My therapist asked me if I noticed that when we need to take a time out, the universe fills the space we occupied. Not in a “life is moving on without you” way. More of a “life has got your back” kind of way.
I hadn’t noticed.
Could I think of a time, she asked, when I stepped up because someone else couldn’t? I could think of dozens of times. So, why didn’t I think the world could do that for me?
We were having this conversation because I was having a medical crisis. It’s not what I was working through in therapy, but I wanted to let her know I wasn’t feeling well that day. In fact, I hadn’t been feeling well in months. And then I broke down crying.
I have been having migraine headaches since middle school. And in the past 15 or so years, they’ve ebbed and flowed in their intensity and frequency. An MRI formally confirmed the diagnosis: The images showed white matter lesions, consistent with migraines.
According to the Migraine Research Foundation, nearly a quarter of every household in the U.S. has a person with migraines. Acute migraine attacks account for approximately 1.2 million emergency room visits per year. For women, it amounts to 18 percent of us (6 percent of men). It’s most common in people aged 18 to 44.
“We think that hormones are playing a big role in migraine, but it’s not a one-to-one correlation,” says Dr. Rebecca Wells, professor of neurology at Wake Forest School of Medicine. Some women are so convinced it’s hormone related that they will undergo a hysterectomy to try to solve their migraines, even though that is not a recognized or recommended treatment, Dr. Wells tells me. But at the heart of that is the idea that these women are desperate to rid themselves of pain and get to the root of the problem.
Headaches are ranked in the top 10 most disabling conditions by the World Health Organization. True to my nature as a runner, I’ve always prided myself in being able to push through the pain. When doctors and specialists have asked me, “Do your headaches interfere with your daily life? Are there things you’re unable to do because of them?” I would smugly respond, “If I let migraines stop me from doing things, then I wouldn’t have much of a life.” As if that made me stronger. In truth, I was in denial and not taking care of myself.
My body let me know that with a barrage of headaches worse than I’ve ever had starting in May 2020. They felt like there was something inside of my skull trying to push its way out, like a constant jackhammering.
I tried my hardest to fight through them, but they would flatten me out. Every little move made the pain worse. I used to have one or two a month, but now the migraines were striking multiple times a week for days on end.
The headaches started interfering with my running, which was my only real reason to go outside during the pandemic. I tried to decipher the distance I could run without getting a headache, or the specific parameters. At first, I was confident it was any run over eight miles that was triggering them. So I would dial back my training a little. But then six miles would give me a headache. Then four. Eventually I couldn’t run an easy mile without getting a migraine that would last for days.
Knowing there was nothing I could do made my own anxiety worse. When a headache came on I would try ice, heat, a cold compress, stretches, sleeping, medication, caffeine, massaging my neck, essential oils. Nothing ever worked.
Researchers have studied women like me, those who develop anxiety around physical activity and eventually avoid it to prevent migraines. It can lead to an actual fear of exercise. One study found that anxiety surrounding migraine pain can lead to depression.
Dr. Samantha Farris, director of the Rutgers Emotion, Health, and Behavior Lab, studies exercise anxiety in women with migraines. The prevalence of fear among the women she studies is shocking. “The thing that was most surprising is that most of the patients, nearly 80 percent, reported that they intentionally avoid high-intensity forms of exercise like running or biking.”
Anxiety and stress are common migraine triggers. “Worrying about the fact that you might get a migraine can increase stress and tension in the body, activating physiological processes in the body that can increase the likelihood of a migraine,” says Dr. Farris.
What triggers a migraine attack is different than the cause behind the disease. What causes a migraine is not fully known (some doctors think it has to do with an imbalance of chemicals), while triggers of certain attacks can be pinpointed.
“We don’t think any headaches are caused by stress,” says Dr. Wells. “We think of migraine as really a genetic condition, genetic disease, that some individuals are more likely to have than others. And then there are certain factors that may predispose an individual to a migraine attack.”
Dr. Wells also recognizes the let down after stress can trigger a headache, happening a day or two after the stressful event. That just adds to the complexity of the trigger. “We really need to further understand this relationship between stress and headache. A lot of people perceive that stress triggers headaches, but how physiologically that’s going on, we’re trying to understand that,” she says.
