Research Advances Our Understanding of Exercise and Headache

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RESEARCH UPDATE

Migraine represents the top cause for disability during peak wage-earning years and contributes substantially to lost productivity. Migraine prevention is recommended in chronic migraineurs, or people with headaches more than eight times per month or continue to have disability despite medication during attacks. Yet medications don’t always work, and some people prefer non-drug alternatives.

Studies have suggested that exercise may have short- and long-term analgesic effects. But how well aerobic exercise can help prevent migraine is unclear. A new study by Lemmens and colleagues¹ reports that aerobic exercise therapy can reduce the number of days patients endure migraine.

To shed light on the issue, researchers conducted a systematic review and meta-analysis using the Preferred Reporting Items for Systematic reviews and Meta-analyses (PRISMA) method. The analysis included five RCTs and one controlled clinical trial published since 2004. Included studies had a total population of 357 individuals, of which 88% were women with a mean age of 38 years.

Participants exercised 30 to 45, minutes two to three times per week, for 10 weeks or more. Exercise consisted of walking, cross-training, jogging, or cycling. Studies measured whether participants trained in the aerobic zone.

Pooled results showed significant decreases in the number of migraine days per month with aerobic exercise. Results for pain intensity and attack duration could not be pooled due to limitations in the studies included in the analysis. Unpooled results suggested small to moderate decreases in headache duration and pain intensity with aerobic exercise.

All studies had a moderate risk of bias, usually due to a high dropout rate. The most common reason for dropout was difficulty getting to exercise sessions.

Discussion and take home points>>

Though review cannot reach hard conclusions due to the sparsity of quality studies, it does provide some interesting suggestion of ways that exercise may help prevent migraine.

Across studies, participants experienced an average reduction in migraine of about half a day per month.² While that may not sound like much, the authors mentioned that most exercise interventions in this study were relatively low intensity. When high-intensity interval training was studied, it showed the largest reductions in migraine days. Though results were not significant, further research is needed to determine whether intensity of exercise can improve migraine prevention.

In addition, two studies suggested that exercise may be a suitable alternative to medication, or at least a useful adjunct to drugs. A study by Linde and colleagues³ suggested that exercise may provide similar reductions in headache days per month as topiramate. Santiago and colleagues⁴ found that exercise combined with amitriptyline appeared to be more effective than amitriptyline alone.  But the quality of the evidence was low, and further study is also needed.

“For future studies, we recommend standardized outcome measures and sufficiently intense training programs,” the authors concluded.¹

Take home points

• Meta-analysis suggests aerobic exercise linked to significant reduction in migraine days per month

• Further study needed on the impact of exercise intensity on migraine prevention, and whether it can provide an alternative or adjunct to pharmacotherapy

References:

1. Lemmens J, De Pauw J, Van Soom T, et al. The effect of aerobic exercise on the number of migraine days, duration and pain intensity in migraine: a systematic literature review and meta-analysisv. J Headache Pain. 2019;20(1):16.

2. Hanssen H, Minghetti A, Magon S, et al. Effects of different endurance exercise modalities on migraine days and cerebrovascular health in episodic migraineurs: a randomized controlled trial. Scand J Med Sci Sports. 2018; 28:1103–1112.

3. Varkey E, Cider A, Carlsson J, Linde M. Exercise as migraine prophylaxis: a randomized study using relaxation and topiramate as controlsv. Cephalalgia. 2011;31:1428–1438.

4. Santiago MDS, Carvalho D de S, Gabbai AA, et al. Amitriptyline and aerobic exercise or amitriptyline alone in the treatment of chronic migraine: a randomized comparative study. Arq Neuropsiquiatr. 2014;72:851–855.