Headaches: causes, cures and exercise?!

Summary

Podcast Summary: "Headaches: causes, cures and exercise?!"

Podcast: What's That Rash?
Host: ABC Australia
Date: March 31, 2026

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Overview

This episode of "What's That Rash?" explores the omnipresent health concern of headaches—what causes them, how to manage them, and whether exercise can help. Hosts Tegan and Norman, both long-time headache sufferers, address listener questions about stress and cluster headaches, share colorful historical treatments, discuss modern evidence-based therapies, and highlight the importance of recognizing potentially serious warning signs.

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Key Discussion Points and Insights

1. Understanding Headaches: Types and Red Flags

[01:07–05:24]

• Types of headaches:

  • Tension headaches (tightness or pressure)
  • Migraines (often throbbing, one-sided, can include visual aura)
  • Sinus headaches (pain behind eyes, cheekbones, congestion)
  • Cluster headaches (seasonal, severe, often one-sided)
  • Ice-pick headaches (brief, stabbing pain)
  • Thunderclap headaches (sudden, extremely severe)

• When to worry:

  • A new or dramatically different headache warrants a check-up.
  • Warning signs: if headache wakes you up, worsens in the morning, doesn't go away, or is associated with neurological symptoms (speech, facial droop, arm weakness).
  • “If it’s affecting your speech, your face, whether or not you can lift your arms ... then you ... need to call the ambulance.” — Norman [04:54]

2. Cluster Headaches: Adam’s Story and the Latest Science

[06:37–07:34; 17:06–20:09]

• What are cluster headaches?

  • Cyclic, often seasonal, very painful, sometimes linked to circadian rhythm and hypothalamus activation.
  • More common in men and over-30s; familial tendency.

• Adam’s N=1 experiment:

  • 30-year sufferer; headaches have intensified over decades.
  • Finds aspirin at first sensation or intense exercise (“100 to 200 body weight squats”) can prevent or halt headache.
  • “While I know that oxygen therapy is a recognised treatment for cluster headaches ... I may be an N equals one of getting extra oxygen into my system through exercise.” — Adam [18:16]

• Exercise as therapy:

  • Norman cites a systematic review: exercise can outperform conventional treatments for tension headaches and chronic migraine. [18:37]
  • Mechanisms may go beyond oxygen—include hormonal and neurological crosstalk.
  • “Muscles talk to the brain and the brain talks to muscles. … It could be through distraction ... exercise [is] a whole body process, which has extraordinary effects on the brain.” — Norman [19:06]

3. Migraines: Nature, Triggers, and Treatments

[07:34–09:38]

• Migraines are more disabling than simple headaches; often present with throbbing pain, light sensitivity, aura (e.g., flashing lights).
• Migraine with aura slightly increases stroke risk, so take new neurological symptoms seriously.
• Modern migraine-specific therapies are now more available in Australia; early intervention at the first sign is most effective.
• Common triggers: wine (particularly red), certain foods (e.g., chocolate, oranges).
• “Once the migraine is established, it’s quite hard to get rid of the pain and other symptoms ... starting treatment as early as possible [is key].” — Norman [08:17]

4. Historical and Folkloric Headache Remedies

[09:59–12:32]

• From ancient Mesopotamia to the Anglo Saxon “Leech Book,” headaches have inspired creative (and sometimes bizarre) remedies.
• Examples: applying red nettle with vinegar, rue juice up the nostril, stag’s horn, frankincense, catfish skull.
• Ancient treatments occasionally overlapped with modern ideas (e.g. massaging/stimulating areas at the back of the head).
• Delightful asides:
  • Athena was mythically born from Zeus’s headache—“If your headaches aren’t birthing the goddess of war and wisdom, maybe you’re doing them wrong.” — Tegan [13:26]
  • Old neurosurgical technique: drilling a hole in the skull to relieve pressure (not recommended at home).
    • “You’re safer to take your drill from your shed, dip it in cowshit and bur into the brain than not burr it at all.” — Norman recalling a medical school lecturer [14:09]

5. Modern Classification of Headaches

[15:23–15:44]

• Primary headaches: the problem itself (e.g., migraine, tension headache, cluster headache)
• Secondary headaches: due to underlying, often urgent, conditions (e.g., stroke, tumour, infection)
• All headaches should be contextualized—pay attention to significant changes or accompanying symptoms.

