This is part two of the series of articles looking at migraines and headaches. In part one I looked closely at what are the common triggers and causes of migraine attacks are so you can begin to modify your lifestyle habits or seek help in the areas that may be contributing to your problem. If you have not read part one, make sure you go back and read that now as this will help you understand how to correctly use the various strategies we are about to discuss. In this article, we look closely at the value of exercise, diet, sleep, breathing, and your ability to control stress for preventing a migraine attack. 

Before we jump right into the various ways to manage your migraine it is important that you understand how the migraine threshold works. In part one, I explained how there is no one singular trigger responsible for a migraine attack, instead it is the combination of several at once creating the perfect storm. In the book “Managing your Migraine” by Dr Katy Munro she says on page 33, “It is more helpful to think of triggers adding together to irritate the brain, pushing its sensitivity towards a threshold. Once the threshold is breached, a migraine attack starts to roll”.

In part one I created this simple infographic to help give you a good visual of what the migraine threshold looks like. I think this is a great way to appreciate how many factors may contribute to your problem and how you need to look at more than one thing to find your long term solution.

These various triggers now provide you with the framework of what you need to work on in order to prevent this perfect storm from taking place. I am sure you can imagine that the needs of one person will differ significantly to the next even though they both suffer with similar symptoms. You must carefully read the tips I provide below and determine what part needs your greatest attention.

Let’s start with exercise.

Exercise

While exercise is definitely a healthy addition and something you should be trying to adopt into your lifestyle it is very rarely a good strategy to use for getting rid of a migraine. Usually when a migraine sets in the pain can dramatically worsen from moving so the information we are about to discuss is more useful in the times when you are not dealing with the migraine or associated symptoms.

The first thing you must understand with exercise is that there is no definitive “best exercise” method or series of exercises that work for everyone. Some types of exercise may be therapeutic and relieving for some, while others it may trigger an attack. You have to experiment with what works for you and even how much is enough. Sometimes I see people do really well with a series of exercises but they increase the volume too fast or to a level that is too high and their best efforts backfire on them. This is a classic example of where the choice of exercise was correct, but the dosage applied was wrong.

However, one thing is certain when it comes to exercise and that is, if you do nothing you will make matters worse.

Let’s take a look at various methods you could use.

Cardio exercise

It has been well documented that cardio activity can release endorphins and the feel good hormones that can help to counter the damage of inflammation and stress hormones like cortisol. The more intense the exercise is the higher the release of these endorphins which explains why low intensity walking does not provide that same “high” feeling that running does.

This is why exercise is often prescribed as a way to help combat chronic depression and anxiety that can wreak havoc on someone’s mental health. In the book “Spark” by John Ratey MD he states,

"Regular aerobic activity calms the body, so much that it can handle more stress before the serious response involving heart rate and stress hormones kick in. It raises the trigger point of the physical reaction. In the brain, the mild stress of exercise fortifies the infrastructure of our nerve cells by activating genes to produce certain proteins that protect the cells against damage and disease. It also raises our neurons stress threshold."

You can read the detailed article about exercise for mental health here and below is a quick video summarising this.

One study found that looked at the results of an aerobic endurance training program building up to 30 minutes of running over a ten week period, found that not only were people’s migraine attacks reduced with exercise, but their attention and information processing improved too.

Reference: Claudia H. Overath, Stephanie Darabaneanu, Maire C. Evers et al. (2014) Does an aerobic endurance program have an influence on information processing in migrainers? Journal of headache and pain, 15 (1), art. 11, www.ncbi.nlm.rih.gov/pme/articles/PMC4017768

While it may help with depression and anxiety it does not guarantee it works for migraine sufferers. The intensity of this type of exercise can be a trigger for some people so this may not be the best solution.

Strength Training

This is an interesting type of training to use when discussing its value to migraines. I would argue it is of much greater importance than cardio for numerous reasons that you can read in this article – Strength training changes more than just your muscles.

If you remember the potential causes of migraines that we just discussed in great detail, and the factors that are under your control were stress, gut health, hormone fluctuation, and poor posture of the neck and shoulder. Each one of these factors shares a common theme in that they are heavily influenced by how much muscle you have. The more muscle you have the better, which also explains why women are more likely to suffer with migraines than men.

