Researchers have determined that there is moderate quality evidence suggesting that aerobic exercise as prophylactic treatment can decrease the number of migraine days among patients with migraine.
Researchers have determined that there is moderate-quality evidence suggesting that aerobic exercise as prophylactic treatment can decrease the number of migraine days among patients with migraine. However, they were unable to draw conclusions on the impact of the exercise on pain intensity or duration of attacks.
Prophylactic treatment is typically recommended to patients if migraine is present more than 8 days per month, disability persists despite acute medication, or migraine is present more than 3 days per month when acute medication is not effective. Patients with migraine often request and experiment with nonpharmacological alternatives to prophylactic treatment. Aerobic exercise is often touted as such an alternative; however, its value as a treatment for migraine prophylaxis has remained unclear.
“The rationale for using aerobic exercise in migraine is based on the fact that exercise can play a substantial role in the modulation of pain processing,” explained the researchers. “Moreover, analgesic effects of both short-term and long-term aerobic exercises have been observed at both a central and peripheral level.”
The researchers analyzed literature published on the subject in 3 databases between January 1, 2014, and February 21, 2018. Of the 6 studies included in the analysis consisting of 357 patients with migraine, 5 were randomized controlled trials, and 1 was a controlled clinical trial.
Before patients began exercising, the mean migraine frequency was 9.4 days per month with an average disease duration of 19 years.
The studies included multiple variations of aerobic exercise, such as a walking program; a jogging protocol; cycling; a combination of cross-training, walking, jogging, and cycling; and a behavioral weight loss program. The intervention lasted at least 3 weeks in all but 1 study.
Three of the studies saw a significant reduction in the number of migraine days, ranging from 22% to 78%. According to the researchers, data-pooling of 4 studies, totaling 176 patients, showed a significant impact of the exercises on the number of migraine days at 10 to 12 weeks. There was a mean reduction of 0.6 migraine days per month.
“The clinical relevance of this is low,” noted the researchers. “However, it may be of interest if it is added to the value of current usual care.”
Looking at the impact on pain intensity, the researchers found that 3 studies reported a reduction of 20% to 54% and a decrease in attack duration of 20% to 27%. However, they noted, these outcomes were not pooled because the heterogeneity of the units used for outcome measurement, resulting in low-quality evidence of the impact.
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-analysis [published online February 14, 2019]. doi: doi.org/10.1186/s10194-019-0961-8.