing one. We will be discussing headaches and sports. And most importantly, how to exercise safely so that, on one hand, you don't do yourself harm, and on the other, you improve your well-being. After all, that is why we exercise. And perhaps,

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if anyone here in the room gets headaches (and let's see, who gets headaches, out of everyone present, the majority?), this story might sound familiar: you've finished your workout, your pulse is gradually dropping, you're heading home, everything seems fine, 20-30 minutes have passed since

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training, and—bam—your head starts to hurt. And it's not very clear; is it some kind of dehydration, just tiredness, or from training in the heat or overheating during the workout, or is it a migraine, or something else that might be dangerous to ignore?

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Actually, a lot of questions arise because it would seem that we took up sports to feel better. In the end, the whole evening or morning is wasted because a headache started. And, naturally, it's important for us to distinguish between types of headaches.

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All headaches can be divided into two main categories: primary headaches, which are an independent disease. That is, just like how we perceive, for example, ARVI as an independent disease — it's a disease in itself. This type includes tension headaches, migraines,

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and a rare type of headache. We'll discuss that one today as well. Headaches caused specifically by physical exertion. The good news is that this type of headache accounts for 90% of cases. So the probability that your headache is an independent

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condition is very, very high. And there are secondary headaches, which we try our best to rule out during a doctor's visit, where the headache is a symptom of another condition. That is, the headache is just a manifestation of

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something else. For example, how your head might hurt during the flu. We understand that our head doesn't hurt because the head itself got sick, but because we are suffering from something like the flu or a fever, and all that

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triggered the headache. Or, for example, a headache associated with brain vascular disorders, like aneurysms—nasty things we are afraid of—which can also be accompanied by headaches.

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Statistically, this type of headache is extremely rare. It usually has characteristic signs, so-called red flags. We will discuss those today as well. How can we tell if a headache is safe or potentially unsafe? Regardless, we’ll focus mainly on primary

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headaches today, simply because statistically that is what we encounter most often and what is most likely bothering you. Why is it important for us to understand exactly which headache you have? Because if we’re talking about migraine, it might require

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specific treatment and, at the same time, it can worsen with physical activity and hinder your training. If we’re talking about tension headaches, the second most common type, it usually follows a much milder course.

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It generally doesn’t interfere with working out, and the attack doesn’t intensify. Conversely, people with tension headaches will often say that after they took a walk or exercised, they felt better, as if the headache went away. But these aren't the main

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criteria. And, most importantly, we need to know if it's a secondary headache, because it could be a symptom of a dangerous condition. And, in principle, continuing a workout can be dangerous if any such red flags have appeared. We will discuss migraines in

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more detail because they are a nasty thing that intensifies during physical activity. One of the main migraine triggers, on one hand, is intense exercise. An attack can be triggered by your workout, or it can worsen if you go training while already having a

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migraine. But that is not the only sign. Hunger is also a frequent migraine trigger. I often hear patients say at appointments, "Well, my blood sugar probably dropped, that's why my head started hurting." Most likely, no. Most likely, it is actually a migraine. We

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need to figure out what is going on. Stress is also a frequent trigger. I won't focus too much on that. Who doesn't have stress? Everyone does.

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Some intense stress can indeed trigger a headache. Among the unusual things, there's sleep deprivation, but that’s understandable. However, getting too much sleep feels quite strange, although it is a very frequent trigger for migraine-type headaches. You took a nap during the day, your head started

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hurting, and the whole day is ruined; or you worked all week and decided to sleep in on the weekend. It would seem everything should be fine, but no, it's not fine at all. Your head starts hurting, and the day is ruined. Alcohol

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is a trigger for migraines. At the same time, I often encounter people coming to me saying that, well, it's just a hangover headache. But the thing is, it most often starts after a small amount of alcohol, even just less than a glass

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of wine, and almost within half an hour or an hour; it's unlikely that a hangover would hit you that fast, the probability is extremely low. Therefore, alcohol is a very characteristic migraine trigger. Also, it matters which alcohol it is. Red wine is

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considered the most frequent culprit, and people really try to avoid it. It contains a large amount of tannins, which can indeed have an effect. Bright light itself can be a trigger for a migraine attack. That's why some women

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avoid going to cosmetics stores, because there is bright light, noise, some kind of flickering, glaring floor, and a bunch of smells. And all of this combined is such an unpleasant trigger that can set off a headache attack.

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Caffeine. For some, caffeine relieves headache attacks, and they are the majority, but for others, coffee can trigger a headache attack. It's very, very individual, it's slightly different for everyone. And altitude itself. We have gathered here in the context of sports activities, after all.

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There is trail running and running at altitude; altitude can also be a migraine trigger on the one hand, and on the other hand, it can be a trigger for altitude headache. It is important to distinguish and differentiate

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between them there as well. Another trigger that I didn't include in order to make this slide, let's say, more universal. But for women, most often it is the menstrual cycle. There is a feature that 3 days before menstruation

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and in the first 2 days of menstruation, you may also have a headache. And most often it is exactly a migraine.

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Generally, there shouldn't be any headache during menstruation in a normal state. If you have headaches during menstruation, it is worth thinking about whether we might have missed a migraine in your case. This is connected to the fact that estrogen

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levels fluctuate, and actually, because of this, an attack is triggered. The most common myths that I encounter simply every day, I just don't have the strength to tolerate them anymore, because it's literally every appointment of mine, and people really

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underestimate the pain sensations. And it is believed that it is normal for everyone to have a headache. But I know many people who never have a headache at all. They only had one once in their life when they had a fever. All

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the rest of the time they feel fine, they feel safe going out without ibuprofen in their purse, they feel completely fine and calm, so no, not everyone has headaches. And the second myth is that a headache is necessarily because of

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the neck, because, well, something is happening with the neck: I slept wrong, I sat wrong, and my neck hurts during a headache attack—so it must have gone from the neck to the head. But this is a very common myth. Uh, there is such a

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condition, osteochondrosis, but it doesn't actually exist. It is essentially a norm that is described in

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that something is wrong with the neck, that something is pinched, not going somewhere, some kind of hernia, or poor blood circulation. That's not the point . The point is that during a migraine attack, the central nervous system becomes overexcited. And the central

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nervous system is quite extensive. It interacts with the first three cervical nerve endings, which can cause pain in the neck. In 90%of cases, the neck will hurt during a migraine. The problem is not in the neck; the problem is in the

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head. It is believed that simple painkillers like analgin or citramon will never work for migraines.