In terms of overall health the muscles of people who regularly lift weights absorb blood sugar in response to insulin much more effectively helping the pancreas to secrete lower amounts of this hormone. This is very important to the health of the entire body and maintaining homeostasis and potentially keeping a migraine in check. This is one reason why strength training is essential to people with Type 2 diabetes and for those looking to lose weight and restore optimal metabolic function.

Lastly, we cannot underestimate how valuable strength training can be for correcting postural asymmetry and movement dysfunction. We discussed how damaging poor posture is to the person with chronic migraines and this should be one area you look very closely for signs of weakness. Using massage and stretching to get rid of trigger points is a futile exercise if the underlying problem is weakness. The trigger points are there for a reason and will continue to come back as long as the weakness remains. A well designed strength training program can resolve this problem allowing you to rule this out as an ongoing factor. More on this shortly.

However, as much as all of this sounds great there is one big problem with the migraine sufferer and that is the intensity of the training can very easily trigger an attack. This has a lot to do with the intensity of the training and the fact that lifting loads to your potential with deadlifts and squats require you to partially hold your breath to create intra-abdominal pressure to protect your spine and other joints from damage. For most people this is okay and causes no problems. For the migraine sufferer this could cause a large enough blood pressure rise to trigger a migraine or serious headache.

Some researchers speculate that people with migraine may have a difficult time regulating their metabolic function with a sudden change in blood sugars or blood pressure triggering a brain response. This may help to explain why it is estimated that 38% of people report exercise as a trigger.

As I explained earlier it may not be that the exercise is necessarily wrong, just the intensity was too much for the body to handle. Perhaps moderate exercise may produce better results or ensuring you have food and water on hand to avoid sudden drops in energy. This is why you need to experiment a fair bit to find what works for you. This is not limited to strength training either, as high intensity interval training can also trigger the same effect.

Remember the worst thing you can do is nothing. Many people feel the migraine takes control of their daily life and this is one part where the effort is well worth it so you can take some of that control back.

Improve Your Posture

There are many reasons people adopt poor postures, such as siting poorly or too much, performing repetitive tasks with poor form, dysfunctional breathing, emotional disorders, and even developmental dysfunctions evolved through childhood.

It is during a state of ideal posture that the muscles will function most efficiently. In ideal posture, a line extending down the side of the body should run through the ear lobe, transect the shoulder, hip and knee joints and fall just in front of the ankle bone.

There are many different variations of poor posture as you can see from the visual below.

The good news is you can correct these problems if you have a well-designed plan that targets the right areas and you spend the time to do so. The bad news is I cannot tell you exactly what these exercises for you to do are. I would only be guessing and could give you the wrong exercise to do. My best advice is to find a physical therapist or a trainer who specializes in postural training to provide you with the right plan.

Having said that, there are a few exercises I use with almost every person who suffers from scapula dysfunction, shoulder pain, and of course neck pain related headaches. These exercises are all based around improving scapula function.

The quote in the picture explains exactly why this is so important for working with a migraine or headache.

Improve Your Thoracic Mobility

Thoracic mobility is always very tough for the neck pain person to work with for they often have compressed the spine so much that it has lost a great deal of its mobility with extension and rotation. Until this is addressed you will never be able to stabilize the head and neck to prevent the ongoing tension and stiffness in the muscles of the neck.

It is important to understand that the mobility of the thoracic spine is vital for the lumbar spine and the shoulder joint to achieve stability. Both of these joints are regularly exposed to injury when the thoracic region becomes stiff and rigid. I prefer to use this as a test as it tells me a lot about where the restriction is hiding exactly. This is also an example of where the test is also a great corrective exercise in its own right.

Watch the video below to see how this works.

Wall Slides

This is such a great exercise to use for the neck pain person as it teaches them how to lift their arms correctly without the need to shrug into their neck, but more important it begins to free up the scapula with its correct motion and get the serratus anterior activated.

The scapula is the key here and it is very unique in that it needs lots of mobility but not too much, as the scapula also needs stability too but again not too much! The secret to restoring optimal mobility and stability at the right time to the right muscles is to teach movement mechanics, and very specifically with POSTERIOR TILT and UPWARD ROTATION of the scapula. This is the purpose of the wall slides exercise and it does an amazing job of restoring these movements.