6. Lifestyle Factors and Practical Management

[16:10–21:26]

• Stress is a well-recognized trigger for headaches, impacting muscle tension and brain chemistry.

• Sleep, nutrition, and mental health profoundly affect headache frequency and intensity.

• Keeping a headache diary: helps identify personal triggers (may include foods, stress, sleep changes).

• Standard first-line pain relief: paracetamol and ibuprofen.

• Oxygen therapy is effective in cluster headaches; exercise also shows promise but isn’t a universal prescription.

• “If you are feeling psychologically distressed ... that does not help headaches.” — Norman [21:10]

• “Get in quickly: paracetamol, ibuprofen, see what works for you.” — Norman [21:23]

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Notable Quotes and Memorable Moments

• “If you get a headache out of the blue and you haven’t had it before ... you need to go and get it checked out.” — Norman [03:21]
• “It’s not a tumour. But really, what you’re saying is ... it could be a tumour.” — Tegan [04:10]
• “We love an N equals one here at What's That Rash.” — Tegan [02:52]
• “Have you heard the story of the birth of the Greek goddess Athena?” — Tegan [12:44]
• “No leeches. The whole book is called the Leech Book.” — Tegan [11:03]

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Important Timestamps

• [01:07] — Introduction to episode and listener questions
• [03:21] — When to worry about headaches/new symptoms
• [06:37] — Cluster headaches explained
• [07:34] — Origin of 'migraine' and historical context
• [09:38] — Early migraine treatment and triggers
• [09:59] — Historical treatments and “Leech Book”
• [13:26] — Athena and the mythology of headaches
• [14:09] — Hair-raising neurosurgical anecdotes
• [15:23] — Modern classification: primary vs secondary headaches
• [16:10] — How stress impacts headaches
• [17:06] — Adam’s experience with exercise for cluster headaches
• [18:37] — Evidence for exercise as therapy
• [20:29] — Toolbox: tracking triggers, sleep, nutrition, psychology
• [21:23] — Painkillers: when and how to use

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Takeaway Messages

• Always get new, severe, or unusual headaches medically assessed—don't just “wait and see.”
• For long-term headache sufferers: track triggers, maintain healthy lifestyle habits, and treat early.
• Exercise may be a valid adjunct therapy for some, with mounting scientific support.
• Migraine management has improved; specialized treatments exist—discuss with your doctor if standard painkillers aren’t enough.
• The understanding and treatment of headaches continues to evolve, and everyone’s experience is unique.

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Transcript

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[Tegan]

You.

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[Tegan]

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[Norman]

It's just your average suburb, but there's a whiff of someone playing Silly Duckers. Reg Grundies, kids clothes and stuffed toys are going missing.

[Tegan]

It's Leonardo da Penchi.

[Dr. Anne Jones]

Hi, I'm Dr. Anne Jones and I've secured an interview with Leonardo da Pinci, the criminal cat thieving mastermind for my podcast series Nature's Most Wanted. What the Duck on abc. Listen. Or wherever you get your podcasts.

[Tegan]

So, Norman, when was the last time that you experienced cephalagia?

[Norman]

I think you mean kephalgia. Do you?

[Tegan]

Do I?

[Norman]

Yeah. Cephalgia, yeah. Correcting you. You know I love aphasia.

[Tegan]

Please correct my Greek. I'm not a native speaker. I've never been accused of being a Greek speaker. And I, of course I'm kefalting.

[Norman]

I say kephalagia.

[Tegan]

What do you say?

[Norman]

It's a pain in the head.

[Tegan]

Pain in the head. A pain in the head. Quite literally, rather than me being a

[Norman]

pain in the neck. It's a pain in the head.

[Tegan]

So to answer my question. When was the last time you felt one? Right as I started asking these questions.

[Norman]

I get them quite a lot. I'm a headache person since childhood.

[Tegan]

Well, same here. And it's the same for many of our listeners here too. What's that rash? Because it is the health question that everyone is asking about this week. So we've got Susan and Adam here asking about headaches in particular today. Could you tell us listeners of any studies that make good suggestions that could be helpful for stress headaches? And with Adam's question. I'm only going to give you part of Adam's question for now because there's a fun second chapter to Adam's story. But basically, Adam wants to know if we could do a show explaining the latest research and theories about cluster headaches for which Adam says, I may be an N equals 1.

