Monday, January 20, 2014

Cycling and Headaches

Being prone to migraines and tension headaches, I make sure to carry pain meds as part of the standard dayride kit in my cycling bag. But I've never actually had to use them to treat a headache. In fact, I cannot remember ever having a headache on the bike. This realisation came to me a couple of nights ago, when a quiet evening of movie-watching at a friend's house ended in a brain-piercing, want-to-bang-head-against-wall type of headache the likes of which I haven't experienced in some time. It felt mild enough to ignore at first, and after a trip to the kitchen for a glass of water I settled back on the sofa amidst the other lounging bodies in the darkened living room. But when the film was over and the lights came on, the real pain began. Behind the left eye. Throbbing. Spreading with a slow horrible pressure toward the back of my head. I was getting a lift home in a friend's car, a 25 minute drive. In the course of those minutes things went from bad to worse, and I'm pretty sure that my face came to resemble Munch's The Scream in its grotesque contortions. Even after I got home and took a hefty dose of headache medication, it took an hour of lying perfectly still in a dark room for the storm in my head to calm. But it was while writhing in the passenger's seat with the window rolled down that it hit me: I have countless memories of being stuck in a car with debilitating headaches - but none of having a headache on a bike.

Certainly all the ingredients have been there. Long, windblown hours under direct sun. Physical exhaustion and dehydration. Hasty departures without morning coffee. Tightly adjusted helmets. Tail lights of cyclists in front of me shining directly into my eye on group rides. And yet it has never happened. I've had headaches after bike rides and before bike rides, just never during. And I've had headaches during other forms of exercise - namely running (well, attempting to run). Could there be something special about cycling that prevents them?

According to a neurologist friend, that is not impossible. The research on headaches and exercise is mixed. In some instances exercise can actually induce headaches ("exertional headaches"), and there appears to be a higher risk of this with high-impact exercise and weight lifting. In other instances, exercise can be used therapeutically to treat headaches, including migraines. These would be exercises that are low impact and promote relaxation and tension-reducing posture alignment. Yoga is probably the most typical. But it is plausible that cycling could play that role as well - depending on how it makes us feel and how our body is positioned on the bike. And I suppose all that fresh air couldn't hurt either.

Whatever the reason for it, I am thankful to be headache-free when I pedal. I will continue to carry pain meds on rides, just in case. And I hope to continue not needing them.

49 comments:

  1. If you drink a lot of coffee, you may get some relief from headaches by tapering off of coffee. Don't go cold turkey! That can be quite unpleasant--that I know from my own experience.

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    1. I could not agree more about tapering off of the coffee. After largely eliminating caffeine from my diet, I have been migraine-free. I used to get headaches later in the afternoon when my two morning cups of coffee wore off. I don't get those either. I would also agree that tapering is key. I tried to go cold turkey, only to get a terrible migraine. Much as I love the taste of coffee, I just can't drink it anymore.

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    2. I suppose it's different for everyone. I've quit coffee twice in the past for significant periods of time and this did nothing for my headaches.

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    3. How interesting. My mother's doctor actually prescribed espresso when she felt a migraine coming on. Yet I have had fewer since laying off the daily coffee and switching to tea. And now that you mention it, have never suffered a migraine or even just tension headache on rides.

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  2. I suffer from migraines and much like yourself I almost never get them riding a bike. Unfortunately the one time I did was during my only attempt at a brevet! I had to bail at mile 40 :(

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  3. I realize this seems "magic diet cure" from a complete stranger, but I have traumatic brain injury and for years part of it was stunningly spectacular headaches. Shifting to a diet that eliminates grains, most carbs (except veggies and fruit), all industrial oils (veggie oils), and is made of 70-80% grass-fed/wild caught fats has eliminated those headaches. Might be worth looking into -- and it will help you in myriad other ways as well. May God startle you with joy!

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    1. The Book "Grain Brain" is excellent at laying out the why's and wherefores of healing your brain by going low carb/high fat (and many of the other health benefits of it to).

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  4. V.....when having one of these awful headaches, have you ever ridden your bike to see if cycling would relieve the headache?

    I've had a bad back for years. I do get on my recumbent and for whatever reason (constant circulation? certain movement?) my back loosens up.

    Other times I've had a cold and found when I cycled the symptoms seemed to disipate. So when I'm feeling "sick" I tell my wife: "I know I'm sick..but I'm going to ride my bike." Not every time, but often it seems to help.

    Headache? Ride Your Bike? Somewhat Cure?

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  5. "I was getting a lift home in a friend's car, a 25 minute drive"

    well theres your problem right there!