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paracetamol and ibuprofen. That means it's not a migraine. No, that is actually not true. These are the first line of therapy. We also use them to stop headache attacks. This does not distinguish a migraine in any way. A

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migraine can also be relieved by them. For some, they don't work, for others, they do. There are people for whom only these work. There you go. Another story is that a migraine is always some kind of inevitably unbearable headache.

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Everyone has a friend or acquaintance who lies flat during a migraine attack, feels terrible, calls off work, and we think: "Well, I definitely don't have it like that, not like this person." But migraines vary in intensity and there aren't always shimmering glares

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before them either. This is somehow ingrained in society, that if something is shimmering before your eyes, then it must be a migraine. No, that's actually quite rare. It occurs in only 20%of people with migraines. It is called an

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aura. It is also believed that migraines only happen to women. This is not true. Absolutely. Statistically, it is indeed more common in women, but they are not the only ones who suffer from it. And that headaches occur due

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to poor blood vessels or osteochondrosis. In principle, that is exactly what I said. Well, you shouldn't blame the vessels; they are not bad, they are good. There. And osteochondrosis, well, it has been proven that it does not cause headaches

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. Facts about migraine. Migraine is most often inherited. And most people suffering from migraine have someone in their family who also had headaches.

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Most likely, our mothers, grandmothers, and aunts won't tell us they have migraines. They have a headache because of blood pressure. They have a headache because they slept in an uncomfortable position. They have a headache because they have vegetative-vascular dystonia.

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Any type of headache. Simply because it was poorly diagnosed in the past, and there were no clear criteria. And upon focused questioning, most people find that they have relatives who also suffered from headaches. It turns out, more often than not, that this was also

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migraine. It just might have been either completely unnoticeable, or they only started paying attention when it became frequent and they associated it with age or, I don't know, high blood pressure. One in five women will experience a migraine at some point in

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their life, with the peak at 20-30 years old, a prime working age. We finish university. And hello.

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An interesting fact is that there are now two Sport-Marafon stores in adjacent buildings. Come on, I'll show you. At 6 Saikina Street, there is a huge running department with sneakers and clothing, as well as hiking gear.

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And everything else remains at 4 Saikina Street. Also, you can view all products on our website, where there is always up-to-date information on availability.

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There. But we shouldn't forget that migraine also occurs in men, and it is often overlooked because it is considered a "female" disease. And in general, our men are like: "Well, my head hurts, it's no big deal." They don't focus on it. Therefore, men often

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come in with such severe headaches, which are more complex to treat. And as I mentioned, pain very often starts from the neck, namely in 90%of cases according to statistics. We have criteria for making this diagnosis. And in general, we, um...You don't have to

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be a super-professor to diagnose a migraine or tension headache. We have an International Classification of Headache Disorders. It was adopted in 2018. We all use it actively, and it contains the criteria based on which we establish one diagnosis of a headache

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or another. And if we are talking about a migraine, we require at least five headache episodes in a lifetime that meet the criteria listed in the gray boxes. Specifically, the duration of the headache is from four to 72 hours;

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that is, the head can hurt for up to three days in a row. If, for example, you didn't take a pill on time, didn't take a pill at all, or took a pill and it turned out to be ineffective. It is

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clear that if we take medication, the headache should pass. And then no 4 hours, 12 hours, or 72 hours will appear. But we are talking about a " pure" one that was not relieved by medications. In this case, the headache

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has main criteria, there are four of them, and two additional criteria. From the main criteria, we need at least two in order to suspect a migraine. And, accordingly, we finalize this with additional criteria. We need at least one. So, what are our criteria? It is a

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predominantly one-sided headache; that is, only the right half of the head hurts, for example. It can be pulsating , and it usually worsens with physical activity or forces you to avoid such physical activity. That is, if you ask

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yourself: "Will I go pour myself tea during a headache, or would I rather ask someone because I need to lie down, as I don't feel very well?" So then we count this criterion. And, accordingly, it can be of moderate or high intensity

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, from four points. That is, where zero points means there is no pain at all.

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Ten is the worst pain you can possibly imagine in your life. A migraine can hurt from four to ten. And all in all, right? It can have at least two characteristics. We will already be thinking that this is probably a

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migraineous headache; additional criteria, which are also most often found, help us make the final diagnosis . This is either nausea, or vomiting during an attack, or both. Very often, when I ask about nausea, people tell me : "No, I'm definitely not nauseous."

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Thinking that it's something where we are already by the toilet. But even that slight queasiness, some discomfort in the stomach, loss of appetite, or unwillingness to eat food—think about it, maybe this is an analog of such nausea, such a slight haziness. Or,

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another criterion could be increased sensitivity to light and increased sensitivity to sounds. Meaning, you're irritated by bright light, annoyed by loud sounds, if you work in an open-plan office, you want to dim your monitor, you want to put on

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noise-canceling headphones, because everything is just infuriating. To sum up, we can imagine a person with a migraine, having that typical unilateral, intense, pulsating headache , who is annoyed by everything, and is literally feeling nauseous and vomiting . Or perhaps, it's a person whose whole

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head hurts, but they generally feel like, well, they can function at a four out of ten level. Meaning, their head just, well, hurts moderately. Yes, it will get worse if they move around. And , yes, they feel slightly nauseous and

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are slightly bothered by bright light, and this is also a migraine. But it is important here that we meet these criteria. At the same time, please note , I have highlighted tension-type headache in blue frames here, which is

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a common headache that, well, in most cases is diagnosed by doctors who don't specialize in headaches. And it's also quite simple. Out of four criteria, there must be at least two, and additionally at least one. Accordingly, it is most often bilateral, it doesn't

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pulsate, it doesn't get worse with physical activity, it is very mild or moderate. In other words, a tension-type headache is unlikely to hurt at an 8, 9, or 10 out of ten.

