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Diagram shows the measurements before and after 8-week resistance training protocol in control and experimental groups. The change percent of indices is depicted in the right-hand position in both groups. CON control group, EXP experimental group, WHR waist-hip ratio, BMI body mass index
Source publication
Purpose
The benefits of resistance training (RT) for migraineurs appears to be lacking although beneficial of aerobic training have been shown in previous studies. The aim of the current study, therefore, is to investigate the influence of RT on migraine headache indices, upper and lower-body strength, and quality of life (QOL) in women with migrai...
Similar publications
The aim of this study was to determine and compare the separate effects of Aerobic Endurance Exercise (AEE) and Progressive Resistance Exercise(PRE) on some Anthropometric features of Body weight (BW), Body Mass Index (BMI), Percent Body Fat (PBF) and Waist-to-Hip Ratio (WHR) of type 2 diabetics. Type-2 diabetes outpatient volunteers who registered...
Citations
... Nonetheless, both aerobic and resistance exercises have been shown to be effective separately in migraine. [56][57][58] Clinical Implications and Future Research ...
Objective:
The goal of this study was to reach consensus about the best exercise prescription parameters, the most relevant considerations, and other recommendations that could be useful for prescribing exercise to patients with migraine.
Methods:
This was an international study conducted between April 9, 2022 and June 30, 2022. An expert panel of health care and exercise professionals was assembled, and a 3-round Delphi survey was performed. Consensus was reached for each item if an Aiken V Validity Index ≥0.7 was obtained.
Results:
The study included 14 experts who reached consensus on 42 items by the third round. The most approved prescription parameters were 30 to 60 minutes of exercise per session, 3 days per week of moderate-intensity continuous aerobic exercise, and relaxation and breathing exercises for 5 to 20 minutes every day. When considering an exercise prescription, initial exercise supervision should progress to patient self-regulation; catastrophizing, fear-avoidance beliefs, headache-related disability, anxiety, depression, physical activity baseline level, and self-efficacy could influence the patients' exercise participation and efficacy; and gradual exposure to exercise could help improve these psychological variables and increase exercise efficacy. Yoga and concurrent exercise were also included as recommended interventions.
Conclusions:
From the experts in the study, exercise prescriptions should be adapted to patients with migraine considering different exercise modalities, such as moderate-intensity aerobic exercise, relaxation, yoga, and concurrent exercise, based on the patients' preferences and psychological considerations, level of physical activity, and possible adverse effects.
Impact:
The consensus reached by the experts can help prescribe exercise accurately to patients with migraine. Offering various exercise modalities can improve exercise participation in this population. The evaluation of the patients' psychological and physical status can also facilitate the adaptation of the exercise prescription to their abilities and diminish the risk of adverse events.
... However, this effect was also found in the control group that received sham ultrasound. One small randomized controlled trial (RCT) applied an upper-and lower-body strength exercise program and found significant within-group differences for migraine frequency, duration, and pain intensity (Sari Aslani et al., 2022). The clinical guideline for non-pharmacological management of persistent headache associated with neck pain recommends low-load endurance cranio-cervical and cervico-scapular exercises for TTH (Côté et al., 2019). ...
Introduction:
Neck pain is a prevalent neurologic and musculoskeletal complaint in the general population and is often associated with primary headache disorders such as migraine and tension-type headache (TTH). A considerable proportion, ranging from 73% to 90%, of people with migraine or TTH also experience neck pain, and there is a positive correlation between headache frequency and neck pain. Furthermore, neck pain has been identified as a risk factor for migraine and TTH. Although the exact underlying mechanisms linking neck pain to migraine and TTH remain uncertain, pain sensitivity appears to play an important role. People with migraine or TTH exhibit lower pressure pain thresholds and higher total tenderness scores compared with healthy controls.
Purpose:
This position paper aims to provide an overview of the current evidence on the relationship between neck pain and comorbid migraine or TTH. It will encompass the clinical presentation, epidemiology, pathophysiology, and management of neck pain in the context of migraine and TTH.