I was certainly stressing myself out. I would lay on the couch, phone in hand, reading everything I could on how to make the pain go away or prevent it from happening. I read about the central nervous system, which includes the brain and the spinal cord, hoping I could pinpoint what was askew with me, as if there were a Wiki page that would point out which one of the 100 billion neurons in my brain wasn’t firing correctly.
When I couldn’t get a clear answer and the pain was becoming unbearable, I would start to cry. The congestion from crying would only add pressure and make the pain worse. Which made me want to cry more. There was no break in sight.
The greatest minds in the world don’t know what truly causes migraines, because there is still so much to be known about how the brain works. There are theories and treatments that seem to work for some people, but not for others. Dr. Elena Becker-Barroso, editor-in-chief of The Lancet Neurology, has called issues around brain health like migraines “the greatest challenges of societies in the 21st century.”
I started tracking everything about the headaches (when they started, when they stopped, their intensity, what I ate, the weather, when and how I exercised, how much water I was drinking, what supplements or medications I took, my menstrual cycle), trying to arm myself with all the information I needed. No pattern emerged except for the fact that they were happening a lot. I had 22 migraines in 34 days before I stopped keeping track. This went on for months. When I couldn’t fix my head on my own, I sought out some of the more traditional routes.
I made an appointment for a video call with my physician. In the 15 minutes allotted to me, she suggested that I wasn’t actually having migraines and that exercise would help. While research shows that exercise can be effective in preventing attacks, she didn’t take the time to hear about how physical activity was triggering my anxiety or how my desperation to run was adding to that stress.
Dr. Farris agrees: “Exercise, especially moderate to vigorous aerobic exercise, is actually recommended or advised for individuals with migraine as a management strategy for headache. But we know that individuals with migraine are significantly less active than those without migraine.”
When I couldn’t get an appointment with my overbooked neurologist, I turned to alternative approaches: acupuncture, yoga, massage. The acupuncturist asked me to think back to my earliest trauma, then placed the needles and left me be. The massage therapist was appalled at the tension in my neck and shoulders. She was a runner, too, and talked me through breathing techniques to try while running, all while forcefully working the knots out of my neck.
I hired a sports dietitian to take a look at my nutrition. Maybe I was missing something, or not eating enough, or eating something I was sensitive to. And while there were some serious lapses in my diet, including unintentionally underfueling, fixing that didn’t stop the headaches.
Research has connected migraines to hormones, but not all migraines are hormonal. During reproductive years, up to 43 percent of women suffer from migraines and 72 percent of migraine sufferers are women. So I saw my gynecologist to adjust my birth control, hoping that could help. The new pill had fewer side effects than my previous one and helped me feel better in other ways, but didn’t stop the headaches.
I was looking for a cure I wouldn’t find (there is none). Or an explanation of why my brain was the way that it was; why couldn’t I live normally? All I wanted was to go for a run—my biggest stress reliever—without pain.
Dr. Farris worries about women avoiding really critical parts of their life out of fear. “There’s this concern that higher intensity exercise might trigger or worsen an attack and therefore avoiding it seems like a reasonable decision, except that avoidance can really shrink your world. People, especially those with migraine, avoid all sorts of triggering factors, whether food, different
environmental stimuli, strong light, sound. Exercise is one of those triggers that people often are very fearful of,” she says.
The truth is, people with migraine must learn to live with and accept some amount of pain in their lives. “There are things that can be done to decrease the likelihood of having an attack,” says Dr. Wells. “But it’s important to recognize that sometimes attacks are going to happen no matter what you do.”
When Giving Up Gets Good
All the time and money I spent on trying to figure it all out helped put into perspective how little I was taking care of myself before, even if they were all dead ends. When I opened up about my migraines in therapy, my therapist cracked the issue wide open. She asked: Have you ever considered doing nothing?
I felt vulnerable and curious learning about something new. Aren’t we supposed to do things to solve problems? But maybe my obsession was making the problem worse.