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Moreover, there is no nausea or vomiting during it. Well, light might be slightly annoying or sounds might be slightly annoying. So it is drastically different from a migrainous headache.

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It’s clear that it can sometimes be confusing, and it is the doctor’s job to make a correct diagnosis. But nevertheless, if you realize that you correspond more to the gray frames, we are more likely talking about a migraine in your case. There is, uh, a

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very simple questionnaire. It doesn't suit everyone, but it is quite sensitive. Invented in 2003. Three questions to suspect a migraine. First.

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Has a headache limited your daily activity or work in the last 3 months? Do you experience nausea or stomach pain during a headache attack? And does light bother you more than usual during a headache attack? If you answer yes to

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two out of three questions, you have a 93%probability of having a migraine. But this is the kind of questionnaire you can give to a colleague at work, ask yourself, or ask your relatives.

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And it’s something that helps to more or less understand what is happening. We don't use it as doctors, you know, during an appointment. It is more of a screening method, but nevertheless, for some, it is more understandable, for

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example, more convenient. Why not? It is important to understand that a migraine is not just a headache. A common phrase, which is actually quite dismissive, is: "Come on, your head just hurts, take a painkiller, don't be dramatic, it will pass." But a migraine

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is a disease of the central nervous system, and the headache is just one phase of this condition. That is, the head hurts for anywhere from 4 to 72 hours. But the problem with migraines is that, because it is a disease of the

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central nervous system, a day or two before the headache starts, the nervous system begins to signal that something is changing or happening. And this often manifests as mood swings, fatigue , frequent yawning, trouble concentrating, or heaviness in the neck

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. Basically, we just feel like, well, we feel unwell. The head doesn't hurt yet, but things feel pretty lousy.

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There is an aura—these are neurological signs like, for example, flickering lights or spots before your eyes that can precede the headache. Or there might be numbness in half of the face, half of the tongue, or half of a

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hand, and then the head starts to hurt. There are complex types of auras, but they occur in about 20–25%of cases.

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So, people who experience an aura generally know about it. It is hard to mistake it for anything else. And after the headache has passed, everything doesn't just immediately return to normal. The brain is in shock from what just happened. In common parlance, this

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is often called a "migraine hangover." And this can be accompanied by fatigue and exhaustion. Again, there are those problems with concentration. You might feel a bit nauseous, and your head feels heavy, humming, and uncomfortable . And there is still discomfort in the

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neck. If we take a person experiencing a severe migraine attack, where their head hurt for 3 days straight and no medication worked, they were knocked out of life for 3 days—but in reality , it was longer: a day or two before

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the headache started, and a day or more after. So, what seems like just a " regular" migraine attack—why be so dramatic?—actually knocked the person out of life for almost a week. And unfortunately, this is very often underestimated. Prodrome is present in

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almost everyone. If you keep a headache diary—I will provide some at the end —you can track how often your head hurts. But the prodrome phase exists in almost everyone. You can use it to predict what is about to happen. For me

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, for example, it's yawning, I have migraines, and it's really awkward during appointments when I start yawning uncontrollably. I explain it, usually it’s uncomfortable, but the yawning happens every 3–4 minutes. I mean, it’s uncontrollable, unfortunately. I realize a migraine is

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coming on, and yes, it most often starts 4–5 hours later. Yeah. Is there anything to be done during this period? Yes. You can adjust those triggers we discussed earlier. That is, dim the lights, remove some triggers, stress, uh, noise. And if coffee is

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your friend, you can drink coffee. There’s no real point in taking medication at this stage. We’re still waiting for the headache. Maybe you’ll get lucky. There’s also this strategy where people often go to bed when they have a headache, thinking it

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will pass, but actually, it won't. After all, a migraine is a neurological disease. Most often, if your strategy is to go to bed, it’s just likely finishing on its own due to time.

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Meaning the attack continued while you were sleeping. And when you woke up, it had simply ended. So if an attack lasts about 16 hours, your head starts hurting in the evening, you get a good sleep, wake up in the morning,

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theoretically, it might not hurt anymore, just because time passed. That’s why this isn’t the best treatment. And there is also a specific type of headache that, since we’re talking more about sports today, I would really like to mention. It’s

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rare, it’s also safe, but it does occur nonetheless. And I have such patients. This is primary exertional headache. Meaning it’s a headache that exclusively appears only during physical exertion. At other times, this person is not bothered by these pains

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at all. They live their life. They can sleep for an hour and their head won't hurt; everything will be fine. And they can drink as much alcohol as they want.

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A reminder: alcohol is harmful to your health. But nevertheless, as soon as they engage in sports or some physical activity—and there’s a similar analog of headache during sexual activity at the time of orgasm—a headache can arise. It usually lasts no

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longer than 48 hours. The very important point here is that if you don’t have headaches in your daily life, but during sexual or physical activity a headache appears, this is a very important sign that requires seeing a doctor. Why? Because, first

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and foremost, we rule out any underlying causes that could have influenced it. This is how certain vascular problems in the head can manifest. And in case we have ruled that out, we have separate guidelines and recommendations on how we will

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treat such a headache. It is not a migraine, it is just another type of headache from the endless international classification of headaches. It spans 400 pages there. And we are moving on to danger symptoms. associated with a headache. These are not all the danger

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symptoms; physicians use stricter criteria during appointments because they know how to interpret them, but in my opinion, these are more than enough to use in everyday life. And what is a danger symptom? These are like flags; we all actively use the word "red flag"

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now, not only in relation to medicine but also in everyday life. Well, these are our favorite red flags. This is a sharp, intense headache, like a blow to the head. As if you were hit with a club. No one hit you, but suddenly your

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head started hurting very sharply and intensely. This is a bad sign. It is a sign that something unsafe is happening and you need to contact a specialist urgently, even calling an ambulance. If it is some new, unusual headache for

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you—you have headaches, you know how they usually feel. And then something extremely unusual for you happens.