Implications:
The relationship between neck pain and comorbid migraine or TTH is incompletely understood. In the absence of robust evidence, the management of neck pain in people with migraine or TTH relies mostly on expert opinion. A multidisciplinary approach is usually preferred, involving pharmacologic and non-pharmacologic strategies. Further research is necessary to fully dissect the linkage between neck pain and comorbid migraine or TTH. This includes the development of validated assessment tools, evaluation of treatment effectiveness, and exploration of genetic, imaging, and biochemical markers that might aid in diagnosis and treatment.
... Third, all three articles on strength training were rated as high-risk or exhibited some risk of bias according to supplementary Fig. 2 Aslani et al. (observed mean difference − 7.32 [− 10.50 to − 4.14]) allowed the use of drugs (nortriptyline, duloxetine, propranolol, dexamethasone, gabapentin, and venlafaxine) with a sample size of only 10 participants in each group. Therefore, the promising efficacy of strength training can be biased owing to uncontrolled oral preventive medications or small sample size [7]. Sun et al. enrolled patients with vestibular migraine and evaluated vertiginous attacks instead of headache days [8]. ...
In Woldeamanuel and Oliveira (2022)’s article about the efficacy of exercise in the treatment of migraine, the ranking of the efficacy of strength training (mean difference, − 3.55), aerobic exercise (mean difference, − 2.18 to − 3.13), topiramate (mean difference, − 0.98), and amitriptyline (mean difference, 3.82) using network meta-analysis can mislead readers. First, the inclusion criteria were reported at a monthly frequency of migraine and the end of the intervention, but some article did not meet the inclusion criteria or had data inconsistency. Second, there was an inconsistency in the placebos used in the included studies, which can be problematic in network meta-analysis. Third, all three articles on strength training were rated as high-risk or exhibited some risk of bias. Finally, the effectiveness of this statistical method is questionable for assessing physical activities because strength training, aerobic exercise, and preventive medications can be simultaneously recommended for possible synergistic effects in the prevention of migraine.
... For Scopus Advanced Search, TITLE-ABS-KEY (migraine AND exercise AND clinical trial) = 305 and TITLE-ABS-KEY (headache AND exercise AND clinical AND trial) = 2759. The final number of articles included was 21 [10,[12][13][14][15][16][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37]. See Fig. 1 for PRISMA [20] flowchart depicting a summary of the identification, screening and inclusion/exclusion of articles. ...
... All studies used International Classification of Headache Disorders (ICHD) [38] criteria for migraine diagnosis. Of the 21 studies included, 9 (43%) [10,12,15,27,28,30,31,36,37] involved patients with chronic migraine out of which 2 studies enrolled exclusively patients with chronic migraine. The NMA provided 27 pairwise comparisons and 8 indirect comparisons. ...
... Strength/resistance training was initiated with 2-3 sets of 12-15 repetitions at a capacity of 45-60% of the maximum weight lifted in a single repetition (one repetition maximum or one RM) [23,36] performed thrice a week These workouts progressed by 5% one RM each week to reach a target of 75-80% of one RM with 3 sets of 8-10 repetitions by 8-12 weeks [23,36]. The weight/resistance training included deep flexor and extensor muscles of the cervical region, superficial muscles of the cervical region, shoulder external and internal rotations, seated row, shoulder extension and flexions, press and curl, butterfly and reversed butterfly, leg extension, and latissimus pull down [10,23,36]. ...
Background
Multiple clinical trials with different exercise protocols have demonstrated efficacy in the management of migraine. However, there is no head-to-head comparison of efficacy between the different exercise interventions.
