Among patients with episodic migraines who use prophylactic medication for migraines, those who exercise moderately to vigorously at least three times a week have fewer monthly headaches, according to the study results published in Headache.1
This study tried to evaluate a possible synergistic effect between regular exercise and the use of preventive medication in episodic migraines. The study researchers performed a secondary analysis of the data from a prospective cohort study published in Neurology that examined the relationships between this amount of exercise and the frequency, intensity, and duration of prospective headaches
The sample included 98 patients recruited from Beth Israel Deaconess Medical Center, Brigham and Women’s Hospital, and Massachusetts General Hospital who had episodic migraines with or without aura as defined in the criteria of the International Classification of Headache Disorders 3 and confirmed by the study doctors. Enrolled patients had fewer than 15 headaches per month.
Patients kept online diaries of health behaviors and migraine headaches every morning and evening for 6 weeks. They completed the Headache Impact Test-6 (HIT-6), which was used to assess exposure to episodic migraine headaches.
In the secondary analysis, the study researchers excluded patients whose data on both exercise frequency and exercise intensity were incomplete, leaving 94 participants (women, 82 women) behind [66 of whom were premenopausal]) in the analytical sample. The mean age of the participants was 34.3 years (standard deviation) [SD]11.4 years).
The participants gave a mean of 5 (SD, 3.5) headaches per month and a HIT-6 value of 60.8 (SD, 6.1). 25 patients were using prescription prophylactic medication, and 59 reported that they typically did moderate to heavy exercise at least three times a week.
The relationship between exercise days and headache days per month varied depending on the use of migraine prophylaxis at the start of the study (P = 0.009). In patients who reported regular use of migraine prophylaxis, moderately vigorous exercise at least three times a week correlated with 5.1 fewer headache days (-5.1 headache days per month; 95% CI, -8.2 to -2.0; P. = 0.001) compared to patients who reported lower levels of stress. The relationship between exercise days and headache days per month in people without migraine prophylaxis was not statistically significant.
One of the limitations of the study was defining exposure in terms of exposure reported at enrollment, which limited the ability to distinguish participants who changed their habits shortly before enrollment from participants who were active or sedentary for several years. Other limitations include the potential for exposure misclassification and the possibility of other confounding factors influencing the relationship between migraines and exercise.
Based on their results, the researchers concluded that “routine moderate-vigorous exercise can be an important add-on strategy to improve headache stress in patients eligible for migraine prophylaxis.”
1. Hagan KK, Li W., Mostofsky E. et al. Prospective cohort study of routine exercise and headache in adults with episodic migraines. A headache. Published online December 21, 2020. doi: 10.1111 / head.14037
2. Bertisch SM, Li W., Buettner C. et al. Nocturnal sleep duration, fragmentation, quality and daily risk of migraines. Neurology. 2020; 94 (5): e489-e496. doi: 10.1212 / WNL.0000000000008740