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Either it is strange in general, meaning it gets worse when you lie down , although you usually feel better lying down, or it is triggered by coughing or sneezing; something about it has changed. This is also a reason

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to see a specialist. Or if the headache , despite all your efforts, is progressing, meaning it is becoming more frequent, more intense, and stronger over time. In this situation, we also evaluate it to see if something dangerous is occurring. It is bad if

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the headache intensifies with coughing, sneezing, or straining. This is also a sign that it might be something secondary, not just primary. If it is accompanied by any neurological disturbances—impaired vision, hearing , or consciousness—meaning it is quite severe, a person might even lose

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consciousness during a headache attack, which is not normal, by the way. And some numbness, weakness, or loss of balance are also signs that indicate you need to see a specialist. At the same time, these neurological disturbances, like vision problems,

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flashes we discussed, or numbness. Yes, we might think it's an aura, but if it happened for the first time in life, we don't fully understand what's happening to the person yet, so we'll most likely run further tests. Age over 50, if

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it’s the first time—meaning you’ve never had headaches your whole life, and after 50 they start. That is not characteristic of primary headaches . They, as a rule, manifest themselves earlier. If a headache appeared only during pregnancy or in the postpartum

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period, that is also, let's say, unusual. Especially if you never had headaches before. I mean, you didn't have them, and then bam, they started —that's not normal. If the headache is accompanied by weight loss, a constant fever, or night sweats, that

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also suggests something is wrong. And if the headache reacts to the position of the head, for example, it appears or gets worse when lying down—meaning you're fine while standing, but as soon as you lie down, the headache starts.

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These are markers that tell us we need a specialist in this situation. In some cases, it needs to be addressed extremely quickly, even by calling an ambulance. For example, with a sudden, intense headache. Or if there are very

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clear neurological disturbances, we need to rule out strokes and other unpleasant things in the head that could happen. Or, if there is a slow progression of the headache or if the headache reacts to head position. Just because you've been living with it like

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that for some time. This is just a more scheduled visit, but still to a neurologist, a headache specialist.

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What does a neurologist actually do during an appointment? Besides asking a lot of questions. We really do ask a lot of questions, because we need to understand the person's triggers, what kind of headache they have, and how it

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has changed over their lifetime. Sometimes we are not that interested in the period when the person already has headaches 20 days a month. We start asking things like: "Try to remember the period when it happened once a month, say, 30 years ago. How did it

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feel then?" And we don't ask all these questions during the appointment out of idle curiosity. We actually do very little out of idle curiosity at work.

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And it is important to answer them. Because it is very important for us to understand how the headache behaved, to assess how it progressed, changed or didn't change, whether new symptoms appeared or not, which ultimately led to the current state. The second thing

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the doctor does during the appointment is evaluate the neurological status. So , they check if there are definitely no neurological abnormalities. This is what a neurologist should do, uh, during an initial appointment, at least regarding headaches. And third, if you

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have any test results, they are usually not needed for migraines, as no MRI of the brain, ultrasound of neck vessels, or X-ray of the cervical spine will show us a migraine. Uh, but nevertheless, if you brought them with

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you, the neurologist will definitely look at them too. And finally, we give recommendations for headache treatment, how we will strategically approach this issue now. Uh, at the same time, all treatment is divided into two, well, actually, into three layers. I just

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combined them into two. The first is non-pharmacological methods. No one likes them, because these are methods that require effort. You have to pull yourself together and change something yourself. None of us like that. No one likes going to bed and waking up at

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more or less the same time. No one likes working on stress. Does that mean I have to visit a psychotherapist too?

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Regular eating also often becomes a difficulty, because how can I, I have a meeting, how will I eat, I can't eat there, that means 3 hours, and then my head will hurt. And all of this, this is actually the foundation of migraine

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treatment. It is tedious, it is boring, it requires great effort, but it is the base we need. No medications, no, uh, attack relief, or preventive therapy will work as well as changing habits after all. Next, we definitely discuss

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pharmacological methods of treatment. At the same time, they are divided into two large layers. On one hand, it is attack relief, that is, your head hurts right now, what will we treat it with in the moment. And if the person has

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indications, we can also prescribe preventive therapy. That is, these are drugs that a person takes not just at the moment when their head hurts, but with the goal of taking them on a daily basis so that the head hurts less often

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, less severely, and does not spoil the quality of life. So these are the three layers that we always discuss. Most often, if the headaches are rare, we only discuss non-pharmacological methods and ways to correctly relieve headache attacks. If the headaches are

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already more frequent, then we will definitely discuss preventive therapy as well. Plus, the doctor at the appointment must determine if any additional examination methods are required. They must definitely rule out those red flags that we discussed with you. As I said earlier, they are more

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extensive for a doctor. They determine whether we need any MRI study, or a computed tomography scan. Sometimes, however, it is necessary to do so. And they explain the extent to which it should be done. But for a doctor to say

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before a headache appointment that you need this specific list of tests and exams—no, that’s unlikely. Most likely, you will simply be invited for an appointment, after which it will be clarified whether anything actually needs to be done. Most often, nothing

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needs to be done, because the criteria we discussed mention neither MRIs nor ultrasounds. In other words, we simply don't need them. And so, we have finally reached the topic of sports.

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This is one of the ways of non-pharmacological correction for migraine attacks, and, frankly, for tension headaches as well. At the same time, there is a balancing act here. On one hand, physical activity can intensify a migraine or even trigger an

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attack. On the other hand, regular exercise can reduce the number of headache days and lower pain intensity by, according to various data, 20 to 54 %. Why? Because there are many studies showing that people who exercise regularly produce more pain-relieving

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substances: endorphins, cannabinoids, and enkephalins. All of this is produced and provides better pain relief for the person. Plus, their cardiovascular system adapts to regular exercise, which also has a positive effect on migraines. What is the problem with this disease during a

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migraine? It’s that, as we discussed, it begins long before the actual headache attack. But what happens during the attack itself? Due to the overexcitation of the cerebral cortex and brain activity, it releases various inflammatory substances that dilate the

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blood vessels in the head. Vessels in the head do not constrict during a migraine attack; they dilate, which is why the headache throbs, worsens with physical exertion, and is accompanied by nausea and light sensitivity.