Her advice: Next time you get a headache, cancel all your plans. Stop what you’re doing. Do nothing.
That’s the basis of some of Dr. Wells’s research into mindfulness and migraines. Not doing anything is part of mindfulness, she says. “This concept of non-doing, because so much of what we do, we’re trying to do, and go, be, and function.” When she leads a meditation she likes to say: “We’re human beings, and yet we’re constantly going and doing, and we can just be.”
Dr. Wells is working to find out exactly what is happening in the body that allows mindfulness to impact migraines the way that it does. “Mindfulness can really teach new ways to respond to stress,” she says, “which is really the most commonly reported migraine trigger.”
She describes practitioners of mindfulness becoming curious about their pain instead of combative and angry, as I had become. “Mindfulness teaches a nonjudgmental way of turning toward pain,” says Dr. Wells. “With our research, we found that mindfulness decreased pain catastrophizing. Pain catastrophizing is a magnification of pain-related thoughts.” Along with approaching pain with curiosity, she recommends “not taking any one experience we’ve had as complete truth about what might happen in the future.”
Independence Day was a few days after talking with my therapist and having my epiphany. I was determined to celebrate how I wanted. That meant starting the day with a run, and I wasn’t going to let fear of a headache stop me. I laced up and went out for six miles at a nearby wildlife refuge. We had plans in the afternoon to see friends for the first time since the pandemic started at a small backyard BBQ. I was feeling good.
The headache started 20 minutes into the party. For the first time I tried not to be mad about what I was missing or guilty for tearing my husband away from the fun. I had a genuine mindset of self-care.
We went home; I laid back and did nothing. Within 4 hours the migraine was gone, where it would normally take anywhere from 8 to 36 hours to dissipate. That evening, I was able to watch fireworks going off in the distance with neighbors. I felt such a sense of calm and gratitude.
That’s been my mindset ever since. I dialed back my training. I added in more cross-training and began cycling more. If I needed to miss a workout, I didn’t beat myself up about it. I went back to basics and started a couch to 10K program that felt painfully easy for a long time, but I stuck with it. I started meditating each morning.
Focusing on the mind-body connection to treat migraine is not woo-woo hype. “By saying that mindfulness is helpful, we’re not saying the migraine is all in your head. On the contrary, we think that mindfulness may target some of the pathophysiological aspects of migraine to make it less likely to happen, or to make you be able to handle it when it does happen,” says Dr. Wells.
And she doesn’t think it should replace other helpful treatments: “We think of mindfulness as a treatment modality in addition to everything else. In our research, people were able to continue all of their medications. This was not an either/or, this was an and.”
It’s been more than a year since the headaches started getting bad. They’re not cured: I still get one or two every month with no obvious cause, but instead of being mad at my body and mind for not doing what I want them to do, I take it as a cue to let off the gas.
I can honestly say that I am a stronger, faster, and fitter runner than I was a year ago. And it took nothing more than doing less.
Common Migraine Triggers for Runners
If you’re worried about high-intensity exercise causing a migraine, you may tend to avoid exercise altogether, according to Dr. Samantha Farris, director of the Rutgers Emotion, Health, and Behavior Lab. “Starting to slowly approach those things rather than avoid them is a really fundamental way to start building up confidence, rather than letting the fear or the anxiety do the talking,” she says. Sometimes a run may trigger a migraine, but understanding what about your run is triggering could give you more confidence to keep at it.
“Exercise can be done safely, and I think part of it is building up that tolerance. What we do know is that triggers—things that might actually cause migraine—can actually become stronger when you’re coming into less contact with them.” Instead of avoiding the run, learn how the following triggers might be affecting you.
According to Migraine Trust, exercise can set off a migraine if:
- You don’t warm up. Starting exercise suddenly puts your body in an immediate demand for oxygen, shocking the system.
- You don’t fuel properly, causing your blood sugar to drop.
- You become dehydrated.
- You are pushing past your physical abilities. Find a training plan and don’t try to progress too quickly.
- You exercise infrequently, causing your muscles to be stiff and achey.
- You run in hot climates or high altitudes.
- You experience a minor blow or head trauma during exercise, causing a concussion.