The association between migraine and physical exercise

DOI: https://doi.org/10.1186/s10194- 018- 0902- y

Abstract-Summary Low levels of physical exercise and high frequency of migraine has been reported in several large population-based studies.

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2 Mechanisms

In experimental studies exercise has been reported as a trigger factor for migraine

as well as migraine prophylaxis.

Possible mechanisms for how exercise may trigger migraine attacks, include acute release of neuropeptides such as calcitonin gene-related peptide or alternation of hypocretin or lactate metabolism.

Mechanisms for migraine prevention by exercise may include increased beta- endorphin, endocannabinoid and brain-derived neurotrophic factor levers in plasma after exercise.

It seems that although exercise can trigger migraine attacks, regular exercise may

have prophylactic effect on migraine frequency.

This is most likely due to an altered migraine triggering threshold in persons who

exercise regularly.

The frequency and intensity of exercise that is required is still an open question, which should be addressed in future studies to delineate an evidence-based exercise program to prevent migraine in sufferers.

Review Although physicians possess several pharmacological options to treat migraine attacks [567], these drugs are often not effective for the individual patient, and they may have side effects.

Exercise has been shown to improve self-esteem which is also associated with

alleviating symptoms of migraine [568].

This might be a reason why the interictal behaviour of migraine patients fre-

quently includes reduced physical activity [568, 569].

Pain aggravation induced by routine physical activity is typically reported by patients during migraine attacks [569] and is therefore included in the diagnostic criteria of migraine according defined by the International Headache Society [304]. The purpose of this review is to investigate whether recommendations for exer- cise in migraine are based on sufficient data and to assess what role exercise might play as a trigger for migraine and as a preventative non-pharmacologic treatment.

This review is intended to help establish a proper exercise strategy for patients with migraine enabling clinicians to improve their migraine management strategies.

Methods A Dutch prospective study conducted on 103 persons with migraine, reported a lifetime prevalence of exercise-triggered migraine attacks at 38% among migraine patients.

A Danish study examining experimental provocation of migraine attacks using self-reported natural trigger factors, showed that migraine could be triggered by an intense run or by exercise on an ergometer bike in 4 patients out of 12, who reported exercise as their triggering factor [570].

In a recent Swedish rest-retest study on patients attending a tertiary headache

centre and reporting exercise as migraine attacks trigger.

In a later randomized comparative study in Brazil, it was concluded that the combination of amitriptyline and aerobic exercise, resulted in a greater reduction in

2.4 Lifestyle

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frequency, duration and intensity of headache, and depression and anxiety scores compared to amitriptyline alone among patients with chronic migraine [561].

Acknowledgement A machine generated summary based on the work of Amin, Faisal Mohammad; Aristeidou, Stavroula; Baraldi, Carlo; Czapinska-Ciepiela, Ewa K.; Ariadni, Daponte D.; Di Lenola, Davide; Fenech, Cherilyn; Kampouris, Konstantinos; Karagiorgis, Giorgos; Braschinsky, Mark; Linde, Mattias; 2018 in The Journal of Headache and Pain.

Triggers, Protectors, and Predictors in Episodic Migraine