Strengthening The Upper Traps

This process can be very difficult to do so you need to have a lot of exercises in your toolbox that you can use that minimize the risk of aggravating your neck. If you remember from part one I discussed in great detail the danger of a depressed shoulder for creating all types of pain in the neck that can easily lead to a headache. The counter to this is to try to strengthen the upper trapezius and in the video below I provide you with several exercises you could use to do this. I also show you how to put them together in a sequence to give your body the best chance of succeeding.

Obviously there are a ton of other exercises I would use but this gives you a great start and something to build upon with improving your overall posture and ruling out any muscular imbalances as a cause for your migraines. Strength training is not about lifting massive weights and getting buffed. If it is used correctly it is the greatest way to improve movement efficiency and improve posture to avoid muscular tension and imbalances that cause pain.

Specific Shoulder & Neck Program

As I am sure you are aware the neck and shoulder are very difficult areas to work with as there is so many moving parts and pieces to consider. To give you a template to follow is impossible as the only way to determine what to do is assess your body first and let the tests dictate what to do.

Two people with identical symptoms may need completely opposing programs. One may need stacks of mobility where the other it may be the strengthening exercises that are of more importance.

You will find tons of additional ideas of how I might approach this in the articles below.

• 13 exercises to strengthen your neck
• Why I love the serratus anterior wall slides drill
• Releasing upper trapezius tightness requires strengthening

To help you out with a more detailed program using this process I created a detailed shoulder pain report that provides you with all the tests and exercises I might use in a step by step format so you can finally get rid of your problems for good. To see more about what is included in this detailed report click here and to download instantly click the image below.

Nutrition

We already discussed the importance of having a healthy gut earlier and how a poor diet can easily trigger migraine symptoms. Obviously one of the best ways to maintain a healthy gut is to clean up your diet and ensure you eat quality nutrition. Once again there can be big variance with what works with some people and what works for others.

Arguably the one thing that is common to everyone when it comes to nutrition for headaches and migraines is eating foods that provide slow release energy to avoid sudden drops in blood glucose levels. Just as we discussed before with exercise, sudden drops in energy can trigger an attack so the best way to avoid this is to make sure you eat foods that are low in GI.

Avoiding sugar and processed foods is a good thing to do for all of us but it is even more important for those trying to maintain steady blood glucose levels. Eating a diet high in sugar or carbohydrates can set you up for rapid peaks and drops in sugar levels so it is wise to try to avoid these type of foods as much as you can.

This is often where diets like the Ketogenic Diet are suggested for controlling migraines. There is tons of research indicating this has been very successful in treating conditions like epilepsy and diabetes in recent years and is a great way to control blood sugars. The ketogenic diet is a high-fat, low-carbohydrate diet that forces the body to burn fats as the preferred fuel source for energy rather than carbohydrates. The body prefers to use carbohydrates as its energy source as it is so much easier to convert into energy. Unfortunately, many people tend to overeat carbohydrates and end up storing much of it as fat. The keto diet makes your body more fat dependant and less carbohydrate dependant therefor, reducing your fat levels but at the same time maintaining good energy levels.

This all sounds perfect for the person with migraines, however, it can cause problems for some people. The diet can be quite restrictive for some and it can produce side effects of constipation and disrupted bowel movements. Also making the change from carbs as the fuel source to fat takes some time and during this process it could very easily trigger constant migraines and even flu-like symptoms in people until their body adapts to the change. It is fair to say that the jury is still out on this one at this stage as a definitive nutrition solution for migraines.

Perhaps the easier and less controversial diet to follow would be the Mediterranean diet. The Mediterranean diet encourages a variety of nutrient-dense foods, including fruits, vegetables, nuts, seeds, whole grains, and heart-healthy fats. Exactly which foods belong to the Mediterranean diet is difficult to say because there’s a big variation between countries. Having said that, the one thing that is consistent to this diet is the inclusion of seafood.

Eating more fish along with fresh vegetables is one of the best ways to increase your Omega 3 levels which are vital for fighting inflammation. Salmon would be the one of the best foods to include in your diet and is high in Omega 3 and also selenium, which is a trace mineral not found in many foods. We do not need a lot of it to get our daily intake as a single serve of salmon will provide your body 59–67% of the RDI.

Like the Keto diet this eating pattern may help stabilize blood sugar levels and prevent any sudden drops in energy. Interestingly, multiple studies have found that the Mediterranean diet can reduce fasting blood sugar levels and improve levels of haemoglobin A1C, a marker used to measure long-term blood sugar control. The biggest difference to the Keto diet is it is that carbs are reduced but not eliminated entirely allowing an easier transition to this style of eating.