[Norman]

So can people remember what an NICOS one. If you've been listening to watch that rash for a long time, you will. It's a while since we spoke about it.

[Tegan]

Yeah, it is. So of course it is a study in which the N. The number of participants or subjects in the study is one. Normally you and I, Norman, would dismiss anything with such a small sample size, but they are often very fun. So we love an N equals one here at. What's that? Rash.

[Norman]

Which is good because cluster headaches aren't fun.

[Tegan]

No, indeed. So Susan's asking about stress headaches, Adam's asking about cluster headaches. You and I have spoken before, I think, on. On the health report about migraines. I personally have tension headaches fairly regularly. There's a lot to cover with headache. We are not going to be able to cover it all in a single episode of whatsat rash. Consider this your little tasting plate of headache science, after which we will kind of fill in some of the gaps in future. What's that? Rash episodes.

[Norman]

Indeed. So there's one big message I've got for anybody listening is you might have heard that both Tegan and I have had headaches for a long time. I get migraine, which we'll talk about. Tegan will talk about migraine and she'll talk about that. But no, seriously, the key thing to remember here is if you get a headache out of the blue and you haven't had it before or it's very different or more severe, it doesn't actually matter if it's a new symptom, you need to go and get it checked out. If you've had headaches for years and it's just the same, pretty similar to others, it might be getting more severe or less severe. You'll make your decision about when you go and see your gp. But if it's coming out of the blue and you've never had it before, particularly if it wakes you up during the night or it's worse in the morning and it's not going away and it's progressing, then you really need to get it checked out.

[Tegan]

I mean, this is where people would usually make the kindergarten joke of like, it's not a tumour. But really what you're saying is it could be a tumour or something life threatening.

[Norman]

Yeah.

[Tegan]

Or it could be health threatening.

[Norman]

Yeah. Or it could be, for the first time in your life, you've got sinusitis and you've got a headache from that. Got it. We probably overdo brain scans in people who clearly don't have a serious cause of headache. Headache. But some people don't get brain scans who perhaps should. And it doesn't necessarily mean it's malignant. It could be a benign tumor or it could be an infection. It could be meningitis. I don't want to scare the shit out of you, but nonetheless, a new symptoms involving the head needs to get sorted out. And of course, it is a sign of a stroke sometimes, again, a new symptom. And if it's affecting your speech, your face, whether or not you can lift your arms, you know, the whole fast thing, then you, in that case need to call the ambulance and get to emergency departments. This is not something to hang around about.

[Tegan]

So now that you've put the absolute fear of God into people, Norman, I mean, you've given that sort of advice before. New symptom like trust yourself. Trust yourself to go and seek medical attention if you think you need it

[Norman]

and call the ambulance if you've got other symptoms that might be a stroke.

[Tegan]

Absolutely.

[Norman]

Because time counts.

[Tegan]

So let's say that that's not the case for Adam, for Susan, for other people who, like you and me, have had headaches on and off throughout their lives. And you kind of go, I'm pretty sure this isn't killing me, but I don't like it. What can I do about it? That's what we're going to talk about today. So a couple of different types of headaches. We're not going to be able to give a comprehensive list. Like I said before, some people get tension headaches. Tightness or pressure around your head. You mentioned migraine before, Norman. As you said, we'll talk to it. A sinus headache where maybe you've got congestion and that kind of makes you feel like you've got pain behind your eyes or in your cheekbones, across your bridge of your nose. You know that feeling. If you've ever had the flu, there's something horrendous called an ice pick headache, which is a stabbing pain that lasts a few seconds but can come back. Or a thunderclap headache tends to be,

[Norman]

if you've been a Communist leader of the Soviet army, sketch Mexico.

[Tegan]

Comorbidity of, I think, headache.

[Norman]

That's right. Also called the Trotsky headache.

[Tegan]

Goodness me. And then thunderclap headache, similarly sounds horrible. And it is really severe. Lasts a short period of time, but very, very painful. And then, of course, one of the questions we got was about a cluster headache. What do we know about cluster headaches, Norman?