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Because our vessels are located in the area of the meninges, which, because of this, start to become irritated. All of this is painful in itself. This provokes the brain even further. It feels unpleasant, it reads this pain signal, it provokes everything even

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more, and it becomes a snowball effect, which is why, in principle, the attack can last so long. And, I mentioned earlier that there is a common myth that ordinary painkillers, like anti-inflammatory drugs, won't work.

Speaker A

Why wouldn't they? After all, inflammation is exactly what happens at the very start. And it is precisely for this inflammation that the same painkillers like ibuprofen will work very well indeed. Why can working out make this condition worse? Because the

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blood vessels in your head are already dilated, right? Just imagine that throbbing, pounding sensation in your temples. On one hand, your condition might worsen if you’ve taken on too much intensity that you weren’t ready for, like after a break in training

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when you decide to do arms day, legs day, and everything else all at once for two hours at the gym. Bad idea. The risk of leaving with a headache is high . Or, if you’ve never exercised and suddenly decide to run a marathon. A

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sudden increase in load. You weren’t adapted to it, your body wasn’t adapted to it either, and it won’t thank you for it at all. Also, your condition might worsen if you train during a migraine attack. That is, with

Speaker A

migraines, one of the criteria is that for some people, it can intensify with physical activity. Accordingly, if it already intensifies with physical activity for you, there’s a high probability it will get worse during a workout. It doesn’t intensify with

Speaker A

physical activity for everyone, but it does for the majority. So, what should you do? In general, the most common types of physical activity recommended are cardio. This includes brisk walking , stationary bikes, swimming, light jogging, ellipticals, and yoga—

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basically anything that slightly raises your heart rate. Dosage-wise, aim for two to three times a week for 30 to 50 minutes. And the most important thing is a gradual increase in intensity. For people who often have headaches, this

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difficulty with gradually increasing the load happens very often because it’s unclear how much is okay and how much will trigger an attack. You really have to try it out and see. We have guidelines that specifically study which physical activity is most

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appropriate. The most proven and recommended type is aerobic exercise— activities that use large muscle groups , increase your breathing, and maintain your heart rate at a steady level, on average, 64-76%of your maximum heart rate. What is your maximum heart rate?

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There are more precise formulas available. This is just the simplest, approximate one, but overall it’s very easy to calculate. It’s 220 minus your age. For example, if you are 30, your maximum heart rate will be 190 beats per minute. Which you can measure

Speaker A

on your watch. Then an optimal workout for you would be around 130-140 beats per minute, without exceeding it. That way, it will act as a conditioning exercise for you. An example of such a workout. And what is very important is

Speaker A

that we need to slowly raise our heart rate and then slowly lower it as well.

Speaker A

It won't work to just show up at a workout and immediately start running at breakneck speed. No, our task is to do everything slowly so that we can then spend the main part of the workout at 130-140 bpm. For some, this is way

Speaker A

too little, just plain boring, but that’s the price we pay for adaptation. This doesn't mean you will be training in these heart rate zones for your entire life. But if, for example, you get frequent headaches, say 10-15 times a month, or if they are

Speaker A

rare but very unpredictable. Sometimes I go to a workout and it hurts, sometimes I go and it doesn't. In this situation, it makes sense to roll back to this level and move up gradually from there, because this is studied and

Speaker A

recommended for episodic migraine, i.e. , when you have a headache 4-8 times a month. And also for chronic migraine, when the headache occurs 15 days a month or more. So, this is a highly recommended approach, right? For example, do a 5-15 minute warm-up with

Speaker A

a gradual increase in heart rate, like walking on a treadmill or using a stationary bike. The main workout can be anything. It could be strength training, general physical conditioning , running, swimming, or anything at all . But the goal during this main workout

Speaker A

is to maintain your heart rate at around 70%. And then we do a cool-down that gradually lowers our heart rate.

Speaker A

This is the baseline we most often use to get started. But it's not the only thing we can offer. And if you are running, if you are training for endurance, you need to periodically increase your heart rate. You won't be

Speaker A

able to just run at 140 all the time if you want to train for endurance. What else can we offer? We can offer progressive muscle relaxation techniques at the end or at the beginning of the workout. What is that?

Speaker A

It's when we intentionally tense a muscle and then intentionally, consciously relax it. For example, I intentionally tense my trapezius, and then I slowly and calmly breathe, consciously focusing on how it relaxes so nicely. This is called progressive muscle relaxation. High-intensity

Speaker A

interval training is not prohibited, but only for people who have episodic migraines, that is, those who have headaches less frequently, say 8-10 times a month. And the attacks are relatively controlled. You can use exercises to strengthen the neck

Speaker A

muscles, such as various turns and head movements, which are usually selected by a physical therapist or a fitness instructor. They are not suitable for everyone. For some people, they can trigger attacks. Sometimes that happens too. But it is just one of the ways to

Speaker A

stay active that we can also use. These can even be stretches or self-massage with a ball. These are rather additional things. That is, aerobic exercises. The base is how we can diversify our life and live in such a

Speaker A

mode all the time. For example, yes, an example of such a workout. We do a warm-up again that gradually increases our heart rate. Then we do the workout.

Speaker A

It can be aerobic exercises or strength exercises again. And then we have 15 minutes left, and, for example, once a week we give ourselves additional progressive muscle relaxation. This works well for us. And then we do a cool-down or stretching. Or, for

Speaker A

example, an example of a high-intensity interval workout. This is what was directly studied in research, where we give a person 400 meters on a treadmill or 10 minutes on a stationary bike, during which the heart rate gradually increases. And then there are intervals

Speaker A

, yes, 4 minutes of high-intensity load , 3 minutes of medium intensity, for four repetitions. The workout that was given in the studies, which was tolerated safely, again, for a person who rarely had a headache, in the study

Speaker A

people had headaches no more than five to six times a month, no more. They gradually brought this high intensity to 90-95%of their maximum heart rate.

