Indoor bicyclingCarolyn Bernstein, MD, who leads the Headache Center at Boston's Beth Israel/Deaconess Medical Center and is the author of “The Migraine Brain,” appeared in the headlines last month for suggesting that migraineurs take to bicycling for relief. The news segment, produced by CNN, reports that Dr. Bernstein suffers from migraines herself and is exploring alternatives to managing the disease, including indoor cycling. Exercise is valuable for migraineurs, she said, because of its effect on pain-killing neurotransmitters. In particular, cycling is well-suited to migraineurs because it is low-impact and there is no pounding involved.

Q. I have been on Depakote® and amitriptyline for migraines since about 1996. I kept the headaches reasonably under control (I've had them since 1985) with those two preventive medications and lifestyle management (strict diet, regular exercise, enough sleep and decreasing stress). I do, however, have moderately severe arthritis of the neck from a car accident in the 1970s. For the past year, I have had a migraine every day except four intermittent days; I can't figure out what I could be doing wrong. I avoid rebound headaches by alternating my use of Norgesic Forte® with Tylenol 500®, or when necessary, Imitrex® or Amerge®. I'm careful not to take more than the prescribed amount of any medication. My question is this: Would Neurontin® be of help to me? Has Depakote ceased to be effective? Or could the arthritis in my neck have finally won the battle I've been having with it? My neck pain is excruciating at the end of a work day, especially if I've had a headache. Neck pain is one of the precursors to a migraine for me.

Q. Can headaches be a symptom of a wheat allergy? I know it's not usually listed as a food trigger, but I have started getting more frequent headaches after doing really well for a long time. The only thing I can think of that's different in my diet is that I started snacking on a lot of wheat crackers and eating more bread. Nothing else in my life, including stress, exercise, sleep, work, or medications, has changed.

Q. I have had migraines for over 20 years. For many years now I have been on a beta-blocker for preventive therapy as I failed to tolerate Imitrex® or Topamax®. My headaches usually begin after excessive stress and fatigue, but can occur anytime. In spite of having a very healthy lifestyle, I still have migraines at least twice a month, which unfailingly last three days. Do you have any other ideas for me?

Considering the growing obesity epidemic among America’s youth, exercise is typically considered to be a great thing – it increases blood flow, helps manage weight, boosts energy levels – the list goes on and on. However, for children suffering from exertion headaches, exercise can quickly become the enemy. 2722837321_b45148c20c_oExertion headaches are a generalized head pain that occurs during or following physical exertion (running, jumping) or passive exertion (sneezing, coughing, moving one’s bowels, etc.). While most exertion headaches are benign, they do vary in severity, duration (from 15 minutes to 20 hours), and associated symptoms (some children will experience nausea, vomiting, and light or sound sensitivity). Although these headaches may occur in isolation, they are most commonly associated with patients who have inherited susceptibility to migraine and are often triggered by sustained physical exertion that is uncharacteristically strenuous for the particular individual’s conditioning.

Exertional headaches are a group of headache syndromes, which are associated with some physical activity. These headaches typically become severe very quickly after a strenuous activity such as weight lifting or sexual intercourse. Exertional headaches can, in some instances, be a sign of abnormalities in...