-LETTER TO THE EDITOR-
Exercise Withdrawal and Migraine
Headache: Addiction to Endogenous Opiates?Greg E. Bradley-Popovich, MSEP, MS, CSCS1 and M. Doug McGuff, MD2
1Creighton University, Omaha, NE and 2President, Ultimate Exercise Seneca, SC
Exercise has been shown to alleviate, exacerbate, or initiate various types of headaches. For example, research indicates that some migraine sufferers experienced a decrease in symptoms when engaged in regular physical activity (1-3), while exercise has been reported to be a trigger in other migraineurs (2). This letter wishes to propose another possible interaction between exercise and migraine which may not have been previously addressed in the literature.
During the past three years, one of us (G.E.B.P.) has experienced fronto-temporal classic migraine on three occasions, characterized by a visual aura with scotomata (blind spots), phonophobia, photophobia, nausea and vomiting. Though the precise trigger of migraine can be multifactorial, variable, or elusive, we attempted to establish a pattern surrounding the attacks. Dietary analyses revealed no unusual food or alcohol consumption, and no abnormal psychological stress was present preceding the migraine episodes. However, each of the three episodes followed a two-week hiatus from regular, intense weight training and endurance exercise performed 5-6 days per week. We speculate that the migraines were related to the abrupt cessation of intense exercise.
A physiological mechanism supports our hypothesis of a link between abrupt exercise cessation and migraine headache. Migraines are often prevented or alleviated with serotonin agonists such as sumatriptan (4,5). However, in our reported episodes, sumatriptan did not alleviate symptoms when administered during acute symptom onset. But, the administration of the narcotic analgesic meperidine aborted the episodes. The ineffectiveness of the serotonin agonist and the favorable effect of the narcotic analgesic suggest that the underlying cause of the headaches was a dysfunction of the opioid receptors.
Opioid receptors are the site of action for naturally-occurring endogenous opiates, commonly referred to as beta-endorphins. Given that beta-endorphin production increases during exercise, it is plausible that during the periods of chronic exercise described above, the brain essentially became addicted to its own endogenous opiates. With sudden abstinence from training, a simulated opiate withdrawal ensued resulting in migraine. Indeed, opiate withdrawal can induce migraine; this is evidenced by the observation that many opiate addicts and chronic migraine patients who have become narcotic dependent during pharmacotherapeutic intervention experience headaches from narcotic withdrawal that are indistinguishable from classic or common migraine (6-8). Also, low beta-endorphin levels have been implicated in migraine (9-12).
Abrupt cessation of physical activity should be explored as another possible headache trigger among migraineurs. It may prove prudent for a subpopulation of physically-active migraineurs to avoid an abrupt, extended cessation of strenuous physical activity. Rather, it may be best to taper off exercise prior to any foreseeable hiatus in training.
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