Speaker A

Not all at once. That is, they didn't start the first workout with "that's it , we're rushing at a sky-high heart rate of 170 to who knows where." No, they gradually increased this high intensity over 8 weeks, and accordingly

Speaker A

, they also increased the medium intensity. But at the peak of the training load, it can look like this, with a mandatory cool-down on a treadmill or a stationary bike afterwards. So, what is the commonality of all the workouts I listed? These are

Speaker A

just examples. But the commonality is that we need to gradually raise the heart rate and gradually bring it down.

Speaker A

If our condition is not very controlled with the training process, if a workout sometimes triggers a headache and sometimes doesn't, or if we have frequent headaches. We start with this.

Speaker A

If we are already pros, we understand well, we want to progress, we feel safe , we can, and we love high-intensity interval training, for example, we can include interval training for ourselves too. That is, it is not prohibited. It

Speaker A

is important to say that for a person with migraine, very little is actually prohibited. But you can just do it competently, build it into your training process, tell your trainer about it, that I have such peculiarities, let's take them into

Speaker A

account. And based on the experience of my patients, I directly adjust their training program together with their trainer and give recommendations regarding headaches. This really works great and improves the condition. When is it important to see a neurologist in

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general? If you don't know what type of headache you have, meaning you've lived with headaches your whole life and don't know what's going on, this is a reason to see a doctor who specializes in headaches. This way, you'll clearly

Speaker A

understand what to look for, how to control them, how to prevent them from becoming more frequent, and how to avoid needing long-term treatment. If a headache doesn't go away without taking pills, that's also a characteristic feature of migraines; they most often

Speaker A

require medication. If you realize that the headache won't pass without medication, that's a small sign that you might have migraines, so you should see a neurologist at least once in your life to get a diagnosis. If your head

Speaker A

hurts more than four times a month, meaning you find yourself with a headache every Monday or every Saturday , that is not okay. If a headache interferes with your workouts, work, or daily life—it doesn't just ache and go away without medication, but really

Speaker A

demands your attention—that's a sign. These are strong, especially uncontrollable, headache attacks. And, naturally, if there are any red flags, a great and free thing you can do in your daily life, if you suffer from headaches, is to start keeping a

Speaker A

headache diary. It’s all very simple. There are four diaries here; they are all different, for every taste and preference. Migribot is available on Telegram and on Max, as well. And these three are applications. The difference with Migribot is that it will ask you

Speaker A

every single day. This is often very useful at the start, when you haven't yet developed the habit. Why is it important to keep a diary? Because we tend to forget the bad things. We forget how often our head actually

Speaker A

hurts. If we don't record it, we don't have a very good handle on the situation. Keep a diary to see how well you are actually managing your attacks, right? So, what does managing an attack well mean? It means that the next day

Speaker A

your head doesn't hurt and you feel good. If you have attacks lasting two or three days, it means you aren't managing them. It means you need to adjust the methods you use to treat the attacks. And if your head hurts often

Speaker A

—more than four times a month, say five or six times a month—and it isn't well-relieved by medication, we have preventive therapy that can improve your quality of life. And these are tablet-based medications that we can use on a daily basis. There are

Speaker A

also modern injectable drugs that we can administer once a month—my patients call it the "migraine vaccine" —which also work coolly and effectively, and accordingly, they don't restrict you at all because they have practically no side effects.

Speaker A

That's how things are. Can a tension headache turn into a migraine? A person can have two different types of headaches. So. But most often, if we are talking about a single attack, it will usually be just one thing. If it

Speaker A

was already a migraine, then it was a migraine from the start. For example, it might start feeling like a tension headache—something pressing, your neck hurts, but you don't feel nauseous . And then it starts to escalate and becomes throbbing. That was a migraine

Speaker A

beginning. Well, it just doesn't start all at once. It comes on gradually, like a wave. At the start, it might seem like you just overexerted yourself , but then the lights start to bother you, you want to dim them, and you feel

Speaker A

a bit nauseous. That is a migraine. And many people just endure it, not taking a pill, because what if the headache goes away on its own? That is very risky because you cannot know what kind of headache it is, and it is usually

Speaker A

safer—if you have no contraindications or restrictions on taking medication—to take a pain pill rather than not taking one. We have pills that work mainly at the onset of a headache attack. There are pills, and also nasal sprays, that can work even

Speaker A

when the headache has already peaked. So. But this is all discussed on an individual basis.

Speaker A

What about altitude headaches? Oh, there is a distinct high-altitude headache. It is separate, truly separate. But for people who have migraines, altitude can also be a trigger for an attack in some situations, though it is very difficult , so to speak, to distinguish a

Speaker A

high-altitude headache from a migraine. Therefore, at altitude, we will assume in any case that it is a high-altitude headache. And we treat it as a high-altitude headache, as a sign that it could be acute mountain sickness, yes, altitude sickness. Because

Speaker A

altitude sickness is accompanied not only by headaches—that is one mandatory symptom—but also by additional symptoms. Impaired balance, nausea, loss of appetite, sleep disturbances, and so on. It is just important to understand here that if we are talking about altitude, it is an

Speaker A

area of increased danger a priori. We will immediately consider a high-altitude headache if we are at an altitude of more than 2,500–3,000 meters; according to various sources, the average is 2,500. The strategy for headaches at altitude is such that we

Speaker A

first think about something potentially dangerous. This is altitude headache, which may start being accompanied by additional symptoms of acute mountain sickness that require a stop, acclimatization, and sometimes taking specific medications that the instructor has in their backpack. Until

Speaker A

we have proven that it is not an altitude headache. It is very similar to a migraine; it also throbs, and it is also accompanied by nausea. And then we think about acute mountain sickness, because we already have two criteria

Speaker A

met immediately. It will also react to physical activity. That is, it truly has migraine features. Why is that?

Speaker A

Because during an altitude headache, the blood vessels in the head also dilate due to hypoxia. And it really does have those migraine features.