[Norman]

So cluster headaches are runs of headaches that you get, usually in a pattern, and in some seasons you don't have any cluster headaches. And then in a particular season you may get headaches. It's thought that the biological clock may be involved in that the circadian rhythm, it may be that you've got lower melatonin levels at a time of year when you shouldn't have. And when you do brain scans, the hypothalamus, which is like a central control box, if you like, in the brain for hormones and hormone control throughout the rest of the body. PET scans show that the hypothalamus, parts of the hypothalamus are activated when you're having an attack. So it's a very physiological process that's quite complex. Men are more affected than women. Tends to come on when you're over 30. Alcohol doesn't help and people with traumatic head injury can have it too. And it tends to run in families and tends to be one sided.

[Tegan]

It's funny that it mentions one sidedness. You know Galen, you know our guy Galen, the Greek philosopher surgeon dude of the four humours. Of the four humours. And also the coiner of the word hemicrania, as in half of the head, which is what he called migraine and is probably where our English word migraine comes from as well. So hemicrania, but in Middle English it was called emigrania, in Wales it was called migran and in Scots it was called maghream. That's probably where our word for migraine actually comes from.

[Norman]

So migraine, that's what I get and luckily I don't get it very severely, but people can get it. So it's really quite disabling.

[Tegan]

It's not just a headache. That's the thing, that's the key and

[Norman]

it goes with other stuff and it's often throbbing. You often don't like the light. It can be. You get symptoms. Come on. It could be flashing lights that indicate that a headache's about to come, which is a very useful thing actually for people to get because you've really got to start treatment of your headache as soon as you feel that it might be coming on. Once the migraine is established, it's quite hard to get rid of the pain and other symptoms, so can rarely be associated with other neurological effects which make you think that you might be having a strok. But usually you've had those in the past. The confusing thing here is that if you have migraine with an aura, in other words, a premonition that it might be coming and these flashing lights or what have you, then you are probably a little bit more at risk of having a stroke than others. So again, if you get weakness in an arm or your face, don't assume that it's just the migraine, and it's the first time it could be a stroke.

[Tegan]

And there's a lot better treatments around migraine these days than they used to be. They're much more available in Australia than they used to be. I do think we should actually do an episode of WhatsApp rash about migraine, because it's a much deeper seam than we're gonna be able to mine today. Norman.

[Norman]

It is. And lots of theories there, so let's come back to that. But key message here, if you want one, is you might learn that there's something that triggers it. It can be food, oranges, chocolate, wine. I get migraine after wine. Red wine.

[Tegan]

Is that a migraine or is that just a hangover?

[Norman]

No, I think stimulates it. I know which red wines I get it from, so I avoid them. But anyway, that's another story. And starting treatment as early as possible. And there are all sorts of treatments which, if regular paracetamol or ibuprofen isn't helping, can help you more effectively.

[Tegan]

So speaking of treatments, I'd love to have a bit of a trip down memory lane of ways that we used to treat headaches back in the olden days, as I generally like to do. I did a bit of a deep dive in how we used to think about headaches back in the day. And it was a just absolute smorgasbord of craziness. So, of course, as long as we've had heads, they have been able to ache. There's cuneiform tablets from Mesopotamia, which is obviously where our earliest writing samples known writing comes from. The ancient Egyptian hieroglyphs described headache symptoms. But my favorite text that I found when I was looking around is an old Anglo Saxon medical text that is literally called the Leech Book.

[Norman]

Oh, really?

[Tegan]

Have you heard of the Leech Book?

[Norman]

No. It doesn't surprise me. One exists.

[Tegan]

It's from about the year 950, and it has six different herbal remedies for that headache. Basically a half headache. So we were talking before about hemicrania. This is what it was called in the Leech Book.

[Norman]

So did you put leeches on that side of your head?

[Tegan]

No, no leeches. No leeches. The whole book is called the Leech Book. It covers all of all manner of complaints that the human body can have. This one, there's things to do with bruising, red nettle with vinegar. You put it on your head, some of the things they wanted you to take the juice of rue and ring it on the nostril. Which is on the sore side. So like putting R juice in your nostril. Or you could take the clusters of laurel and mustard, mix them together, pour vinegar on them, smear that on your sore head. Actually, as far as like old remedies go, they're pretty tame. There was some other ones from ancient Egypt that included catfish skull being boiled or using stag's horn or frankincense. So, yeah, it is one of those things that, that we've had for a long time and have had a lot of remedies for over the years.

