Exercise as migraine prophylaxis: a randomized study using relaxation and topiramate as controls

Emma Varkey, Asa Cider, Jane Carlsson, Mattias Linde, Emma Varkey, Asa Cider, Jane Carlsson, Mattias Linde

Abstract

Aim: Scientific evidence regarding exercise in migraine prophylaxis is required. Therefore this study aimed to evaluate the effects of exercise in migraine prevention.

Methods: In a randomized, controlled trial of adults with migraine, exercising for 40 minutes three times a week was compared to relaxation according to a recorded programme or daily topiramate use, which was slowly increased to the individual's highest tolerable dose (maximum 200 mg/day). The treatment period lasted for 3 months, and migraine status, quality of life, level of physical activity, and oxygen uptake were evaluated. The primary efficacy variable was the mean reduction of the frequency of migraine attacks during the final month of treatment compared with the baseline.

Results: Ninety-one patients were randomized and included in the intention-to-treat analysis. The primary efficacy variable showed a mean reduction of 0.93 (95% confidence interval (CI) 0.31-1.54) attacks in the exercise group, 0.83 (95% CI 0.22-1.45) attacks in the relaxation group, and 0.97 (95% CI 0.36-1.58) attacks in the topiramate group. No significant difference was observed between the groups (p = 0.95).

Conclusion: Exercise may be an option for the prophylactic treatment of migraine in patients who do not benefit from or do not want to take daily medication.

Figures

Figure 1.
Figure 1.
Study design.
Figure 2.
Figure 2.
Flow of participants throughout all stages of the study.

