If you’ve noticed an episode of migraine often follows your workouts, you may be experiencing exercise-induced migraine. But it could also be caused by other contributing factors.

Moderate exercise, in general, can help some people manage migraine and other health challenges. But, in some cases, physical activity may trigger a migraine attack in some people.

If you experience exercise-induced migraine episodes, you might notice your pain frequently starts around your neck, a common feature of this type of migraine noted in a small 2013 Dutch study.

Although rare, exercising can cause migraine attacks in some people. There may also be a connection between exercise-induced migraine and benign exertion headaches.

This could mean that if you live with both conditions, you may experience intense head pain after working out because of exertion headache, not migraine.

Migraine or headache

Exercise-induced migraine and benign exertion headaches are two types of head pain that can be caused by exercise, but they’re not the same condition.

Exertion headaches can often be mistaken for migraine attacks. They can present with many of the same symptoms, including:

  • pulsating pain
  • nausea
  • neck stiffness
  • vision changes

According to the International Classification of Headache Disorders 3rd edition (ICHD-3), an exertion exercise headache can have similar causes to exercise-induced migraine:

  • intracranial pressure changes
  • increased vascular demands

Benign exertion headaches, however, are often linked to situational conditions like hot weather or high altitude. An exercise-induced migraine episode, on the other hand, may occur just as frequently in the absence of such conditions.

Exertion headaches rarely last more than minutes, with the diagnostic cutoff at 48 hours.

Unlike migraine, which is considered a neurological condition, primary exercise headaches occur in the absence of any intracranial disorder. They’re often self-limiting which means after 3 to 6 months, you may not experience them again.

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Why exercise may become a migraine trigger is still under study, though genetics may be a significant contributing factor to migraine, in general.

Exercise may also be involved in migraine attacks by rising levels of pro-inflammatory substances in the brain. These substances could increase natural pulsations and result in an elevated heart rate, intracranial pressure, and blood pressure.

However, while it may seem like exercise is causing your migraine episodes, other factors besides physical activity may be the contributing factors.

These could include:

  • sudden changes in temperature or extreme temperatures
  • dehydration
  • not eating enough before exercising
  • not sleeping enough
  • underlying medical conditions
  • side effects of medications

Symptoms and diagnosis

Migraine is a neurological condition that often presents with episodes of throbbing pain on one or both sides of the head. Sometimes, it’s possible to experience a migraine episode without any pain.

Migraine episodes tend to occur in 4 phases:

  • prodrome (pre-head pain symptoms lasting hours or days)
  • aura (sensory disturbances and reversible neurological deficits) occurring up to an hour prior to head pain)
  • headache (lasting hours to days)
  • postdrome or migraine hangover (a variety of aftermath symptoms lasting 1 to 2 days)

Migraine attacks are often accompanied by debilitating symptoms like:

  • vomiting and nausea
  • sensitivity to light, sound, or smell
  • body aches and muscle stiffness
  • throbbing or drilling head pain
  • fatigue
  • depressed mood
  • insomnia
  • concentration challenges
  • anxiety

There’s no definitive test or diagnostic imaging that can tell you if head pain is a result of migraine.

Your health team will likely make a diagnosis based on the frequency of episodes, family history, specific symptoms, level of impairment, and basic neurological exams.

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Because the exact mechanisms behind exercise-induced migraine episodes are unclear, which workouts are more likely to trigger an episode may be individual to your situation.

Exercise-induced migraine may be linked to the consequences of working out like:

  • neck pain
  • changes in intracranial pressure,
  • increased heart rate
  • increased blood flow

This could mean workouts that cause sudden changes in movement, bending, or demand high levels of exertion may be more likely than others to lead to migraine.

This could include activities such as:

  • weightlifting
  • circuit training
  • running and sprinting
  • rowing
  • basketball
  • football
  • tennis
  • swimming

If you’re experiencing a workout migraine, continuing your activity may only make your head pain worse.

Removing yourself from the trigger and resting in a cool, dark, quiet place may provide some immediate relief.

Many people living with exercise-induced migraine can also benefit from a variety of migraine treatments, including medication.

Migraine, in general, can sometimes be managed as needed with over-the-counter products like ibuprofen or acetaminophen. For severe symptoms, your health team may prescribe a variety of options as preventive interventions, including:

  • blood pressure-lowering medications
  • anti-seizure drugs
  • antidepressants
  • medications targeting certain peptides (natural amino acids)

Some behavioral approaches may also help manage migraine, including:

A 2018 review suggests you may be able to manage exercise-induced migraine through:

  • longer warm-up periods
  • changing aerobic workout routines from isometric exercises to cycling or walking
  • limiting workouts to 2 or 3 days per week

Although not always, exercise may cause migraine episodes. This is sometimes referred to as exercise-induced migraine.

Unlike exertion headaches, exercise-induced migraine episodes can occur despite intense temperature or altitude conditions.

If you experience a migraine episode as a result of physical activity, modifying your workout, adopting behavioral approaches, and decreasing intensity help you find relief. Discussing these episodes with your health professional is highly advised.