Speaker A

Therefore, my advice is: when on a hike with a group, you must inform the instructor that you have a headache and then decide together with them how to manage this attack. Well, the main treatment for migraines is to follow a

Speaker A

daily routine and take the necessary medications. Use medications if you have frequent pain, and consult a specialist for preventive therapy. There. Because we have limitations on the use of painkillers, for example, or triptans, which are drugs used to relieve a

Speaker A

migraine attack. It is undesirable to take painkillers or use triptans more than ten times a month. It depends on the specific drugs, but on average, if you take them more than ten times a month, a complication can arise over

Speaker A

time called medication-overuse headache , that is, a headache due to an excessive amount of painkillers. If you previously just had a migraine, but we treated it with ibuprofen, then another one joins it, which has its own characteristics. It usually blurs the

Speaker A

characteristic features of migraine attacks. Not to mention that painkillers in uncontrolled quantities can affect the stomach and the kidneys, among other things. That just might not be very safe. There are safer ways to control an attack.

Speaker A

But if you are sitting at work and your head starts to hurt from mental strain, most often, for an attack to be triggered, it requires either some kind of "super-trigger"—for women, for instance, menstruation is a super-trigger. Or it is usually like a

Speaker A

bucket into which water drips, and at some point, the bucket can overflow. So , what was happening 3–4 days before your head started hurting? Uh-huh. I didn't get enough sleep, I had an argument with my husband, I was hungry

Speaker A

and angry all day. And then the next day I caught up on sleep, it was Saturday evening, so I drank some wine.

Speaker A

And so on Monday I'm at work, my head hurts from the mental strain. But it usually builds up and builds up like this, and then spills over. But against a backdrop of stress, I mean, if there's mental strain there, well, in

Speaker A

general, yes, it can. We all have cognitive biases. We live with them our whole lives. That is normal. Our brain finds it easier to think logically and not think illogically. That's why we often don't...well, we have an objective reason. My neck hurts, it's

Speaker A

osteochondrosis, so my head hurts. Logical. But you have to take a look at that. On the other hand, it might turn out not to be the case. The same applies to the weather, for example, many people note changes in weather,

Speaker A

but this has been studied separately. At the moment, it hasn't been proven, because the weather changes daily. We have different atmospheric pressure, wind speeds, cloud cover, and temperatures every day. And if we are indeed talking about weather changes,

Speaker A

then your head should hurt every single day. It changes one way or another every day. And they studied large groups, looked at patient diaries, and no correlation with temperature, sunlight brightness, wind speed, or magnetic storms has been found yet. So,

Speaker A

weather changes might just be such an objective...Well, it's cloudy today, so that's why. And I got a headache. Well, for example, when it's cloudy, I like to sleep in. And it's most likely because I slept longer. Or before a

Speaker A

thunderstorm, it can get very stuffy. Stuffiness is my trigger. So can I get a headache because of stuffiness? Yes.

Speaker A

One of your slides said that a headache is an inflammatory process. And that means it is treated with anti-inflammatory drugs.

Speaker A

An inflammatory process in the brain. We have a term for that: neuroinflammation. Inflammatory substances can be released from nerve endings. But this is what happens inside our skull. It’s not pus, we aren't talking about pus, we're talking about neuroinflammation. It is a very

Speaker A

subtle matter, against the background of which a vessel can dilate. How do you distinguish stroke symptoms from a simple headache or migraine?

Speaker A

Yes, that is a red flag. So we have these red flags, and this is a neurological impairment. A stroke is usually accompanied by neurological manifestations. The most common signs of a stroke, how we diagnose it, is to look in a mirror and check your smile.

Speaker A

It's checking the strength in your arm and leg, whether the arm has become clumsy, the leg is dragging, or we can't hold a mug, right? Meaning some kind of clumsiness, weakness in the arm . Another common symptom is impaired

Speaker A

speech or impaired understanding of speech. You have mush in your mouth, you can't speak, you mix up words, or you don't understand what people are saying to you. These are all signs that you need to call an ambulance

Speaker A

immediately and get it checked out. But can the neck or collarbone muscles somehow block blood supply to the brain and lead to headaches and migraines?

Speaker A

Anatomically, that is impossible, because we have main vessels that carry blood to the head. Two here in front, you can feel them, they will be pulsating right here. And two in the back—this is our notorious vertebral artery, which many specialists like to

Speaker A

latch onto. So, the vertebral artery; nature isn't stupid, and all of this was very well protected. The vertebral artery runs like a subway train in a tunnel made of bone. Our cervical spine has special outgrowths on the sides,

Speaker A

holes like that, through which the vertebral artery runs. So muscles cannot compress this artery; it is protected. And therefore, it cannot happen that due to muscle tension, something gets pinched somewhere, causing poor blood circulation and, as a result, a headache. I mean, purely

Speaker A

anatomically, it is impossible. But could it be that the neck, just the muscles, got overstrained and they hurt ? They, as a rule, will hurt locally, and the zone of radiation might, well, reach up to here maybe. But could that

Speaker A

happen, purely theoretically? Yes, of course it could. You decided to dig in the garden, and did everything with your right hand, and overstrained yourself here. Will a headache follow that? Well, purely theoretically, there might be some tension in the head, in

Speaker A

the back of the neck area. Will it meet the criteria for a migraine, with throbbing, worsening with physical activity, feeling a little nauseous, light sensitivity? No, it won't, it’s just a muscle. Why would you feel nauseous? "But when my head hurt, I

Speaker A

massaged the muscle and my headache went away." Ah, look at what’s going on here.

Speaker A

That happens, for one thing, with tension-type headaches. A tension headache, as the term implies, means that the muscles around the head are tense. And, in principle, if you massage them, it will get easier. This can sometimes happen with migraines as

Speaker A

well. But the point is not that the neck was hurting. Also, during a migraine attack, once everything is already underway, the muscles around the head and neck also tense up, becoming an additional source of pain that the brain registers, which makes

Speaker A

things even worse and creates more tension. On one hand, relaxing the muscles can help a little, but it's not the primary method; it's an additional one that can be used alongside medication, for example. Or another point: when we press hard on someone or

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cause them pain somewhere, regardless of where, their body immediately produces a larger amount of natural painkillers. So, I pressed down, and for instance, painful massage techniques work on this principle because after a very painful massage, you feel better for a while due to the

Speaker A

release of a large amount of painkillers. We need painkillers urgently, it hurts. The same thing can happen here. You might also just feel a bit better because you've caused yourself some extra pain. So, that means there is no point in rubbing