References

    1. Menken M, Munsat TL, Toole JF. The global burden of disease study: implications for neurology. Arch Neurol 2000; 57(3): 418–420.
    1. Evers S, Afra J, Frese A, Goadsby PJ, Linde M, May A, et al. EFNS guideline on the drug treatment of migraine ⊟ revised report of an EFNS task force. Eur J Neurol 2009; 16(9): 968–981.
    1. Diener HC, Tfelt-Hansen P, Dahlof C, Lainez MJ, Sandrini G, Wang SJ, et al. Topiramate in migraine prophylaxis ⊟ results from a placebo-controlled trial with propranolol as an active control. J Neurol 2004; 251(8): 943–950.
    1. Holroyd KA, Penzien DB. Pharmacological versus non-pharmacological prophylaxis of recurrent migraine headache: a meta-analytic review of clinical trials. Pain 1990; 42(1): 1–13.
    1. Campbell JK, Penzien DB and Wall EM. Evidence-based guidelines for migraine headache: behavioral and physical treatments. (2010, consulted March 2011).
    1. Busch V, Gaul C. Exercise in migraine therapy − is there any evidence for efficacy? A critical review. Headache 2008; 48(6): 890–899.
    1. Thompson PD, Buchner D, Pina IL, Balady GJ, Williams MA, Marcus BH, et al. Exercise and physical activity in the prevention and treatment of atherosclerotic cardiovascular disease: a statement from the Council on Clinical Cardiology (Subcommittee on Exercise, Rehabilitation, and Prevention) and the Council on Nutrition, Physical Activity, and Metabolism (Subcommittee on Physical Activity). Circulation 2003; 107(24): 3109–3116.
    1. Narin SO, Pinar L, Erbas D, Ozturk V, Idiman F. The effects of exercise and exercise-related changes in blood nitric oxide level on migraine headache. Clin Rehabil 2003; 17(6): 624–630.
    1. Lockett DM, Campbell JF. The effects of aerobic exercise on migraine. Headache 1992; 32(1): 50–54.
    1. Koseoglu E, Akboyraz A, Soyuer A, Ersoy AO. Aerobic exercise and plasma beta endorphin levels in patients with migrainous headache without aura. Cephalalgia 2003; 23(10): 972–976.
    1. Kelman L. The triggers or precipitants of the acute migraine attack. Cephalalgia 2007; 27(5): 394–402.
    1. Varkey E, Hagen K, Zwart JA, Linde M. Physical activity and headache: results from the Nord-Trondelag Health Study (HUNT). Cephalalgia 2008; 28(12): 1292–1297.
    1. Varkey E, Cider A, Carlsson J, Linde M. A study to evaluate the feasibility of an aerobic exercise program in patients with migraine. Headache 2009; 49(4): 563–570.
    1. Headache Classification Committee of the International Headache Society. Classification and diagnostic criteria for headache disorders, cranial neuralgias and facial pain. 2nd ed. Cephalalgia 2004; 24 (Suppl 1): 1–160.
    1. Tfelt-Hansen P, Block G, Dahlof C, Diener HC, Ferrari MD, Goadsby PJ, et al. Guidelines for controlled trials of drugs in migraine. 2nd ed. Cephalalgia 2000; 20(9): 765–786.
    1. Altman DG, Schulz KF, Moher D, Egger M, Davidoff F, Elbourne D, et al. The revised CONSORT statement for reporting randomized trials: explanation and elaboration. Ann Int Med 2001; 134(8): 663–694.
    1. Lundqvist C, Benth JS, Grande RB, Aaseth K, Russell MB. A vertical VAS is a valid instrument for monitoring headache pain intensity. Cephalalgia 2009; 29(10): 1034–1041.
    1. Edvinsson L, Linde M. New drugs in migraine treatment and prophylaxis: telcagepant and topiramate. Lancet 2010; 376(9741): 645–655.
    1. Patrick DL, Hurst BC, Hughes J. Further development and testing of the migraine-specific quality of life (MSQOL) measure. Headache 2000; 40(7): 550–560.
    1. Macsween A. The reliability and validity of the Astrand nomogram and linear extrapolation for deriving VO2max from submaximal exercise data. J Sports Med Phys Fitness 2001; 41(3): 312–317.
    1. Astrand PO, Ryhming I. A nomogram for calculation of aerobic capacity (physical fitness) from pulse rate during sub-maximal work. J Appl Physiol 1954; 7(2): 218–221.
    1. Ekelund U, Sepp H, Brage S, Becker W, Jakes R, Hennings M, et al. Criterion-related validity of the last 7-day, short form of the International Physical Activity Questionnaire in Swedish adults. Public Health Nutr 2006; 9(2): 258–265.
    1. Larsson B, Andrasik F. Guidetti V, Russell G, Sillanpää M, Winner P. Relaxation treatment of recurrent headaches in children and adolescents. Headache and migraine in childhood and adolescence. London: Martin Dunitz, 2002. 307–316.
    1. Borg G. Perceived exertion as an indicator of somatic stress. Scand J Rehabil Med 1970; 2(2): 92–98.
    1. American College of Sports and Medicine Position Stand. The recommended quantity and quality of exercise for developing and maintaining cardiorespiratory and muscular fitness, and flexibility in healthy adults. Med Sci Sports Exerc 1998; 30(6): 975–991.
    1. Evans RW, Linde M. Expert opinion: adherence to prophylactic migraine medication. Headache 2009; 49(7): 1054–1058.
    1. Kumar KK. Exercise for prophylaxis of migraine. Headache 1988; 28(3): 228–228.
    1. Hedenrud T, Jonsson P, Linde M. Beliefs about medicines and adherence among Swedish migraineurs. Ann Pharmacother 2008; 42(1): 39–45.
    1. Franklin G, Howard B. What makes placebo-controlled trials unethical? Am J Bioeth 2002; 2(2): 3–9.
    1. World Medical Association Declaration of Helsinki. Ethical principles for medical research involving human subjects. (2011, consulted March 2011).
    1. Schwartz CE, Chesney MA, Irvine MJ, Keefe FJ. The control group dilemma in clinical research: applications for psychosocial and behavioral medicine trials. Psychosom Med 1997; 59(4): 362–371.
    1. Streng A, Linde K, Hoppe A, Pfaffenrath V, Hammes M, Wagenpfeil S, et al. Effectiveness and tolerability of acupuncture compared with metoprolol in migraine prophylaxis. Headache 2006; 46(10): 1492–1502.
    1. Diener HC, Kronfeld K, Boewing G, Lungenhausen M, Maier C, Molsberger A, et al. Efficacy of acupuncture for the prophylaxis of migraine: a multicentre randomised controlled clinical trial. Lancet Neurol 2006; 5(4): 310–316.
    1. Cady RK, Mathew N, Diener HC, Hu P, Haas M, Novak GP. Evaluation of carisbamate for the treatment of migraine in a randomized, double-blind trial. Headache 2009; 49(2): 216–226.
    1. Silberstein SD, Neto W, Schmitt J, Jacobs D. Topiramate in migraine prevention: results of a large controlled trial. Arch Neurol 2004; 61(4): 490–495.
    1. Brandes JL, Saper JR, Diamond M, Couch JR, Lewis DW, Schmitt J, et al. Topiramate for migraine prevention: a randomized controlled trial. JAMA 2004; 291(8): 965–973.
    1. Storey JR, Calder CS, Hart DE, Potter DL. Topiramate in migraine prevention: a double-blind, placebo-controlled study. Headache 2001; 41: 968–975.
    1. Mei D, Capuano A, Vollono C, Evangelista M, Ferraro D, Tonali P, et al. Topiramate in migraine prophylaxis: a randomised double-blind versus placebo study. Neurol Sci 2004; 25(5): 245–250.
    1. Haskell WL, Lee IM, Pate RR, Powell KE, Blair SN, Franklin BA, et al. Physical activity and public health: updated recommendation for adults from the American College of Sports Medicine and the American Heart Association. Circulation 2007; 116(9): 1081–1093.

Source: PubMed

3
Sottoscrivi