Methods
A systematic review and network meta-analysis was performed involving all clinical trials which determined the efficacy of exercise interventions in reducing the frequency of monthly migraine. Medical journal search engines included Web of Science, PubMed, and Scopus spanning all previous years up to July 30, 2022. Both aerobic and strength/resistance training protocols were included. The mean difference (MD, 95% confidence interval) in monthly migraine frequency from baseline to end-of-intervention between the active and control arms was used as an outcome measure. Efficacy evidence from direct and indirect comparisons was combined by conducting a random effects model network meta-analysis. The efficacy of the three exercise protocols was compared, i.e., moderate-intensity aerobic exercise, high-intensity aerobic exercise, and strength/resistance training. Studies that compared the efficacy of migraine medications (topiramate, amitriptyline) to exercise were included. Additionally, the risk of bias in all included studies was assessed by using the Cochrane Risk of Bias version 2 (RoB2).
Results
There were 21 published clinical trials that involved a total of 1195 migraine patients with a mean age of 35 years and a female-to-male ratio of 6.7. There were 27 pairwise comparisons and 8 indirect comparisons. The rank of the interventions was as follows: strength training (MD = -3.55 [− 6.15, − 0.95]), high-intensity aerobic exercise (-3.13 [-5.28, -0.97]), moderate-intensity aerobic exercise (-2.18 [-3.25, -1.11]), topiramate (-0.98 [-4.16, 2.20]), placebo, amitriptyline (3.82 [− 1.03, 8.68]). The RoB2 assessment showed that 85% of the included studies demonstrated low risk of bias, while 15% indicated high risk of bias for intention-to-treat analysis. Sources of high risk of bias include randomization process and handling of missing outcome data.
Conclusion
Strength training exercise regimens demonstrated the highest efficacy in reducing migraine burden, followed by high-intensity aerobic exercise.
Purpose of Review
This review aimed to investigate emerging evidence regarding the effectiveness of exercise for migraines, focusing on the results of recent trials. Additionally, it explored the possibility of exercise as a treatment for migraines.
Recent Findings
Between 2020 and 2023, five, four, one, and two trials were conducted regarding the effect of aerobic exercise, anaerobic exercise, Tai Chi, and yoga, respectively, on migraine; all studies showed significant effects. Two trials on aerobic exercise showed that high-intensity exercise was similar to or slightly more effective than moderate-intensity exercise as a treatment for migraines. Three trials on anaerobic exercise reported its effectiveness in preventing migraines.
Summary
Regarding efficacy, side effects, and health benefits, aerobic exercises and yoga are potentially beneficial strategies for the prevention of migraines. Further studies are needed to develop evidence-based exercise programs for the treatment of migraines.
Previous research has focused on the possibility of cervical dysfunction in migraine patients, similar to what is observed in patients with tension-type headaches. However, there is no evidence concerning the physical function of other body regions, even though lower levels of physical activity have been reported among migraine patients. The aim of this study was to compare cervical and extra-cervical range of motion, muscular strength, and endurance, as well as overall levels of physical activity, between patients with chronic migraine (CM) and asymptomatic participants. The secondary objective included the analysis of associations between CM-related disability and various physical and psychological variables. A total of 90 participants were included in this cross-sectional study: 30 asymptomatic participants (AG) and 60 patients with CM. Cervical and lumbar range of motion, strength and endurance, as well as handgrip strength were measured. Headache-related disability, kinesiophobia, pain behaviors, physical activity level and headache frequency were assessed through a self-report. Lower values were found in CM vs AG for cervical and lumbar ranges of motion (p<0.05; effect sizes ranging from 0.57 to 1.44). Also, for neck extension strength (p=.013; d =-.66), lumbar strength (p<.001; d =-1.91) and handgrip strength (p<.001; d =-.98), neck endurance (p<.001; d =-1.81) and lumbar endurance (p<.001; d =-2.11). Significant differences were found for physical activity levels and kinesiophobia between CM and AG. The headache-related disability predictors were headache frequency, activity avoidance and rest, which explained 41% of the variance. The main findings of this study suggest that patients with CM have a generalized fitness deficit and not specifically cervical dysfunction. These findings support the hypothesis that migraine patients have not only neck-related issues but also general lower body conditions.
