Research Summary: Prospective cohort study of routine exercise and headache outcomes among adults with episodic migraine

Headache®: The Journal of Head and Face Pain published “Prospective cohort study of routine exercise and headache outcomes among adults with episodic migraine.”

The authors of this study set out to investigate the impact of frequent moderate-vigorous aerobic exercise on headache frequency, intensity and duration, and whether the impact varies with baseline use of prescription preventive medication in patients with episodic migraine (reporting fewer than 15 headache days per month at baseline).

Although previous studies have suggested that aerobic exercise for at least 40 minutes three times a week may be beneficial, this study did not assess duration of exercise—but rather whether patients were undergoing moderate-vigorous exercise three times per week or not.

Background

• Migraine negatively impacts multiple aspects of daily life, requiring a comprehensive treatment plan to reduce disability.
• Since the use of migraine preventive medication is often limited by side effects and contraindications, it is important to identify behavioral factors that may help prevent attacks and reduce impairment.

Study Results

• The study was a secondary analysis of data from a prospective cohort study of adults with episodic migraine.
• Data were prospectively collected on headache and health behavior for at least 6 weeks using electronic questionnaires from 94 participants.
• Participants reporting moderate-vigorous exercise at least three times per week at enrollment had 1.5 fewer headache days per month (−1.5 headache days/ month; 95% confidence interval [CI] −3.1 to 0.1) compared to those reporting less exercise, but this was not statistically significant (p = 0.066).
• Participants reporting regular use of migraine prophylaxis and moderate-vigorous exercise at least three times per week had 5.1 fewer monthly headache days (−5.1: 95% CI −8.2 to −2.0; p = 0.001), compared to those who also took migraine preventive medication but reported lower levels of exercise.
• Those reporting moderate-vigorous exercise at least three times per week but not using migraine prophylaxis only had 0.4 fewer headache days per month than those reporting lower levels of exercise and no migraine preventive use (−0.4: 95% CI −2.2 to 1.3), which was not statistically significant (p = 0.636).
• There was no association between routine moderate-vigorous exercise and headache intensity or duration.

Implications for Primary Care Physicians

• Patients with episodic migraine reporting moderate-vigorous exercise at least three times per week reported fewer headache days per month, although this was not statistically significant.
• The association between regular moderate-vigorous exercise and reduction in monthly headache days is significantly stronger in patients using migraine prophylactic medications.
• Routine moderate-vigorous exercise may be an important adjunctive treatment strategy to reduce migraine burden in patients who are also using migraine preventive medications, but this needs to be explored in a controlled trial, as the current study only established associations between exercise, migraine preventive use and headache frequency—thus no conclusions about causality can be drawn.

This summary is part of the First Contact – Headache in Primary Care initiative, an American Headache Society program that provides educational resources to empower healthcare professionals and improve headache and migraine care. We encourage providers in all stages of their careers to visit our homepage to access educational tools to improve patient care.