My suggestion is to try to find what works for you. If you are eating a wide range of vegetables with some quality protein and good fats you are well on the right track to getting this part of the migraine equation right. Take a look at the picture below to see how important it is to eat a wide range of foods.

Lastly, apart from eating quality foods it is vital you eat at regular times. Skipping meals or waiting too long between meals can also lead to sudden drops in glucose levels. Many office workers fall into this trap and when you add the stress of their job on top it can very quickly lead to serious problems later in the day. A good rule of thumb is to eat every four hours.

You will find a ton of great information about nutrition in the report below.

Breathing Exercises

Just about any illness can be made worse by an imbalance of oxygen and carbon dioxide gases. In the book “The TMJ Healing Plan” by Cynthia Paterson MD she discusses the effect of poor breathing and how it can easily relate to jaw pain and headaches. On page 106 she shares some great research that shows how decreased oxygen to parts of the brain can trigger migraines or headaches. Also an interesting finding from this research found that inhaling pure oxygen for 5 to 15 minutes could ease the pain of cluster headaches.

We already know how damaging stress can be to the body in terms of hormone imbalance and inflammation it creates, but the other massive factor to consider is how easily it can disrupt your breathing. Chronic over-breathing produced by the stress response can lead to serious changes in the body, and this may be all you need to be tipped over the migraine threshold!

Carbon dioxide is not merely a waste gas. Although you breathe to get rid of excess CO2, it's important to maintain a certain amount of CO2 in your lungs, and for that, you need to maintain a normal breathing volume. When too much CO2 is lost through heavy breathing, it causes the smooth muscles embedded in your airways to constrict. When this happens, there is a feeling of not getting enough air and the natural reaction is to breathe more intensely. But all this does is create an even greater loss of CO2, which constricts your airway even further.

A vicious cycle is now beginning to take place. What you need to do is break this cycle before it becomes a habit by breathing through your nose and breathing less. Deep breathing, by the way, will often make you feel a bit light-headed, and this is due to eliminating too much CO2 from your lungs, which causes your blood vessels to constrict. So, the heavier you breathe, the less oxygen is actually delivered throughout your body.

The good news is that there are many very simple methods that you can use to help restore your breathing back to normal and break this cycle.

From Yoga to Tai-chi, to the more advanced and scientific methods like Buteyko or the Wim Hoff method, there are several great ways to help you get everything back to normal. It is no surprise to see breathing exercises prescribed immediately by most doctors and therapists for anyone dealing with migraines or severe headaches.

You will find tons of information about each of these methods in this article – 7 breathing methods to improve respiratory function, reduce anxiety, and strengthen the core

Getting your breathing under control will allow you to improve another massive factor, sleep!

Sleep

Getting good quality sleep and following a regular night time routine is critical for the person suffering with migraines. Most people with migraines will need more sleep than people who do not have this problem as the body will need more time to repair the inflammation. However, too much sleep can be a powerful trigger for some so it is important to focus on the quality of sleep and following a consistent routine.

Many people think we shut down at night but it is the exact opposite, the body's digestive system is in hyper-drive at night as it uses this time to repair damage cells and tissue caused from activities during the day. We discussed earlier how important gut health is to controlling migraine attacks and if you are not getting time to shut down your gut will inevitably be disrupted. It is important to understand that if our sleep is compromised in any way so is our ability to heal our body and this will help to explain why people with poor sleep are more likely suffer with chronic illness and disease.

Some people may have difficulty getting to sleep, whereas others may have difficulty staying asleep as they keep waking up around 2am. These are both reactions to stress and by adopting many of the strategies we have already discussed you should be making some progress as to changing these habits.

Apart from keeping a consistent routine here are some other good tips to help you get a good night sleep.

1. Keep your bedroom cool and dark
2. Avoid bright lights, TV & computers after 8pm
3. Be in bed by 1030pm at the latest
4. Practice meditation or slow breathing exercise before bed
5. Have a warm shower at night at the same time
6. Avoid coffee, alcohol and sugar
7. Exercise early in the day
8. Eat well balanced diet of vegetables and protein

You will find a stack of additional information in this article – Why sleep is so important to your health

Control your Stress

Last but not least is stress. By far the most difficult of the factors to change, and also the most destructive one that can derail all of your previous efforts if it gets out of control.

