My partner gets migraines and is now sca

The hard spin class is very likely the whole problem, not exercise itself — a hard effort after weeks off is exactly the "overexertion" trigger, and the fix this week is to restart at an effort she can hold a conversation in, and build back up over 4–6 weeks rather than proving anything on Friday.

I'd also book her a clinician review in the next couple of weeks — not because I think anything is wrong, but because "safe exercise with my migraines" is one of the questions a doctor can answer properly, and there are prevention options I can't advise on here. This isn't a diagnosis, and I'm not changing or adding any medicine.

美国国立医学图书馆 MedlinePlus（页面今天 2026-10-02 查阅）原文摘录：

> 诱发偏头痛的因素因人而异，包括：压力、焦虑、女性荷尔蒙变化、明亮或闪烁的灯光、巨大声响、强气味、药物、睡眠过多或不足、天气或环境的突然改变、过度用力（过多的体力活动）、烟草、咖啡因或咖啡因戒断、漏餐、药物过度使用。

> 有一些生活方式的改变可以帮助预防偏头痛：压力管理策略，例如运动、放松技巧和生物反馈，可能减少偏头痛的发作次数和严重程度。

> 偏头痛在早上更常见，人们常常醒来就头痛。有些人在可预测的时间发作，比如月经前，或者在一周紧张工作后的周末。

So: overexertion is on the trigger list, and regular exercise is on the prevention list. Those two don't conflict — the problem is the *jump*, not the movement.

(1) What she's already tried vs. what to do instead

The 4-week ramp (she doesn't have to be exact — the point is no sudden jumps):

• Weeks 1–2: the Friday walk plus 1–2 easy mat sessions. She should be able to talk the whole time. If a headache comes, that week's level is the level — stay there or drop back, without it counting as a failure.
• Weeks 3–4: same, plus one session with a little more length. Still conversational.
• After that: add intensity one step at a time, and re-read the diary before each step up. If a headache follows a step up, go back one step.

Two rules that cost nothing: cool down slowly at the end instead of stopping dead, and treat a headache as a "too much this week" signal, not a reason to give up exercise for good. A person who stops moving for two months after one bad class is the more common problem.

(2) What not to do

• Don't go back to hard efforts to "test" whether she's over her limit — the diary is the test, done gradually.
• Don't train through a headache. During an attack, activity usually makes it worse: rest and quiet, in a dark room.
• Don't skip food before a session because you're busy, and don't rely on water alone after a long effort.
• Don't use a bright, hot, loud, airless studio for the early return sessions.
• Don't add someone else's migraine tablet, a triptan, an opioid, or a supplement (including anything sold as a migraine cure) on her own. Any new preventive or rescue medicine is her doctor's decision — including whether she needs one at all.
• Don't stop her current medicines to "make room" for exercise.
• Don't let the fear itself become the plan: total avoidance usually makes the next attempt harder, not easier.

(3) Red flags — when to stop home management

Call your local emergency number now, or go to an emergency department:

• A headache that reaches full strength in seconds, and is the worst she has ever had — even in someone who gets migraines.
• New one-sided weakness, numbness, trouble speaking, or vision loss / double vision. A first-ever aura that is unlike her usual is not "wait for it to pass".
• Fever with a bad headache, a stiff neck, vomiting, or becoming drowsy and hard to wake.
• A severe headache with confusion, difficulty staying upright, or a fit.

Same day, don't wait for the review appointment:

• A headache during or after exercise that is different from her usual ones, or the first severe headache she's ever had while exerting.
• A pattern that has clearly changed: more frequent, more severe, or no longer eased by her usual routine.
• A headache that's there most days, or waking her from sleep, or much worse on coughing or bending.
• Painkillers needed more and more often for the same thing — worth saying out loud to the doctor, because taking them too often can itself keep headaches going.
• She hasn't been able to sleep, eat, or get through the day for a few days running.

She can keep doing the plan above: headaches that are recognisably her usual migraine, in a well person, on days when she's had proper sleep, food and water.

Quick decision tree

```
During or after exercise
│
├─ Peaked in seconds / worst ever / one-sided weakness / speech or vision
│ change / fever + stiff neck / confusion / drowsy
│ → call your local emergency number now
│
├─ Usual migraine, comes on over hours, she is well otherwise
│ → stop that session, dark quiet room, fluids, cool cloth,
│ only her usual advised pain relief, sleep if she can
│
└─ Back to baseline within a day
→ open the diary, drop one step for the next week,
rebuild after 2–3 good weeks
```

What "done" looks like in the next 24 hours

1. Friday's walk happens at an effort she could hold a conversation at — or she takes the rest day without treating it as a relapse.
2. She ate something before the session and drank on a schedule, not when thirsty.
3. The diary has the four new columns filled in for that session.
4. The review appointment is requested, and one question is written down for the doctor: *"What counts as safe exertion for me, and is there anything that would let me train without this fear?"*
5. None of the red flags above appeared.

This is general self-care guidance, not a diagnosis or a substitute for seeing her. Whether her headaches need a preventive plan, a different exercise approach, or nothing at all is for her doctor to decide; I don't give doses or medication changes here.

What I can't see from here: which country or city she's in (that's what decides the emergency number, the clinic route and the pharmacy), how long she's had migraines and how many days a month they take, whether she already has a preventive or rescue medicine from her doctor, and whether the headaches that came on during exercise looked exactly like her usual ones. That last one is worth telling me — and worth telling her doctor.

Source: medlineplus https://medlineplus.gov/migraine.html

(MedlinePlus = the U.S. National Library of Medicine's health site; page read 2026-10-02.)