Prospective cohort study of routine exercise and headache outcomes among adults with episodic migraine
Authors: Hagan Kobina K. , Li Wenyuan , Mostofsky Elizabeth , Bertisch Suzanne M. , Vgontzas Angeliki , Buettner Catherine , Mittleman Murray A. 
Published: December 2020

AbstractObjectiveTo evaluate the association of routine exercise with headache frequency, intensity, and duration among adults with episodic migraine (EM).BackgroundA comprehensive management plan for EM must aim at reducing disability and cost of care; to do so requires optimizing acute and preventive medications, and behavior changes. Prophylactic medication use is associated with adverse events and contraindications with comorbidities. Aerobic exercise is reported to decrease migraine frequency. However, no study has evaluated a potential synergistic relation between regular exercise and preventive medication use among patients with EM.Design and MethodsThis was a secondary analysis of data from a prospective cohort study of adults with EMs. In that study, adults with EM (using International Classification of Headache Disorders‐3 criteria confirmed by study physicians) were recruited from three academic medical centers in Boston, MA. At baseline, participants provided information on exercise, clinical and demographic characteristics, and lifestyle behaviors. We prospectively collected daily information on headaches and health behavior over at least 6 weeks using electronic questionnaires from 94 participants. We assessed the association between baseline self‐reported moderate‐vigorous exercise at least three times per week, at baseline, and prospectively recorded headache frequency, intensity, and duration. We further assessed whether these associations differed by the prevalent use of prophylactic migraine medication.ResultsData from 94 of 98 eligible participants were used in the analysis as 4 participants had missing data on routine exercise frequency or intensity at baseline. On average, patients who reported moderate‐vigorous exercise at least three times per week at enrollment had 1.5 fewer headache days per month (−1.5 headache days/month; 95% confidence interval [CI] −3.1 to 0.1) compared to less exercise; this was not statistically significant (p = 0.066). The association between exercise and headache days per month varied by baseline use of migraine prophylaxis (p‐value of interaction = 0.009). Among those who reported regular use of migraine prophylaxis, a report of moderate‐vigorous exercise at least three times per week was associated with 5.1 fewer headache days (−5.1: 95% CI −8.2 to −2.0; p = 0.001) compared to those who reported lower levels of exercise. However, among those not using migraine prophylaxis, we observed only 0.4 fewer headache days per month (−0.4: 95% CI −2.2 to 1.3; p = 0.636) associated with moderate‐vigorous exercise at least three times/week, a result that was not statistically significant. There was no association of self‐reported moderate‐vigorous exercise at least three times a week with headache intensity or duration.ConclusionIn patients with EM, those who reported moderate‐vigorous exercise at least three times per week had fewer headache days per month, though not statistically significant. This association was significantly stronger in those who used prophylactic medication for migraines. Exercise appeared not to be associated with the severity or duration of headaches. Routine moderate‐vigorous exercise may be an important adjunctive strategy for improving headache burden in patients eligible for migraine prophylaxis.