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  6. I get headaches while attempting to run, as well. You're right; I've never gotten one on my bicycle.

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  7. I'd thought cycling made me immune too until the aura hit in the middle of a ride.... I carry a pill now.

    Also while some riders carry chain tools, I have antibiotic cream and some band-aids in my saddle bag.

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  8. I'm guessing that you're experiencing some kind of visual migraine related to a disconnect between your vestibular system and visually-based orientation. When you're in a car they are often out of sync since the surrounding of the car gives you a static reference frame but the motion of the car tells your inner ear you're moving. That's why people get carsick. On a bike, the two systems are perfectly in sync, so you don't get headaches.
    If you have to drive in a car, try sitting up front and focus on the road ahead. That should keep the two systems working together. Not sure how well that would work at night.
    Maybe you should just take analgesics in advance of activities you expect to give your brain conflicting signals, like riding in a car, or watching TV on a big screen in a dark room.

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    1. Really? I knew that about the car, but never thought to apply it to watching television in the dark. Going to read up on this.

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    2. I'm just guessing, trying to fit your symptoms together -- I'm not a doctor. But it occurred to me that you might try some experiments to see if this is a problem. Such as sitting in a swivel chair and having someone spin it, see if that causes a headache. Then try it with your eyes closed, or while blindfolded. In the second case your brain would be getting different info from your eyes and vestibular system. If you get a headache then, that might help you track down what's going on.

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    3. Wow, Jon. That makes so much sense. I get barfy when watching certain movies (fast-paced action on a large screen) and my migraines will get worse when in a car.

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  9. Out of curiosity, what meds work for you? I have similar headaches (though riding in hot weather will frequently trigger them - as will many other things). Glad that cycling brings you some relief!

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    1. Most of the time a high dose of Ibuprofen works for me (paracetamol does not). In the UK they have something called Neurofen Plus, which is ibuprofen laced with codeine and that works even better (but is addictive, so meant for occasional use only). I have not had an actual migraine (as opposed to tension headache) for a while now, knock on wood. But when I did get them, I took an excellent Austrian medication called something like Atamigran.

      That said, just keep in mind that it's not just about what works, but about side effects. Paracetamol is bad for the liver, ibuprofen is bad for the stomach, etc. Before taking anything, your own medical history needs to be taken into consideration, so best to talk to your doctor.

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    2. Of course:) I usually use ibuprofen with caffeine (just consume with coffee) but I have been finding that to work less well of late. My doc's suggestions tend to be things with long lists of side effects, so I am always on the search for alternatives:)

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    3. V @ 1:09
      Avamigran is caffeine and ergotamine. Old school but still works for many migraineurs.

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    4. Right, Avamigran. It's been a while, which I guess is a good thing. Do you know what a US or UK equivalent of that would be? American doctors always pushed Tomapax, but it gave me adverse reactions.

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    5. This may be a double post. Something funny happened with captcha. I did want to respond to V's query.

      AFAIK ergotamine is prescribed as generic ergotamine tartrate. Adding caffeine is pretty simple. There was a preparation called Cafergot, don't know it's current status. Ergotamine is well out of fashion. It is still in the VA formulary and they prescribe it for low cost. Older migraineurs use ergotamine because they've used it forever and don't want to change so long as it's effective.

      Discussing Topamax will be hard. It is an epilepsy medication and an anti-convulsant. It is widely used off-label. I have a dear friend who was DOA on Topamax and alcohol. Mercifully the doctors were able to revive her. Life goes on, life is not the same.

      Street name for Topamax is Stoopamax. Because it makes you stupid and leaves you open to doing stupid things. "Adverse reactions" are normal for Topamax. I would keep a lot of distance between myself and any doctor who prescribed Topamax for migraine.

      Mainstream allopathic medicine for migraine i the US is triptans. In this household it's rizatriptan and sumatriptan which I believe are the most common. As noted in a comment below sumatriptan is OTC in the UK. Talk to your chemist. All the other remedies discussed here - well they sound safe to me and if they're effective for anyone, good.

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  10. To quote an over-used Clintonism, "I feel your pain." For years I have had issues around migraines as well, and am in the habit of trying to avoid medications if possible. One thing that does work for me is going on a low tyramine diet whenever I start feeling like I'm getting to the point where a migraine is likely. Usually I know myself well enough that I can tell, and if obvious triggers (stress, exhaustion, lack of sleep, etc) are present, then I know I have to change my diet to compensate. It takes some practice and good self awareness and mindfulness, but it has worked very well for me. The low tyramine diet is very difficult to stay on indefinitely, since almost everything has tyramine, especially many of my favourite foods, but it's an easy experiment to try, and has no side effects.

