I have seen a lot lately on the migraine chats about exercise: Does it help? Does it make things worse? Does it depend on the type and extent of exercise?

As a migraine sufferer since the age of four who has had to use exercise (very specific types of exercise) as one of the primary ways to prevent my migraines, I am always interested in the number of people whose migraines are affected (good or bad) when they try to exercise. TRUST ME, IF YOU’RE ONE OF THOSE PEOPLE WHO GETS A MIGRAINE EVERY TIME THEY TRY TO EXERCISE, I BELIEVE YOU! If I told you all the crazy things that make my migraines worse or better you would probably think I was nuts. In my mind, expecting exercise to benefit you because it’s so important for my treatment is like telling everyone Topamax will cure them because it helps me. As almost everyone knows, Topamax does not help everyone.

In the spirit of investigating what to do when it comes to exercise, I thought I would review a paper published on migraine and exercise in Headache, The Journal of Head and Face Pain. It is titled – “Aerobic Exercise for Reducing Migraine Burden: Mechanisms, Markers, and Models of Change Processes”. This paper does not report any original data, but functions to outline what information is out there and what questions need to be answered.

IMPORTANT POINTS FROM THE INTRODUCTION:

  • American Academy of Neurology, American College of Physicians, American Headache Society, and the National Institute of Neurological Disorders and Stroke all recommend exercise as a means to manage migraines.
    • This is mostly based on the fact that aerobic exercise can improve symptoms of many chronic diseases
  • A review of the trials that have looked at migraine patients and exercise has shown that exercise was moderately beneficial. However, this is difficult to interpret as very few of these trials were looking at exercise as the only migraine treatment tested.
    • This review was based on only nine studies. None of these studies found that exercise made migraines worse.
  • Results from the few trials where exercise was the sole intervention showed an average headache reduction of 40%.
  • The authors point out that an association has been found between low levels of physical activity and high migraine frequency. However, it is not really known if the migraines are causing the low activity or vice-versa.
  • Interestingly, the ICHD (International Classification of Headache Disorders) definition of migraine lists EXACERBATION of headache by exercise as a feature of migraine; however, not TRIGGERING of headache by exercise. (Makes it worse, doesn’t cause it).
    • Approximately 30% of migraineurs report a lifetime history of at least one exercise-triggered migraine attack.
  • A study where patients were asked to keep a diary for 4 weeks recently did NOT find any association between recorded physical activity and how often physical activity was cited as an exacerbating factor for migraine.

POSSIBLE MECHANISMS

  • This paper goes on to list a number of biological molecules and psychological and behavioral mechanisms that are related to both migraines and exercise. These include biological factors like inflammatory mediators, calcitonin gene- related peptide, and hormones. Some of the psychological and behavioral factors they list include: self-efficacy (a person’s belief in their ability to succeed or accomplish a task), locus of control (the extent to which a person believes they have power over their own lives), and mood state.

The authors include a theoretical model for how exercise and social-cognitive factors can reduce migraine burden. It’s actually a great schematic for those of you interested in finding the article. I cannot paste it into this blog because of copyright limitations. In short, it shows how aerobic exercise could theoretically decrease migraine burden in the following manner:

  • Exercise improves aerobic capacity and biology: including brain and blood vessel biology, processes involved in neuron signaling, and inflammation of the nerve tissue, thus theoretically decreasing migraine activity.
    • This leads to improved self-efficacy for self-management of migraine and improved expectations of outcome
    • This, in turn, leads to improved mood (decreased depression and anxiety)
      • Improved mood leads to improved ability to carry out activities and to self-manage migraines (including increased exercise capacity)

MY TWO CENTS

I love that this article gives a biological basis for the relationship between exercise and migraine. I also love that they point out that much more work needs to be done to determine who will benefit from exercise, how much is helpful, if exercise can precipitate an attack and why, what intensity is optimal, etc.

There are two things that I am a little bothered by after reading this article. Although I would definitely say I am someone who needs exercise to prevent my migraines, there seem to be many people out there who feel that they cannot exercise because it makes their migraines so much worse. This article failed to explain what could be happening in these instances and why exacerbation of headache by physical activity has been listed as one of the criteria for migraine by the ICHD. The second thing has less to do with the article but with the response of the scientific community. This article was written in October of 2015 and it clearly outlines what work needs to be done in this area. Yet so little has been done since then. I hope we will see more soon. I give this article a thumbs up.