Saturday, May 2, 2020

Can Exercise Give You Headaches Or Migraines?

My patient rings up complaining of having a terrible migraine after going out for a run. She suffers frequently from migraines and usually exercise and/or seeing us in the clinic would help. She was hoping to come and see us since Physiotherapy has been reclassified as "essential services".

Despite Physiotherapy being reclassified as an "essential service" recently on 29/4/20, the criteria to see patients in the clinic are very strict.

The Ministry of Health (MOH) have told us that face to face sessions are only for "patients whose condition would deteriorate significantly or rapidly if treatment is not provided or performed and would potentially threaten their health and well being".

We can only open once a week seeing a maximum of 6 patients and we're told to "leverage on tele-consult/ tele-rehab as far as possible".
Many of our patients have called or messaged us asking to be seen and we've explained that we can only treat them if they meet the above criteria.

My running patient did add that she ran a lot harder and that was when her migraine started. I told her that I just read an article on runners and their calcitonin gene-related peptide (CGRP) levels.

In that study, 46% of the enlisted running subjects reported suffering from headaches/ migraines while 54% did not.

CGRP helps with making your blood vessels larger (vasodilation), which then increases blood pressure and inflammation in your nervous system. Increased CGRP levels are known to be associated with headaches and migraines.

The researchers measured CGRP levels (by drawing blood) in  runners before and after running. They then got the runners to run 21 kilometres at 75-85 VO2 max.

 CGRP levels significantly increased by one and a half times in the entire group after the run. CGRP was significantly higher for those who had prior migraines before the run and those runners reported suffering from migraines after the run.

This led the researchers to conclude that medium to long distance endurance exercise boosted CGRP levels and that high intensity exercises can heighten the reaction further. This can potentially trigger both headaches and migraines brought on by exertion.

Previous research has shown that exercise can decrease frequency of migraines and improve symptoms and reduce migraine triggers (Aristeidou et al, 2018). With this new article I have to add that migraine sufferers need not stop exercising, but they do need to watch their exercise intensity.

Low to moderate exercise intensities does not seem to be a trigger. There are also medications that helps with blocking CGRP for those of you who don't mind ingesting medication in order to exercise hard. Check with your doctor for the prescription.

Good news for those who do not suffer from headaches or migraines as an increase in CGRP levels is good for you as it has a protective effect for cardiovascular function.


Aristeidou S, Baraldi C et al (2018). The Association Between Migraine And Physical Exercise. J Headache Pain. 19(1): 83. DOI: 10.1186/s10194-018-0902-y.

Tarperi C, Sanchis-Gomar F et al (2020). Effects Of Endurance Exercise On Serum Concentration Of Calcitonin Gene-related Peptide (CGRP): A Potential Link Between Exercise Intensity And Headache. Clin Chem Lab Med. DOI: 10.1515/cclm-2019-1337.

To all our patients reading this and asking to be treated. Yes the government has indeed allowed some businesses to open. As you can see from the MOH circular, clinics have very strict criteria regarding who we can see even though this is not published in the news. Rightfully so since we are still in the circuit breaker period.

Please bear with us, we will inform you as soon as we are given further instructions by MOH to allow us to see more patients.

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