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  11. Try rubbing capison cream (marketed in the US as Capzacin) on the base of the scull and neck. A coach recommended it to me, and it does the trick. Works for muscular pain as well.

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  12. Reading this brought back something a friend told me years ago, she would get migraines and felt that if they weren't too bad, she could get a degree of relief from painting or drawing ( she was an MFA student).

    Is this a little insight about what's happening with migraines or just co-incidence/positive thinking? Maybe the headaches that responded to that were stress related?

    I cringe when I remember the dumb advice I used to offer when she would feel one coming on and want to leave a movie early or postpone a date, "Oh c'mon, it'll take your mind off it!"

    What a dope.

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  13. Once in a while and with no discernible pattern I get a migraine. Ocular sort, vision is affected, pain peaks and then slowly subsides followed by extreme fatigue. If I recognize what's happening and take ibuprofen while it's still mild I can often get rid of it. I have gotten them while cycling several times.

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    1. What do you do if that happens to you on the bike?

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  14. I too suffer from headaches. I haven't had too many on my bike, but I've definitely had a few. Usually it's when I push it and try to ride when I shouldn't... like when I think 5-day whopper is coming to a close, but really it's just wishful thinking. I also got a really bad headache on my bike one day when it was near 100 degrees outside. A few bottles of water and some ibuprofen seemed to help. We also stopped at a cafe where I could sit in the shade and drink a caffeinated beverage, and that helped.

    BTW - in case you don't know this trick, caffeine increases the effectiveness of both Tylenol and ibuprofen. It is a double edged sword though, because the caffeine constricts your blood vessels, but when it leaves your system they can relax causing a rebound headache.

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    1. I'd take those medicines with food. It can have an impact on the liver, otherwise.

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  15. Forget all this over the counter stuff. Smoke a big joint and let us know.

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    1. Isn't that like over the counter in most states now?

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    2. You whacky foreigners and your crazy ideas about the U.S.of A. We're a clean livin', ALCOHOL based civilization, not like you peat smokers over there.

      Spindizzy

      bunchacrazyleprechaunsdontknowthierassfrom4dollars...

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    3. Oral sumatriptan is OTC in UK. Real medicine for migraine. It does not absorb well through the stomach and of course with many migraines it is not possible to keep anything in the stomach. So there is injectable sumatriptan. These drugs are fabulously expensive in the US, not so much in UK. Sumatriptan works (in minutes) for more than 95% of migraine sufferers. Even given the sheer wackiness of healthcare in the US there is no good reason for anyone not to know there is effective treatment for migraine.

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    4. It's over the counter until the Feds feel disrespected and shut it down.

      Legalizing it has its own illicit subculture.

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  16. I was 30 years old when I realized I had an allergy to MSG (Monosodium Glutamate). It would cause me horrible headaches that only sleep would relieve (if I could fall asleep). Surprising how many pre-made sauces, soups and salty snack use MSG. Still, I must admit I had a hangover headache once and got on my mountain bike... not a good idea.

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  17. I can't say that biking cures every acute problem, but my back only twinges when I haven't ridden in a while. If sciatica does rear its ugly, ugly head, a long, easy, bike ride will generally banish the sciatica for a few days. And biking is an effective, specific cure for depression.

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  18. By the end of my day at work, I often find myself with a headache; about half the time, my 10-minute bike ride home will clear that headache significantly. Sometimes, though, the biking doesn't help.

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  19. I get terrible migraines and other headaches. Chronic static migraines that last weeks, if not months, so I'd be riding to work or the store no matter what. I would say in hindsight that I could 'forget' the pain while riding. Riding a bike is nice because it is exercise and some air, getting circulation going, which helps a bit.
    I cannot afford the fancy medicine, but if things are really bad I would take tylenol 1. I was so pleased last spring when I changed my diet, the evil chronic migraines disappeared. I still get them, and now am working at a place with wireless wifi and fluorescent lights and loud noises that have created a new kind of headache.

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  20. My daughter (now in her mid 20's) suffered from severe headaches and migraines for years and tried every pharmacological treatment available. Finally, she was able to identify her food allergies and substantially avoid headaches by avoiding foods with dairy and gluten. Certainly a better solution than risking liver damage and other side effects from pain meds. May not work for everyone, but something to consider if you are a victim of migraines.

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  21. I also suffer from migraines -- I don't ride if I have one unless I need to for transportation, and then it's a miserable experience. It doesn't get better as I ride or with any other sort of exercise -- generally, anything that gets my heartrate up makes it hurt more, and makes me lightheaded/dizzy. And bright light and a lot of contrast hurt to look at (so both day and night riding are terrible.)