[Norman]

And of course, some of these might have worked indirectly. I think it's been largely debunked or people moved away from it. But one theory is that the nerves and blood vessels at the back of your head have a significant role to play in migraine, even though you might not be feeling the migraine at the back of the head. And there have been some therapies stimulating the occiput the back of the head to try and alleviate migraine. I think it works in some people, but I don't think anybody thinks it's a primary therapy, really that you can use reliably. But some of this stuff from going back all those years, going back centuries, may have actually involved rubbing these things into the back of your head. And that might have had a stimulatory effect on the back of your head.

[Tegan]

It's always nice when someone gives you a little head rub when you're not feeling very well. I wonder if you've ever had a productive headache. Norman, has anything ever really good ever come from one of your headaches?

[Norman]

Well, apart from more time in bed, no.

[Tegan]

Have you heard the story of the birth of the Greek goddess Athena?

[Norman]

Didn't she come out of the thigh of Zeus?

[Tegan]

No, that's someone else. Someone else came out of Zeus's thigh. Athena came out of Zeus's head. So basically, Zeus, famously a player, married to Hera, got around a lot with other ladies, including Metis, the goddess of wisdom. She got pregnant, Zeus decided to swallow her whole to prevent a prophecy. Of course, had an unbearable headache that caused Zeus to scream in pain so loudly it could be heard throughout the Earth. So then Hephaestus chopped Zeus's head open. Athena popped out, fully grown warrior. So I suppose if your headaches aren't birthing the goddess of war and wisdom, maybe you're doing them wrong. I don't really know what we take from this story. I just think it's hilarious.

[Norman]

And one of the first treatments for pressure on the brain, cutting Your head open.

[Tegan]

Is that really something people used to do?

[Norman]

Well, that's right. It was called subdural hematoma. If you've had a head trauma and you've recovered from it, you actually get a collection of blood in the brain which causes pressure and can be life threatening. And that's the old fashioned treatment for that, in fact can be. The current treatment for it is that you do a burhole in the brain to release the blood. And we had this rather eccentric lecturer when I was at medical school who came into the lecture with an old fashioned Braddawl, you know, a hand run drill.

[Tegan]

Like a drill.

[Norman]

Oh my God. And he said if you suspect. This is exactly what he said. He said, if you suspect a subdural hematoma, you're safer to take your drill from your shed, dip it in cowshit and bur into the brain than not burr it at all. So in the exam, in the neurosurgery exam or the surgery exam, one classmate, when asked the treatment for subdural hematoma, he said, get a drill out of your carite, dip it in koshit and drill into the brain. I have to say this person graduated in medicine and is practicing somewhere in the United Kingdom.

[Tegan]

So that's why you moved to Australia.

[Norman]

Just in case you might have thought I was having a migraine. I'm gonna burn into my brain.

[Tegan]

Incredible. Well, I suppose we need to correct the record now with some actual science lest our listeners, who are probably, I'm guessing, certainly smarter than your classmate back in the day, gets the wrong idea. So when we are having a head headache, I'm assuming it's not the work of demons or catfish as the ancient Egyptians thought. What's going on in the head?

[Norman]

Well, the way neurologists classify headaches is primary headache or secondary headache. So a primary headache is a headache in its own right, not due to anything underneath that serious. So when I talked about stroke, headache or headache due to malignancy or infection, like meningitis, those are secondary headaches.

[Tegan]

They're a symptom of something else that's going on.

[Norman]

They're a symptom of something else. Whereas I suppose all headaches are symptoms of something else, but really a primary headache is really a headache that's caused by some problem with the pain sensitive structures in your head. So you've got nerves, you've got blood vessels, you've got chemical transmitters, something's going wrong with this network of structures in your head and, and it causes a headache.

[Tegan]

So like on stress Headaches. I don't know how Susan presents, but I know in my case, Norman, that is often a trigger for me. And I know for me it's a physical tension in my, like, muscles of my shoulders, neck and, like, the back of my head. Because if I. If I push on those muscles, I can make the headache kind of come or go away. And sleep and nutrition are definitely factors for me personally.

[Norman]

Yeah. I think you've probably described how stress actually does its job. I mean, chronic stress, so that's kind of acute stress. You're going through two or three days where things are piling up and there's multiple calls on your time and you're not sure that you're actually getting there. But if you've got chronic stress, which lasts for a long time, it has a profound effect on the hormones, the cardiovascular system and really how your brain works. So stress. It's not surprising that stress can cause headaches.

