Migraine is a highly prevalent disorder. Patients with migraine often use acute medication to reduce an acute migraine attack or prophylactic medication to prevent migraine attacks from occurring.

However, not all patients tolerate these drugs equally and some might request non-pharmacological alternatives. Non-pharmacological prophylactic treatments like self-management strategies, manual therapy and aerobic exercise are also being used in clinical practice.

The rationale for the application of aerobic exercise in migraine is based on the fact that exercise can decrease pain by modulating the pain process in the brain. For example, exercise is already used as a treatment in various acute and chronic musculoskeletal pain conditions, such as fibromyalgia, chronic fatigue syndrome and low back pain.

We reviewed the current literature on the effect of aerobic exercise on the number of migraine days, duration and pain intensity in migraine. Three databases were searched for eligible articles. Six studies were retained from this search. Pooling of results was performed, when feasible based on identical migraine diagnosis and units of outcome measurement, leading to the pooled or accumulated results of 176 participants.

What did we find?

Three out of six studies reported a reduction in the number of migraine days ranging from 22% to 78%. Data-pooling of 176 participants show a significant effect of aerobic exercise on the number of migraine days at 10-12 weeks of aerobic exercise. A mean reduction of 0.6 ± 0.3 migraine days/month was found favoring the aerobic exercise group.

Clinically, the relevance of this finding is low and therefore more studies exploring the effect of aerobic exercise in patients with migraine are needed. Interestingly, high intensity interval training provided greater treatment effects in one study, although statistically not significant.

Pain intensity decreased 20% up to 54% after aerobic exercise combined with a decrease in attack duration of 20-27% based on three studies. Acute medication use did not change significantly in exercise groups compared to control groups.

What are the points of interest?

Moderate evidence shows that aerobic exercise can lead to a decrease of 0.6 migraine days per month. Although the relevance of this finding is low, it may be of interest if it is added to current usual care. This mainly consists of a prophylactic pharmacological treatment to reduce headache frequency with 50%.

More intense exercise programs may provide interesting results, such as greater reductions in number of migraine days per month.

Secondly, we concluded that several types of aerobic exercise were used in the included studies, such as a walking program, a jogging program and a cycling program. Interestingly, these different exercise forms also had different exercise intensities and durations. For example, the exercise time varied between 20-45 minutes. As low training intensities were used in the included studies, we assume that more intense exercise programs may provide interesting results, such as greater reductions in number of migraine days per month.

We also found that topiramate and tricyclic antidepressants, prophylactic medication, show similar results compared to aerobic exercise in decreasing the number of migraine days per month. Therefore, aerobic exercise appears to be a valuable alternative, taking into account that side effects are common with a pharmacological treatment, such as weight changes, memory loss and fatigue. Aerobic exercise did not cause any side effects in the included trials and in general, side effects are uncommon in aerobic exercise.

Dropout rate in total was high in the included studies. The most important reason for withdrawal of participants was lack of time to get to and attend three supervised exercise training sessions per week. Home-based training programs can be used to improve compliance and to reduce stress. Since stress is an important trigger for migraine attacks. However, home-based training might be less therapy compliant, which can lead to false interpretation.

Lastly, our review population is comprised of untrained participants with migraine. This selection might have biased the results as this does not necessarily represent a typical migraine population. On the other hand, positive findings were measured in the intervention group and no negative side effects were registered in any of the trials.

What did I learn from this research?

In my opinion, changes in lifestyle could be encouraged more in current health care as it strongly affects our health state. Disorders caused by a lack of physical fitness, excessive psychosocial stress or excessive food abuse are becoming more common and health-related costs are also increasing, such as in obesity or diabetes mellitus. This research confirms the interaction between lifestyle and health state.

Everyone should do more physical exercise in their daily life, not only because it is fun, but also because it provides great health benefits, such as a reduction of migraine days. So in the end, we should all put on our hiking, running or biking shoes and go for it. Why shouldn’t you?