A new clinical practice guideline for prescription of therapeutic exercises for the treatment of migraine with graded recommendations was published in The Journal of Headache and Pain.
Many guidelines involving exercise for the treatment of migraines provide general guidance but lack information such as frequency or duration of exercise. This guideline was developed to provide in-depth recommendations regarding different types of exercises and lifestyle changes that could be effective for treating migraines.
The Scottish Intercollegiate Guidelines Network assigned recommendation grades to categorize different exercise modalities based on their level of evidence.
The total duration of most exercises performed were approximately 40 minutes. No adverse effects were found in any exercises, excluding minor muscle pain and very rarely an increase in migraine symptoms.
Aerobic exercises were found to reduce pain intensity, frequency, and duration of migraine resulting in quality of life improvement. Minor muscle pain was reported as an adverse effect.
If the patient has very intense pain, very frequently and/or the exercise is a clear trigger factor, the most appropriate recommendation would be to prescribe a gradual and individualized exposure to exercise.
Moderate-Intensity Continuous Aerobic Exercise
In this guideline, aerobic exercise is defined as an exercise that uses large muscle groups, results in increased breathing, and helps patients continuously maintain a heart rate at an intensity from 12 to 16 on the Borg perceived exertion scale, a 64% to 76% of the estimated maximum heart rate, a 40% to 59% of the heart rate reserve, or a 40% to 59% of the oxygen uptake reserve.
Moderate-intensity continuous aerobic exercise 3 times per week for a minimum of 8 weeks is likely to decrease headache frequency. This modality is likely to improve pain intensity and may improve migraine duration, disability, and quality of life.
Similarly, yoga is defined as a mind-body intervention that includes physical alignment poses, breathing techniques, and mindfulness exercises. Strength, balance, coordination, and flexibility are components of this modality.
The intensity varies from light to vigorous. Yoga 3 times per week for a minimum of 6 weeks is likely to improve headache frequency and disability, and may improve pain intensity and duration.
Exercise and Lifestyle Recommendations
The guidelines also recommend a combination of interventions directed for patients to implement habits regarding their physical activity, meal times, sleep, stress management, and medication consumption.
Exercise and physical activities 3 to 5 times per week for a minimum of 6 weeks in conjunction with lifestyle recommendations is likely to decrease pain frequency, improve pain intensity and attack duration, and decrease the disability of episodic and chronic migraines.
Supplementary recommendations are as follows:
- Exercise regularly and have adequate hydration
- Regular and consistent sleep hours throughout the week
- Have consistent meal times and medication consumption
- Schedule time to relax for stress management
High-Intensity Interval training (HIIT)
HIIT exercises encompass alternating intervals of high-intensity aerobic exercise and rest, at or below maximal oxygen uptake with light recovery or no exercise between intervals.
In patients with episodic migraines, HIIT training performed 3 times per week for a minimum of 8 weeks might improve the frequency of pain and may improve the intensity, duration, and disability.
Low-Intensity Continuous Aerobic Exercise
This training encompasses any activity that uses large muscle groups and can be maintained continuously, resulting in increased breathing and heart rate, at an intensity from 8 to 11 on the Borg perceived exertion scale, 50% to 63% of the estimated maximum heart rate, 20% to 39% of the heart rate reserve, or 20% to 39% of the oxygen uptake reserve.
In patients with episodic migraines, low-intensity continuous aerobic exercise 3 times per week for at least 6 weeks remotely improves headache frequency, pain intensity, and total duration of migraine.
Resistance exercise results in an improvement in functional performance by increasing muscular strength, power, speed, hypertrophy, local muscular resistance, motor performance, balance, and coordination.
This training at least 3 times per week remotely lessened pain frequency, intensity, and disability caused by migraines.
Such techniques involve progressive muscle relaxation, autogenic training or cued relaxation, visualization and guided imagery, and diaphragmatic breathing that focuses on muscles in the head, neck, and shoulders.
In patients with episodic migraines, 1 session per week to daily sessions for a minimum of 6 weeks may improve headache frequency, whereas 3 sessions per week after 12 weeks may improve pain intensity.
In this exercise, patients execute slow movements that focus on postural control that require them to move body parts gently and slowly while breathing deeply.
Five sessions per week of Tai Chi for a minimum of 12 weeks remotely improves migraine frequency. However, it will not improve migraine pain intensity or attack duration. Joint pain and muscle pain are some adverse effects that can be experienced when performing these movements.
This encompasses a series of exercises that incorporate elements of slow, gentle movement, awareness and regulation of breathing, as well as the intentional direction of thoughts, attention, imagery, and sensation.
Practicing Qi-Gong daily may improve migraine pain frequency and disability after 3 months in patients with episodic migraine, but might not improve pain intensity.