Speaker A

anything. It makes sense to rub as an additional measure. Well, it's not the primary therapy, so to speak. The point is that different methods can be effective in their own way. And with migraines, for example, we use a

Speaker A

strategy. I explain it like this: sometimes we use a sledgehammer to crack a nut. Why? Because when a headache first starts, we cannot predict what it might turn into. There are people who have had headaches for a long time, but they are few, and they

Speaker A

clearly understand whether it will be bad or a good scenario, but even they make mistakes, according to the diaries and statistics I see during appointments. And the more ways we use to stop an attack at the moment, the

Speaker A

better it will be. So, removing triggers is logical, yes, that is something non-medicinal. Is it possible to do some kind of relaxing self-massage, or use a ball, for example? Yes, we can do that. Will it work? Well, maybe it will work, but we

Speaker A

use the "sledgehammer" strategy and almost always hedge our bets with medication, because it can be very unpredictable. And this whole idea of enduring a headache until the very last moment. The thing is, the strategy for headaches is that it's important to

Speaker A

stop them in the first hour, because if you don't catch it in the first hour, it can behave unpredictably, even lasting for a week or two, which is called status migrainosus. And in that case, we would have to administer IV

Speaker A

medications, and you would need to be hospitalized. I mean, those are some really unpleasant things that can become a reality. Like the girl before you described—her head hurt for a week straight, she was vomiting, and nothing was working. Things like that

Speaker A

can sometimes happen if you try to save on medication at the start. It’s just unpredictable. If you’ve developed a clear strategy for yourself, it should work like a Swiss watch. I know for sure that if I do this, that, and this,

Speaker A

my headache will go away. Great. That’s good. But why do I ask if you’ve kept statistics on how it all works for you? Because most often, there’s a catch.

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So, it turns out you shouldn't endure a headache; you need to take medication right away.

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It’s better not to endure it. It is better not to endure it. Better, yes, but you must monitor the amount of medication you take. So, if you realize you're taking pills four times a month, it’s a reason to discuss preventative

Speaker A

therapy with your doctor so you don’t just take painkillers, but rather medication that will manage it, so your head hurts less often. If we are talking about the goals of headache preventative therapy, then we are aiming to reach the point of having few

Speaker A

days with headaches per month. We use the therapy for at least another six months from that point, after which we discontinue it. And in an ideal world, the person returns to about four days of headaches a month, and it doesn't

Speaker A

start hurting more often. If a person previously had 20 days of pain a month and it drops to 4, that’s great, wonderful. Unfortunately, migraine is currently incurable. We don't have drugs that can just take it away forever. But there are complex cases

Speaker A

where we've tried many drugs; some worked in their own way, and some didn't work at all. It is all very individual, but we do have options to improve your quality of life. So, if we are speaking purely statistically by

Speaker A

criteria—the migraine remains. If we are talking strictly practically about tension headaches, which, well, we have all experienced at least once in our lives: by the evening your head feels a bit heavy, no nausea or anything, you don't really want to take a pill for it

Speaker A

, it's at about a two or three out of ten, just something in the background all over your head. Well, it can usually go away quickly, that is, in half a day or a couple of hours. But then again, it can also last for 7 days

Speaker A

. That happens too. Therefore, saying who is faster or longer, migraine can also last longer. Because if we didn't take a pill in time or took one that didn't work, then it might not end in 3 days. It can turn into a migrainous

Speaker A

status that lasts a week, two, or three , meaning your head hurts for 3 weeks in a row. I have patients who come to see me, and we look at their diaries.

Speaker A

They have a headache 12 times a month. But that is only four migraine attacks.

Speaker A

It's just that each of them lasts for 3 days. And in this situation, our task will be to choose an adequate treatment to stop it at the start, if we can manage that. And in this situation, the person won't have a headache for 12

Speaker A

days a month, but only four. Whether preventative treatment is needed in this situation will be decided individually. It depends on how well we control this whole situation. But that is one type of situation. It happens that a person just has a headache 12

Speaker A

times a month, for 2 days, for one day, for two, for one. And in this situation , stopping the attacks, well, it already works quite well. Sometimes the headache only lasted for one day, you took the medication, and it went away

Speaker A

immediately. Exactly. But in this case, we will lean towards preventative therapy. So, it's a balancing act. On one hand, with migraines, you shouldn't endure the pain; you need to take medication. On the other hand, taking painkillers too often is undesirable.

Speaker A

And that is exactly what prevention is for. I used to have headaches too; I would endure them, and gradually they became more frequent. I got tired of it all, I went to a doctor, and now I follow a

Speaker A

preventative plan. And I haven't had any headaches for almost 2 months now. Ah, I see what you are talking about.

Speaker A

We have a rule: the more often your head hurts, the more often it will hurt in the future. Why? Because we have a brain, and it knows how to restructure itself. And perhaps a simple example would be to imagine it as a metal wheel

Speaker A

with cogs that rotate, like in a clock. That kind of mechanism. It rotates exactly on its axis, and it stops there every second. It knows how to stop. The more often your head hurts, the more that wheel may start spinning

Speaker A

unnecessarily; it becomes smoother. It is easier to trigger a pain attack when one occurred recently, because your brain, unfortunately, gradually learns to trigger pain against you. This means the pain-relief mechanisms that normally suppress pain stop working effectively. Therefore, the more often

Speaker A

your head hurts, the significantly higher the risk becomes that it will hurt even more frequently, as certain mechanisms of chronic pain are activated. And the less often your head hurts, the better these mechanisms will work for you: the head starts to hurt,

Speaker A

you flip the switch, activate the pain defense, and all medications work well. So, this really does exist, and it can be quite noticeable. Therefore, yes, it happens that—well, again, assuming it's not a cognitive bias—if you have additionally started exercising during

Speaker A

this time, paying more attention to your diet, sleeping correctly, and getting enough rest, then, of course, that will have an effect too. Alright, that's all. Super. Thank you very much.

Topics:migraineheadacheexercise safetyneurologypain managementprimary headachessecondary headachesmigraine triggerssports medicineheadache myths

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