Strength grooming is the astir effectual signifier of workout for reducing migraine, with high-intensity aerobics coming successful second, and some beating top-line migraine medications topiramate and amitriptyline, caller probe suggests.
The caller results should promote clinicians to urge patients with migraine prosecute successful strength-training exercise whenever possible, survey researcher Yohannes W. Woldeamanuel, MD, a physician-scientist and instructor, Department of Neurology and Neurological Sciences, Stanford University School of Medicine, California, told Medscape Medical News.
"Exercise is thing patients tin bash each their lives and usage it to forestall migraine attacks alternatively of taking regular medications oregon repetitive injections that person respective adverse effects."
The findings were published online October 13 successful The Journal of Headache and Pain.
Head-to-Head Comparison
Several objective trials person shown workout is effectual for migraine management, but to date, determination person been nary head-to-head comparisons of spot grooming and aerobic exercise, said Woldeamanuel.
This caller survey utilized a systematic reappraisal with web meta-analysis (NMA), which compares aggregate interventions and ranks the efficacy of each one.
After a lit search, researchers included 21 objective trials with an workout regimen limb and a examination power arm. All survey information reported monthly frequence of migraine astatine baseline and astatine the extremity of the intervention.
The full combined illustration size was 1195 patients with migraine, who were a mean property of 35.5 years, with a female-to-male ratio of 6.7:1. All studies utilized International Classification of Headache Disorders (ICHD) criteria for migraine diagnosis.
The NMA provided 27 pairwise comparisons and eight indirect comparisons. The pairwise comparisons provided nonstop grounds betwixt the antithetic interventions.
Researchers combined spot training, including weightlifting, with absorption training. Both modalities people muscles, portion aerobic workout targets cardiovascular health.
The mean fig of weeks was 9.3, 9.3, and 10.7, and the mean fig of hours per league for strength/resistance training, high-intensity aerobic exercise, and moderate-intensity aerobic workout interventions was 50, 56, and 45.3, respectively.
The investigation showed each workout interventions were much effectual than the placebo groups successful reducing the frequence of migraine. In presumption of ranking, spot grooming came retired connected top, with a mean quality successful monthly migraine days of −3.55 (95% CI, −6.15 to −0.95) betwixt the progressive and placebo groups.
Next was high-intensity aerobic workout (−3.13; 95% CI, −5.28 to −0.97) and moderate-intensity aerobic workout (−2.18; 95% CI, −3.25 to −1.11]), followed by topiramate, placebo, and past amitriptyline.
Strength/resistance grooming was superior perchance due to the fact that it targets musculus strengthening, peculiarly large muscles successful the cervix and enarthrosis area, which tin beryllium a root of the symptom trigger, said Woldeamanuel. He added cervix symptom is highly comorbid with migraine.
Interestingly, patients doing exercises that absorption connected unaffected muscles — for example, squats — inactive get the benefits of little migraine burden, said Woldeamanuel.
Training Recommendations
Strength grooming besides increases oregon preserves thin musculus mass, which is associated with reduced migraine frequency. Research shows preservation of thin assemblage wide combats cardinal sensitization successful assorted symptom syndromes, said Woldeamanuel.
The superior effects of high versus moderate-intensity aerobic exercise may beryllium owed to recruitment of endogenous molecules progressive successful exercise-mediated hypoalgesia (pain reduction).
The astir communal pathways are the opioid and endocannabinoid systems, though different systems are besides apt involved, said Woldeamanuel. He noted migraine has been linked to a deficiency of some opioidergic and endocannabinoidergic signaling.
Woldeamanuel commented connected the trouble of comparing workout interventions for patients with chronic versus episodic migraine, as many studies see both.
However, the 2 studies with moderate-intensity aerobic workout exclusively involving patients with chronic migraine showed ample effect sizes (Cohen's d) of 0.80 and 1.10 successful reducing monthly headache frequency.
Based connected these caller results and their ain experience, the researchers urge spot grooming commencement with 50% of repetition maximum (RM) with 2-3 sets of 12-15 repetitions 3 times a week on with 10 minutes of warm-up, stretching, and cool-down, totaling 45-60 minutes per session. Weight/resistance load tin past beryllium accrued play by 5% of RM if the diligent is susceptible of successfully completing 3 sets.
They besides urge including progressive betterment days (low-intensity exercise) betwixt grooming days. All large muscles, including neck, shoulder, and precocious limb muscles, should beryllium trained successful a rotation.
For high-intensity aerobic exercise, the authors urge starting with interval grooming astatine 55% VO2max (maximum respiratory capacity), or 50% HRmax (maximal bosom rate) for 45-60 minutes per session, including 10 minutes of warm-up and cool-down, 3 times per week. The strength tin past beryllium accrued by 5%-10% each week to scope a maximum people of 80%-90% by week 12.
It is champion for patients to commencement with a trainer for guidance and supervision, but erstwhile they maestro the routines, they tin bash the exercises independently, said Woldeamanuel.
Managing Flare-Ups
Headache flare-ups are mean during exercise, which whitethorn beryllium caused by "boom and bust cycles" — exercising excessively erstwhile feeling bully past wholly stopping erstwhile feeling bad, said Woldeamanuel. He noted these flare-ups don't mean "there’s thing incorrect with the encephalon oregon there's immoderate wounded to muscles."
The champion mode to negociate specified flare-ups is to usage a pacing strategy that involves "not going overboard connected bully days and avoiding excessive remainder connected atrocious days," the investigators note.
Woldeamanuel noted workout is simply a lifestyle-based intervention; it not lone helps trim migraine attacks but besides helps power different known comorbidities specified arsenic obesity and hypertension.
Commenting for Medscape Medical News, Elizabeth Loder, MD, vice-chair, world affairs, Department of Neurology, Brigham and Women's Hospital, and prof of neurology, Harvard Medical School, Boston, Massachusetts, said, "it's utile to cod and summarize each of these studies, and to absorption connected helping patients and doctors recognize the imaginable worth of antithetic kinds of exercise."
The reappraisal was "well done" said Loder, adding the researchers "have looked cautiously astatine the prime of included studies."
The survey received enactment from the National Institute of Neurological Disorders and Stroke of the National Institutes of Health. Woldeamanuel has reported nary applicable fiscal relationships.
J Headache Pain. Published online October 13, 2022. Full text
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