Migraines, Part Deux: Dealing With Migraine Hangovers

Running with a migraine hurtsLast time we chatted about migraines and running, I was an occasional migraine-sufferer, once every couple of months. Then last month, suddenly I was having what felt like constant migraines, one or two per week, always triggered by running. That’s a lot of time to spend wishing you could remove your head with various household implements. I came to realize that a migraine is so much more than just the pain and, um, the nausea, the hour or so of blindness, the vomiting, the extreme fatigue … you get it.

For me, a migraine comes with a side of negative emotions: Anxiety that this keeps happening and I don’t know why. Frustration that it’s apparently out of my control and that I can’t do the things I want to do. And most of all, the guilt that once again I can’t do anything with my family or help around the house because I have to spend the rest of the day lying in bed. So it’s only natural that I want to shed that emotional unpleasantness as soon as I can, wishing to pop out of bed the next day as efficient and productive as ever. Me? Weak and sickly? Never!

Unfortunately, it doesn’t work like that.

Even when the pain and nausea of a migraine are gone, the aftereffects linger at least for a day and sometimes even for two. I’m weak, exhausted, and can’t think. My mood is low, and my muscles ache like I just did a hard workout though all I did was lie in bed the day before. I’m extremely sensitive to light, wincing and squinting in the sun. I didn’t drink any alcohol yesterday, but I am most definitely hung-over. From my migraine.

Sounds like a case for self-care, right? I agree, and yet every single time I try to deny that I’m feeling any of this and go about my day as usual. This works up to a point: I can be physically present in the office even when my brain is so foggy I can barely follow a conversation. I can grocery shop and go to the playground and cook dinner. None of it is fun, but it’s all possible.

On the other hand, running in this condition never goes well. I’m slow and heavy and feel like I really have to poop (which I only mention because it never happens otherwise!).  In the worst case, running the day after a migraine will trigger another migraine. Even so, it’s hard to step back and take that extra day off; I end up slogging for at least half an hour because I want to train, dammit! Why is this thing getting in the way of my marathon plans, and why can’t I just pull it together and function already?

Science Says Migraine Hangovers are Real.

Reading up on Lydiard
How am I supposed to follow my training plan when I feel like poo?

So what’s the deal? Is this all in my head?  I did some googling and found out that it’s not just me being a wimp: migraine hangovers are an accepted medical phenomenon known as migraine postdrome. In one 2016 study, 81% of migraine patients reported postdrome symptoms, with the postdrome phase commonly lasting anywhere from two to 48 hours.

It was such a relief to read the list of symptoms and find I’m not alone! The most common symptoms of migraine postdrome are fatigue and difficulty concentrating. All the other symptoms I experience are also on the list: neck pain, paleness, low mood, and sensitivity to light and noise. Some people experience allodynia, which means pain from something that wouldn’t normally hurt you. Cutaneous allodynia, or skin that’s painful to touch, seems to be most common with migraines, but I wonder if my migraine-related muscle pain isn’t also a form of allodynia.

Why does this happen? I couldn’t find a good, scientific explanation of migraine mechanisms written in plain English for non-scientists like me, but here is a medical-journal overview of what happens in your body when you have a migraine. I’m not a doctor, so here is my takeaway: your neurons freak the F out when you have a migraine, and they’re not back to normal yet the next day. Hence the postdrome.

The strangest part about my migraine postdrome is that it ends suddenly. For most of a day (or two) I’m muddling along in some grey, muted half-world, and then all at once I’m totally normal again. Sadly, I haven’t figured out if there is any way to speed up this process. Only 12 results come up when you search “migraine postdrome” in PubMed, the online database of medical journals, so it’s not a well-studied phenomenon and there’s not much information out there about how to deal. According to the study I mentioned earlier, it’s not clear whether treating your migraine with triptans, the most common anti-migraine medication, shortens or eliminates the postdrome phase. I haven’t yet found a triptan that works for me, but migraine patients who have taken medication also report postdromes.

Talk to me about running. Can I run with this bullshit, or not?

In my experience, it is certainly possible to run during the migraine postdrome phase. But is it a good idea? I’ve decided that for me, it isn’t; the risk of incurring another migraine is not worth it. The slogging and feeling terrible on the run aren’t worth it, either. Life is too short! So I’m committing to a new post-migraine protocol, hard as it is to step away from the training plan and spend another day lounging around. The new protocol is to take it as easy as I possibly can. Lots of patting cats. No running. Maybe an easy walk if I feel like it.

Taking it easy may not make the postdrome any shorter, but it will make it more bearable. Being kind to my body seems like the best way to ensure I can keep running for a long time, and what better reason to take a rest day?

Have you ever had a migraine hangover? How do you deal?

I'm a 43-year-old living in Berlin, Germany and currently training for the 2020 Berlin Marathon.

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  1. I have migraine hangovers too. Usually on those days I either the same as you, rest some more. Or, I go for a walk or a swim. Nothing very cardio, but I find being outside or in the water is really soothing to my nerves, which are incredibly raw after being in pain continuously for a long time. I think just the sound of swimming (with no kids around) is very relaxing. After the little bit of work, I am tired enough to sleep well to aide the rest of my healing. Not very scientific, but it works for me.