AEROBIC EXERCISE AND

MIGRAINES

Vincent Tang
3/24/2020
Doctoring 3 CAQ

04/12/2020
 CLINICAL ISSUE
 

In patients with frequent migraines, prophylactic

treatments are used. However, medications can
be poorly tolerated, and patients request non-
pharmacologic alternatives. One option is
aerobic exercise.

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 FOCUSED CLINICAL QUESTION

 Can aerobic exercise decrease the frequency of migraine

headaches?

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 SEARCH STRATEGY

Provide your “best” search strategy that you used to find

relevant research:
 Pubmed, Google Scholar
 Terms: “Migraine AND Exercise”
 Filters: Reviews, Clinical Trials, Systematic Reviews, and
Randomized Clinical Trials
 499 results
 Filter: Systematic Reviews: 14; Clinical Trials: 40
 Librarian: Bruce Abbott
 Strengths: simple terms, able to catch a lot of articles
Weaknesses: not very specific, does not consider the strength
of evidence

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 OVERVIEW OF EVIDENCE

 H a n s s e n ,   H . , Mi n g h e t ti ,   A. , Ma g o n,   S. , R os s m e i s s l ,   A . , R a s e n a ck ,   M .,
P a p a d op ou l ou ,   A. , K l e n k ,  C ., F a u d e ,   O . , Z a h ne r,   L . , S p r e n g e r ,   T . , & D on a t h ,   L . ( 2 0 1 8 ) .
E ff e c t s of d i f fe r e n t e nd u r a n c e e x e r c i s e m od a l i t i e s o n m i g r a i n e d a y s a n d
c e re b r ov as c u l a r he a lt h i n e p is o d i c m i g r a i n e u rs : A r a n d om i z e d c on t r o l l e d
t r i a l .   S ca nd i na v i an Jo ur na l o f Me di c in e & S ci e n ce i n S p o r t s ,  2 8 ( 3 ) , 1 1 0 3 -
1 1 1 2.   h t tp s : / / d o i. or g / 1 0 .1 1 1 1/ s m s . 1 30 2 3
 K r øl l ,  L .   S. , H am m ar l u n d ,  C .   S. , L i n d e ,   M ., G a r d ,  G . , & J e n s e n ,  R .  H . ( 2 0 1 8) . T he e f fe ct s
o f a e ro b i c e xe rc is e f o r p e r s on s w i t h m i g r a i n e a n d c o- e x i s t i n g t e n s i on -t y p e he a d a c h e
a n d n e c k p ai n . A r a n d o m i z e d , c on t ro l l e d , c l i n i c a l t r i a l .   C e ph al a l g ia ,   38 ( 1 2 ) , 18 0 5 -
1 8 1 6.   h t tp s : / / d o i .o rg / 1 0 .1 1 7 7/ 0 3 33 1 0 2 41 7 7 5 2 1 19
 L e m m e n s ,  J. , De P au w ,  J . , V a n So om ,  T . , M i c h i e l s ,   S ., V e r s i j p t ,   J . , va n B r e d a ,   E. ,
C a s t i e n,   R . , & De H e r to g h ,  W . ( 2 0 1 9) . T h e e ff e c t o f a e r ob i c e x e r c i s e o n t h e n u m b e r of
m i g r a in e d a y s , d u r at i on a n d p a i n i n t e n s i t y i n m i g ra i n e : a s y s t e m a t i c l i t e r a t u re r e vi e w
a n d m e ta - a n al ys i s .   T he Jo ur na l o f H e a da ch e a n d
Pa i n,   2 0 ( 1 ) .  h t t p s : / / d o i .o r g / 1 0 .1 1 8 6 / s 1 0 19 4 - 01 9 - 0 96 1 - 8
 S a nt i a g o,   M.  D ., C a rv a l ho ,  D .  D ., G a b b a i ,   A .   A . , P i nt o,   M .  M . , Mo u t r a n ,  A .   R ., &
V i l l a ,   T .   R . ( 2 0 14 ) . Am i tr i p ty l i ne a nd a e r o b i c e x e r ci s e or a m i t ri p t y l i n e a l on e i n t h e
t r e a t m e n t o f c h r on i c m ig ra i n e : a r a nd om i z e d c om p a r a t i ve s t u d y .   A r q ui v o s d e N e u r o -
Ps i q u i at r i a ,  7 2 ( 1 1 ) , 8 5 1 -8 5 5 .   ht t p s : / / d oi . or g / 1 0 . 1 59 0 / 00 0 4 -2 8 2 x 2 0 1 40 1 4 8

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 ANSWER TO THE CLINICAL QUESTION

 Low levels of physical exercise and high frequency of

migraine has been reported in several large population-based
studies
 Exercise can trigger migraines, but REGULAR exercise can act
as migraine prophylaxis
 Aerobic exercise (biking/cross training/brisk walking) can
have significant reductions for migraine duration, intensity,
frequency
 People who are on migraine prophylaxis (i.e.. Amitriptyline)
can have greater efficacy when combined with aerobic
exercise

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 THE LEVEL OF EVIDENCE SUPPORTING YOUR
ANSWER TO THE CLINICAL QUESTION

Level of Evidence Study or article type

IA Evidence from meta-analysis of RCTs
IB Evidence from at least one RCT
IIA Evidence from at least one controlled study
without randomization
IIB Evidence from at least one other type of
quasi-experimental study
III Evidence from non-experimental descriptive
studies, such as comparative studies,
correlation studies, and case-control studies

IV Evidence from expert committee reports or

opinions or clinical experience of respected
authorities, or both

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 THE TOP ARTICLE THAT LEAD TO YOUR
CONCLUSION:
L e m m e n s ,   J . , D e P a u w ,   J . , V a n S o o m ,   T . , M i c h i e l s ,   S . ,
Versijpt, J., Van Breda, E., Castien, R., & De Hertogh, W.
(2019). The effect of aerobic exercise on the number of
migraine days, duration and pain intensity in migraine:
a systematic literature review and meta-analysis.  The
Journal of Headache and
Pain, 20(1). https://doi.org/10.1186/s10194-019-
0961-8

T h i s i s o n e o f t h e s t r o n g e r a r t i c l e s a s i t i s r e c e n t
(2019), a systematic review of RCT’s with meta-
analysis, sample size of 6 for qualitative synthesizes
and 4 in meta-analysis, there is a moderate risk of bias
due to high dropout rate and lack of blinding outcome
assessors.

V a l i d i t y : U s e d C o c h r a n e r i s k o f b i a s t o o l . T h e r e i s
some bias due to high dropout rate in studies analyzed.

R e s u l t : S o m e e v i d e n c e t h a t a e r o b i c e x e r c i s e c a n l e a d t o
a decrease of 0.6 migraines per month. There is low
clinical relevance because there are no clear guidelines
on what types of exercise to do or the intensity.

C o n c l u s i o n : B a s e d o n t h e r e s u l t s o f t h i s r e v i e w , t h e r e i s
a moderate evidence that aerobic exercise decreases
the the number of migraine days. Additionally, there is
low quality evidence that aerobic exercise decreases
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the attack duration and pain intensity
 NEXT STEPS FOR RESEARCH REGARDING THIS TOPIC?

Explore the intensity

and frequency of
exercise and types of
exercise that would be
effective for migraines
There is no evidence-
based exercise plan to
prevent migraine in
patients

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