Objective
To compare various exercise modalities’ efficacy on migraine frequency, intensity, duration, and disability.
Background
Exercise has been shown to be an effective intervention to reduce migraine symptoms and disability; however, no clear evidence exists regarding the most effective exercise modalities for migraine treatment.
Methods
A systematic review was performed in PubMed, PEDro, Web of Science, and Google Scholar. Clinical trials that analyzed the efficacy of various exercise modalities in addressing the frequency, intensity, duration, and disability of patients with migraine were included. Eight network meta‐analyses based on frequentist (F) and Bayesian (B) models were developed to estimate the direct and indirect evidence of various exercise modalities. Standardized mean difference (SMD) and 95% confidence (CI) and credible intervals (CrI) were calculated for each treatment effect based on Hedge's g and p scores to rank the modalities.
Results
We included 28 studies with 1501 migraine participants. Yoga (F: SMD −1.30; 95% CI −2.09, −0.51; B: SMD −1.33; 95% CrI −2.21, −0.45), high‐intensity aerobic exercise (F: SMD −1.30; 95% CI −2.21, −0.39; B: SMD −1.17; 95% CrI −2.20, −0.20) and moderate‐intensity continuous aerobic exercise (F: SMD −1.01; 95% CI −1.63, −0.39; B: SMD −1.06; 95% CrI −1.74, −0.38) were significantly superior to pharmacological treatment alone for decreasing migraine frequency based on both models. Only yoga (F: SMD −1.40; 95% CI −2.41, −0.39; B: SMD −1.41; 95% CrI −2.54, −0.27) was significantly superior to pharmacological treatment alone for reducing migraine intensity. For diminishing migraine duration, high‐intensity aerobic exercise (F: SMD −1.64; 95% CI −2.43, −0.85; B: SMD −1.56; 95% CrI −2.59, −0.63) and moderate‐intensity continuous aerobic exercise (SMD −0.96; 95% CI −1.50, −0.41; B: SMD −1.00; 95% CrI −1.71, −0.31) were superior to pharmacological treatment alone.
Conclusion
Very low‐quality evidence showed that yoga, high‐ and moderate‐intensity aerobic exercises were the best interventions for reducing migraine frequency and intensity; high‐ and moderate‐intensity aerobic exercises were best for decreasing migraine duration; and moderate‐intensity aerobic exercise was best for diminishing disability.
We aimed to describe the potential bio-behavioral factors influencing disability in patients with migraine and present a multimodal physiotherapy treatment proposal incorporating therapeutic education and exercise prescription employing a bio-behavioral approach.
This manuscript highlights the complex interplay between migraine and physical activity, with many migraine sufferers performing reduced physical activity, even during headache-free intervals. The presence of kinesiophobia in a significant portion of patients with migraine exacerbates functional disability and compromises quality of life. Psychological elements, including pain catastrophizing, depression, and self-efficacy, further compound migraine-related disability. Addressing these issues necessitates a multidisciplinary approach that integrates physical activity and behavioral interventions.
We propose a therapeutic education model of motor behavior, emphasizing the enhancement of therapeutic exercise outcomes. This model consists of 4 phases: 1) education about exercise benefits; 2) biobehavioral analysis of movement; 3) movement education; and 4) goal setting. A notable feature is the incorporation of motivational interviewing, a communication strategy that amplifies intrinsic motivation for change.
Recent clinical guidelines have advocated for specific exercise modalities to ameliorate migraine symptoms. However, we emphasize the importance of an individualized exercise prescription, given that not all exercises are universally beneficial. The integration of exercise with other lifestyle recommendations, such as maintaining consistent sleep patterns and employing stress management techniques, is pivotal for improving outcomes in patients with migraine. Although evidence supports the benefits of these interventions in various painful conditions, further research is needed to establish their efficacy specifically for migraine management.