[Tegan]

So Adam has given us his N equals one of being a cluster headache sufferer. Would you like to hear the rest of Adam's story?

[Norman]

Yes.

[Tegan]

So Adam says, I've been getting cluster headaches for about 30 years. Typically, I get them once or twice a year and each cluster lasts two to six weeks. Over the years, the headache severity has increased from quite mild when I was in my 20s and 30s to quite disabling since my 40s. GPs and neurologists have had me try several treatments in an effort to either prevent them or limit the severity. The most effective treatment today has been to take aspirin as soon as I get a precursor sensation behind my right eye. Most of the time, this will stop me from getting a full headache. But, Adam adds, a few years ago, I discovered another way of stopping the precursor sensation from turning into a full headache and even ending a full headache is to exercise enough to increase my heart rate and get me puffing. Adam says, typically I will do 100 to 200 body weight squats. Squats. Squats are good because they require no equipment and they can be done quietly enough not to disturb others in the house. My headaches often occur at night. While I know that oxygen therapy is a recognised treatment for cluster headaches, which is true.

[Norman]

And we forgot to mention that.

[Tegan]

Well, he finishes by saying, I may be an N equals one of getting extra oxygen into my system through exercise. So this is actually something that has been tested in more than one. One person.

[Norman]

Yeah. There is a systematic review on this, which we'll have in our show notes. Looking at exercise versus conventional treatments and in fact, exercise outperformed the traditional treatments for both tension headaches and chronic migraine, which is okay.

[Tegan]

If you have a really bad headache, the last thing you feel like doing is getting your heart rate up. Like, honestly. But it's pretty interesting. Is it the oxygen? Is it the blood flow? Surely if you're exercising hard, you've actually got less oxygen because your body's respirating harder.

[Norman]

Well, don't get me started, but I'll start anyway. Exercise is much more complex than we traditionally have given it credit for. So muscles talk to the brain and the brain talks to muscles. There's cross talk between the muscles. Muscles produce hormones which get to the brain. They're called myokines. The heart muscle itself can produce hormones that go to the brain. So it's quite likely and possible. And also because the heart speeds up and you get an effect on adrenaline and noradrenaline that can have effect on the spinal column and sensations that go through the spine to the brain. So there's all sorts of things that could be happening with exercise, independent of oxygen levels that affect the brain and settle down various areas of the brain that might be causing pain, it could be through distraction that's causing this exercise, the whole of body process, which has extraordinary effects on the brain.

[Tegan]

So in terms of Adam's n equals 1, then we're not dissuading Adam from his 200 body weight squats in the middle of the night to stave off the headache?

[Norman]

No, I think we're not going to make any personal recommendations to people. You've got to be sure about this. But there is a rationale behind it and some evidence.

[Tegan]

So we've covered a lot of ground today, none of it very thoroughly. But we've talked about exercise, we've talked about oxygen as a potential therapy. What else is in the toolbox? If someone is struggling with headache, it's

[Norman]

knowing the triggers and recognising what those triggers are. And if you're getting a lot of headaches over time and again, if it's a new symptom, you really got to see your gp. But if you're having trouble with them and they're not being well controlled, just take a diary and work out what you're doing at that time and how you're feeling. And you may surprisingly find out that it's after you've eaten a particular something. People think, oh, it's coffee. Coffee often relieves headaches, by the way. But it could be oranges, it could be chocolate, it could be anything. And just because it's not on the list of foods that traditionally cause migraine or associated with migraine in your case it might be and you can have assuming it's not going to change your life you could try avoiding that and seeing whether or not it helps you really got to get good night's sleep and if you are feeling psychologically distressed you've got depression anxiety that does not

[Tegan]

help headaches what about I've got a headache I just need some pain relief

[Norman]

get in quickly paracetamol, ibuprofen see what

[Tegan]

works for you well Susan, Adam, thank you both so much for your questions today we hope that this chat has provided some relief and if we didn't answer your specific headache question you can email us thatrashbc.netau because I feel like there's plenty more ground to cover here

[Norman]

Norman Indeed and if you've got your own favourite N1 do send them in

[Tegan]

we love to, we love to get them. We'll catch you again next week See you then.