Expert Review: Exercise and migraine

In 2009, physiotherapist Emma Varkey and colleagues from the University of Gothenburg in Sweden tested the feasibility of aerobic exercise using indoor cycling three times weekly for 12 weeks in 26 migraineurs.

This program was found to be well tolerated, with improvement in fitness markers and no worsening of migraine status. This same research group is now presenting data from a controlled study comparing the effectiveness of aerobic exercise with standard migraine prevention therapies for migraine reduction. Results will be published in the journal Cephalalgia. A headline I saw describing this study read, "Study showed [exercise] worked as well as medication in preventing attacks." While exercise was helpful, the headline is a bit misleading and doesn't tell the whole story.

In this study, 91 adults experiencing 2 to 8 migraines per month were randomly assigned to one of three 12-week treatments: relaxation therapy, exercise, or topiramate:

  • Relaxation involved once weekly training sessions
  • Exercise involved indoor cycling supervised by a physical therapist for 40 minutes three times a week
  • Topiramate was prescribed by a neurologist and a single follow-up visit was scheduled, although patients were allowed to call with problems, if needed

People were excluded from participating in this study if they previously practiced relaxation, exercised at least once per week, or were already using a migraine prevention medication. Nineteen patients quit during the study, so treatment effects were evaluated in 26 people treated with relaxation, 25 with exercise, and 21 with topiramate.

What were the results?

  • The average number of migraines per month decreased by about one migraine in each treated group
  • Average reduction in pain severity was significantly better among patients treated with topiramate

— Using a 0 (no pain) to 100 (worst pain imaginable) scale, average pain severity scores decreased during the last month of treatment among people completing treatment by 20 points with topiramate, 10 with exercise, and 7 with relaxation.

— The number of doses of acute migraine medication taken during the last month of treatment dropped by 2.5 doses with topiramate, 1.5 doses with exercise, and 1.6 doses with relaxation

  • Among those people who completed treatment, the number of people reporting a decrease in headache activity by at least half was 27 percent with relaxation, 28 percent with exercise, and 38 percent with topiramate
  • Fitness improved for exercising patients

What are the limitations from this study?

  • The number of people tested in this study was small, with one in three people treated with topiramate dropping out and about one in six treated with relaxation or exercise dropping out. Because so many people dropped out of the topiramate group, it's likely that those sticking with it were more likely to be good treatment responders. Therefore, benefits with topiramate may have been exaggerated
  • Studies have consistently shown that relaxation training is as effective as most migraine prevention drugs, while aerobic exercise is generally more modestly beneficial. In this study, the increased contact with the therapist for exercise training compared with relaxation may have resulted in exercise benefits being exaggerated compared with relaxation

What does this study teach us?

  • Exercise is good for you AND good for your migraines. While data from this study may not convincingly show us that exercise is as good or better than other prevention treatments, I don't think that's the point. The bottom line is that even the most effective migraine prevention benefits are only moderately helpful for most people. Studies consistently show that people who combine prevention therapies together tend to get better relief than those sticking with either medication treatment alone OR non-drug treatment alone
  • This study does support adding aerobic exercise to your migraine prevention program and making exercise a routine. For most patients, it's a matter of getting a bit of a migraine reduction from relaxation, plus a bit from exercise, plus a bit from.... (you get the idea) to really feel they've made an important impact in their migraines
  • Although this study evaluated benefits from cycling exercise, walking has been shown to be the preferred aerobic exercise for most people. And if you're lucky enough to have a dog, dog walking is a wonderful exercise that helps keep people motivated to stick with exercise and physically fit. (You can find tips on effectively exercising with your dog and a free downloadable walking diary at

— The World Health Organization recommends exercising a total of 150 minutes per week for good health

— Always talk to your doctor before starting a new exercise program

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