As I have said a few times already in this article if you are making some changes with the things we have discussed it is fair to say your stress levels will be already much better. That does not mean all your stress has been removed for there are many events in life that cannot be controlled such as changing jobs, a death in the family, moving house, or sudden illnesses to name a few.

We cannot avoid stressful events all the time, but we can control how we react to them. By practicing meditation or using breathing exercises you can gain control over these difficult moments. Like any type of exercise or learning to play a musical instrument it takes a lot of practice to become good at this. These days there is a much bigger focus on this area of health and there are many great programs and institutions like Beyond Blue and the Black Dog institute that can provide tremendous support in this area.

You can also seek personal help via a counsellor or psychologist if you know that this is an area of concern for you. I highly encourage you to reach out for help if you feel this way.

Using a Migraine Diary

This is something I did not know much about until I researched this topic and it can be extremely useful in helping your doctor or therapist narrow down what may be pushing you over the edge of the migraine threshold. It can help identify patterns in your lifestyle that lead to the onset of the migraine and allow you to make the changes before it worsens or takes a hold of you.

You do not need to make this too complicated and record everything you ate or did each day, just record the main things like.

1. Date and time of a migraine attack.
2. How painful was the attack? Rate on a scale of 1-10 where 10 is the most severe.
3. What medications you were using?
4. Was there a big event that coincided with the attack? Eg a life event or stressful situation.

If you feel your diet is a factor by all means track it, but try not to make things too complicated by over-thinking and over-analysing.

Summary

Well this brings us to the end of what was a huge project for myself to finish. I did not realize just how complex and confusing treating migraines could be. With so many contributing factors all playing a role in triggering a migraine attack it is no wonder people take a long time to find a solution to their constant pain and struggle. I hope this article has provided you with some ideas to explore and gives you a better insight into how you can manage and control your migraines from now on.

Many people like to rely on medication to treat the problem and while this may be an important part of your treatment it may do little to prevent the attacks. I have found that the person who takes responsibility of their situation by seeking help and looking for various ways to control their disease or injury always finds a good outcome in the end. As I have pointed out to you in this article there are many things under your control, it is up to you to try your best to improve these factors as best as you can. This is a much better choice to make as opposed to the person who relies solely on using medications to treat the problem after it has happened. These people tend to live in constant fear of an attack and withdraw from many parts of their life which is not a healthy strategy.

Lastly, make sure you get a correct diagnosis and help from a doctor. The worst thing you can do is self-diagnose or do nothing.

For more ideas and information on specific topics I may not have covered in detail be sure to check out our INDEX PAGE on the website that has over 300 of our best articles. These are all sorted into categories for quick reference so you can find what you are after more easily. You can also subscribe to our FREE fortnightly newsletter by clicking here.

If you live in Melbourne and feel you need specific help with your exercise program please feel free to reach out to me for help and we can set you up with your individualised program.

About The Author

Nick Jack is owner of No Regrets Personal Training and has over 16 years’ experience as a qualified Personal Trainer, Level 2 Rehabilitation trainer, CHEK practitioner, and Level 2 Sports conditioning Coach. Based in Melbourne Australia he specialises in providing solutions to injury and health problems for people of all ages using the latest methods of assessing movement and corrective exercise.

References:

• Managing Your Migraine - By Katy Munro
• Fixing Shoulder & Elbow Pain - By Rick Olderman
• Shoulder & Scapula Injuries in Athletes - By Chris Mallac
• TMJ Healing plan by Cynthia Peterson
• TMJ Therapy by Dr Kimberly Bensen
• Sitting On The Job - By Scott Dunkin
• Movement - By Gray Cook
• Osteoporosis Australia
• Corrective Exercise Solutions for the Hip & Shoulder - by Evan Osar
• Back Pain Mechanic - by Dr Stuart McGill
• Diagnosis & Treatment Of Movement Impairment Syndromes - By Shirley Sahrman
• Low Back Disorders - by Dr Stuart McGill
• Ultimate Back Fitness & Performance - by Dr Stuart McGill
• Core Stability - by Peak Performance
• Assessment & Treatment Of Muscle Imbalance - By Vladimir Janda
• How To Eat, Move & Be Healthy by Paul Chek
• Scientific Core Conditioning Correspondence Course - By Paul Chek
• Advanced Program Design - By Paul Chek