    I generally can head one off with ibuprofen if I feel it coming (and generally I do feel them coming if I'm paying attention and not asleep -- and I'm always paying better attention to my body on long rides than when I'm sitting at my desk or something.)

    Things that also help me: ice on the back of the neck, caffeine, and biofeedback -- thinking about making my hands warm to divert blood flow.

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  22. Although I don't suffer from chronic migraines, I do notice a marked relief from headaches, fogginess of brain, and allergies when I hop on my bike. It does a body good! I don't ride in a car very often, perhaps once a month, and my car sickness and headaches have been seemingly worse every time I ride in a car. I will take the advice of Jon Webb from above. Here's to one more reason riding a bike is great!

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  23. I have dealt with migraines for 60 years and discovered-- FINALLY!-- that as long as my magnesium intake is adequate, I don't get migraines. But one must take enough: 800 to 1200 mg. per day for me. I try to be sure I have enough calcium and potassium in my system as well. They do work together, and, with magnesium, make up the "Big 3" in the mineral department. Pancreatic enzymes help with digestion, so that I don't react badly to what I eat sometimes and start that migraine syndrome again. Try the magnesium; it works, relieves many other symptoms as well, it won't hurt you, and it's cheap.

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  24. for me what you describe is more about running - the mantra of my feet making me transcend and unaware of the mess, I know someone who does neurolinguistic programming for trauma who claims its about mantra and meditation. I'm not sure, I know someone else who believes its about control - activities that occupy us makes us feel in control and so not in the mess that is our lives and consciousness. I felt struck that it happened after a movie. movies can stir up loads of stuff f or me.

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  25. Despite the fact I have rarely headache I can put one’s two cents in: why don’t you search for a bone-setter?
    In the face of painful strong obstacle, we could twist our mind and keep an unconventional path . We need to accept that there are some efficient practices which are out of rational control.
    For instance Miss V. has said “knock on wood” in a reply’s comment, maybe it’s a kind of survival shamanism thinking: funny.
    L.

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  26. I can't believe I have stumbled on another cycling migraine sufferer! I too carry my prescription triptans on the bike, along with some soluble codeine and a tiny, roll-down rubber cup that I found in a camping shop in which to dissolve the codeine.

    Unlike you, I am afraid I have had quite a few migraine begin while cycling and if I have pushed the distance or done a really hard (for me) ride with plenty of hills, the odds are that I will have an attack within the next 12 hours. Fortunately, the pleasure of cycling outweighs the pain!

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  27. One more migraine story - I get a lot of headaches and bad migraines from muscle pain in the hips and legs, shoulder and back. But this past year when I drastically increased the amount of miles I rode, I drastically decreased the number of headaches, so I think something about the circular motion of peddling for hours on end keeps those muscles happy. With the proviso that all bets are off if I'm riding on really rough pavement. My magic solution to migraines is massage, but if that's not available, 1000mg ibprofin and 975 mg acetaminophen taken together often work for me (but I am really really careful not to take anything else with acetaminophen in it).

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  28. I never thought that so many other cyclists with triptanes in their bags are on the road. I suffer from cluster headaches and migraine. Cycling is also some kind of therapy for me, but unfortunaly it doen't prevent me.

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  29. FWIW I have a '96 Nishiki Blazer Mtn Bike with 1.75" road tires, fenders, rack wide bars with "inboard" bar ends for a jockey position, and an aero bar for stretching out AND sitting upright, using the elbow rests as handles. I a 53-tooth chaining upfront (the largest that would fit) and 75mm cranks. It's heavy, but fast! Since I bike-commute for fitness, the extra 17 pounds over my '84 Nishiki International road bike is okay. I love them both. The Blazer has a gel-seat with springs and is comfortable, but heavy, yet fast. And as with all my mtn bike based commuters over the last 30 years, I throw the handle bars forward and approximate a more prone roadbike position.

    Reference Vid here:
    http://www.youtube.com/watch?v=12EyzRuPlZA

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  30. Ha! I've had similar experiences too, albeit in my car that I love oh-so-much. I felt so horrible one day at school that my mom let me come home early (mind you, I'm the type of student to do whatever in my power to not miss school). I laid in bed for two hours feeling absolutely miserable but when it came time to pick my sister up from school, I hobbled to my car and upon feeling the steering wheel in my hands and wind in my face, I felt perfect. Strange, isn't it?
    I'm getting a similar thing now with my bike at college. No matter how tired I am, I feel fresh once I hop on.

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  31. Many a time I've been tempted to skip the bike ride due to a headache. But it never fails...I get going a before I know it I realize my headache is gone.

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