Migraineurs Not Taking Advantage of an 'Effective Prophylactic'

Megan Brooks

March 02, 2021

The majority of patients with migraine do not get the recommended amount of weekly exercise, but those who do gain benefits that extend to fewer migraine days and reduced rates of triggers including stress, depression, and sleep problems, new research shows.

Dr Mason Dyess

"This study adds to an ever-growing body of research that points to exercise as an effective way to promote general well-being and reduce monthly migraine days," study investigator Mason Dyess, DO, from the University of Washington in Seattle, told Medscape Medical News. "This study also highlights that exercise is an underutilized resource in migraine sufferers," Dyess said.

The findings will be presented at the American Academy of Neurology (AAN) 2021 Annual Meeting in April.

An Accessible Prophylactic

Dyess said that the COVID-19 pandemic prompted him and his colleagues to investigate how many migraine patients in their headache clinic were utilizing "one of the most accessible prevention tools for migraine — exercise."

"The pandemic has restricted physical and financial access to care for patients in our community and across the country, so understanding how exercise is being used by our patients and its effect on monthly migraine days has never been more important," Dyess said.

The study involved 4647 people diagnosed with migraine. About three fourths of them had chronic migraine (at least 15 migraine days a month) and about one quarter had episodic migraine (up to 14 monthly migraine days).

The patients provided information via a questionnaire about their migraine characteristics, sleep, depression, stress, anxiety, and the amount of moderate-to-vigorous exercise they got each week.

Only 27% of patients reported getting at least 150 minutes of moderate-to-vigorous exercise each week, the minimum amount recommended by the World Health Organization.

Migraine patients who did not achieve the minimum two-and-a-half hours of moderate-to-vigorous exercise recommended per week had increased rates of depression, anxiety, and sleep problems.

A Word of Caution

Depression was reported by 47% of patients who reported no exercise compared with 25% of people who reported the recommended amount of weekly exercise.

Anxiety was reported by 39% of people who did not exercise compared with 28% of those who got the recommended 150+ minutes of exercise. Sleep problems were reported by 77% of the nonexercisers versus 61% of those who achieved the recommended exercise amount.

Exercise also appeared to reduce the risk for migraine attacks.

Among patients who did not exercise, 48% had high headache frequency (25+ headache days per month), while only 5% had low headache frequency (0 to 4 headache days per month).

In contrast, of people who got the recommended 150+ minutes of exercise per week, 28% had high headache frequency and 10% had low headache frequency.

"Exercise should be part of the discussion while counseling patients with migraines. This is a resource available across the socioeconomic spectrum that is easily integrated into the plan of care for many patients," Dyess told Medscape Medical News

However, he cautioned that there is a subgroup of migraine patients for whom moderate-to-vigorous exercise is simply not tolerable.

"In these patients, research points to the promotion of a healthy diet and lifestyle with gentle movement exercises like yoga rather than aggressively pursuing moderate or vigorous exercise regimens," Dyess said.

A "Puzzling" Relationship

Reached for comment, Shaheen Lakhan, MD, PhD, a neurologist in Newton, Massachusetts, and executive director of Global Neuroscience Initiative Foundation, said the interaction of exercise and migraine is "puzzling."

"First, it is well known that strenuous physical exercise may aggravate or even trigger migraine attacks. These are found even in the migraine diagnostic criteria," Lakhan told Medscape Medical News.

"Interestingly," he added, "there is a body of evidence that demonstrates a basic level of exercise as prophylactic treatment for migraine."

Lakhan said that exercise is "definitely underutilized in clinical practice for migraine for these reasons: migraineurs have fear avoidance behavior given the strenuous physical exercise as a potential trigger."

Also weighing in on the study for Medscape Medical News, Noah Rosen, MD, director of Northwell Health's Headache Center in Great Neck, New York, said it's a "useful reminder of the benefits that can be achieved without medication, but we need more information to give better guidance. I wish this study had given us more information as to what type of exercise was best for people with migraine, whether active group sports, running, swimming or others."

American Academy of Neurology (AAN) 2021 Annual Meeting: Abstract 2571. To be presented April 18, 2021.

The study had no specific funding. Dyess, Lakhan, and Rosen have disclosed no relevant financial relationships.

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