Exercise for Migraine Prevention?
When it comes to Migraine and exercise, most of us have probably been advised that regular exercise would help our Migraines. Now researchers in Sweden and Norway have released the results of a study with this aim:
"Scientific evidence regarding exercise in migraine prophylaxis is required. Therefore this study aimed to evaluate the effects of exercise in migraine prevention."1
study design and methods:
91 participants were divided into three groups:
- One group was asked to exercise on a stationary bicycle for 40 minutes, supervised by a physical therapist three times a week.
- One group performed relaxation techniques - once weekly training sessions.
- One group was prescribed topiramate (Topamax), starting at 25 mg per day and tapering up to the highest dose the individual participant could tolerate, with a maximum dose of 200 mg per day.
Of the 91 participants:
- 44 had Migraine without aura,
- seven had Migraine with aura, and
- 44 had both Migraine without aura and Migraine with aura.
- One participant had chronic Migraine.
- There was a four- to 12-week baseline period followed by a 12-week treatment period.
- Migraine status was assessed daily by using Migraine diaries.
- Quality of life was assessed using the Swedish version of the Migraine-Specific Quality of Life Questionnaire, which is made up of 20 items to be rated.
- The final measure of the study was reduction of the frequency of Migraine attacks during the final month of treatment compared with the baseline.
Number of participants who left the study before completion:
- four participants from the relaxation group, leaving 26 participants;
- five participants from the exercise group, leaving 25 participants; and
- nine patients from the topiramate group, leaving 21 participants.
Among the participants who completed the study, the number of people reporting an improvement of at least 50% was
- 28 % in the exercise group,
- 27% in the relaxation group, and
- 38% in the topiramate group.
Among the participants who completed the study, the number of people reporting an improvement of 25-49% was
- 20 % in the exercise group,
- 19% in the relaxation group, and
- 14% in the topiramate group.
Among the participants who completed the study, the number of people reporting an improvement of less than 25% was
- 52% in the exercise group,
- 54% in the relaxation group, and
- 48% in the topiramate group.
- The reduction in pain intensity for the same period of time significantly favored the topiramate group.
Varkey, a physiotherapist and doctoral student at the Sahlgrenska Academy, University of Gothenburg, commented
"Our conclusion is that exercise can act as an alternative to relaxations and [the migraine drug] topiramate when it comes to preventing migraines, and is particularly appropriate for patients who are unwilling or unable to take preventative medicines."2
Summary and Comments:
I found several weaknesses in this study:
- 91 participants were divided into three groups:
- The number of participants in the study was very small.
- There was no placebo group to match the topiramate group. I consider this important since it's not unusual to have a placebo rate around 30% in many studies.
- Nine participants, nearly 30% of the topiramate group dropped out of the study. This could mean that the 21 participants left in that group were patients who respond well to topiramate. Does that skew the statistics?
To say that the study shows that, "exercise can act as an alternative to relaxations and [the migraine drug] topiramate when it comes to preventing migraines, and is particularly appropriate for patients who are unwilling or unable to take preventative medicines," is a stretch. A more valuable study would be one to determine how much regular exercise could help improve Migraine prevention when added to other preventive therapies.
There are also other issues to be considered here:
- For some people, exercise is actually a Migraine trigger.
- For those with frequent or chronic Migraine, exercise can be difficult because it often makes the intensity of Migraines worse.
1 Varkey, Emma; Cider, Asa; Carlsson, Jane; Linde, Mattias. "Exercise as migraine prophylaxis: A randomized study using relaxation and topiramate as controls." Cephalalgia published online 2 September 2011. DOI: 10.1177/0333102411419681.
2 HealthDay News. "Regular Exercise Seems to Guard Against Migraine." U.S. News & World Report. October 12, 2011.
Medical review by John Claude Krusz, PhD, MD