Individuals with migraine, tension-type headache may fare well with exercise

Working out can bring relief to patients with primary headaches, with aerobic and strength training beneficial in migraine or tension-type headache (TTH), respectively, according to the results of a meta-analysis.

Pooled data from 19 studies showed that in migraine patients, aerobic training yielded a small-to-moderate effect on pain intensity (standardized mean difference [SMD], –0.65, 95 percent confidence interval [CI], –1.07 to –0.22), frequency of headache episodes (SMD, –0.72, 95 percent CI, –1.22 to –0.23), and medication use (SMD, –0.51, 95 percent CI, –0.85 to –0.17) but not on anxiety. [J Pain 2021;doi:10.1016/j.jpain.2021.12.003]

In patients with TTH, on the other hand, aerobic training had a null effect. It was strength training that exerted a moderate clinical effect on pain intensity (SMD, –0.84, 95 percent CI, –1.68 to –0.01).

“We found that aerobic training, or a mix of aerobic and strength training, could improve disability in migraine patients. [Furthermore] … upper limb and/or craniocervical strength training seemed to be effective at improving disability in patients with TTH,” the investigators noted.

A decrease in pain intensity correlated with a reduction in the frequency of days with migraine. This, according to the investigators, can translate into a potential improvement in the overall physical state and quality of life, although additional investigations are needed to confirm this. [Cephalalgia 2015;36:437-444; Cephalalgia 2016;36:67-91]

In terms of safety, only two studies reported adverse events. These included minor musculoskeletal pain in 20 percent of participants in the intervention group, as well as paresthesia, fatigue, or depressed mood in the pharmacological control group.

However, “the studies included showed a low certainty of evidence, replicability, and transparency, and a high risk of bias,” they added.

Exercise-induced hyperalgesia

Of the studies, those that examined aerobic training comprised a total of 439 participants (age 31–47 years, headache duration 12–28.8 years). Most interventions were moderate-to-vigorous continuous training, with walking and jogging being the most common modalities.

Strength training studies consisted of 2,177 participants (age 25.1–48.3 years, headache duration 5–10 years). The interventions included upper limb and neck strength training or craniocervical training specifically.

Meanwhile, other studies examined combined aerobic and strength training and yoga training. The most common control group was no-intervention, while some studies used usual care, education, manual therapy, relaxation, and pharmacological approach, among others.

How exercise interventions might help alleviate primary headaches may have a lot to do with exercise-induced hyperalgesia (EIH), the investigators stated. For instance, aerobic training has the potential to induce a widespread EIH in patients with migraine who have lower levels of β-endorphin than healthy individuals. Meanwhile, resistance training may enhance local and global EIH in TTH patients who harbour generalized pain hypersensitivity. [Cephalalgia England 2013;33:316-322; J Pain 2019;20:1249-1266; Pain 2007;129:113-121]

In addition to the neurobiological effects of exercise interventions, they can also influence the affective aspect of pain perception, the investigators pointed out. “Following exercise training, patients may experience reduced pain-related fear and threat perception, and they may develop new safety-related inhibitory associations.” [Br J Sports Med 2019;53:907-912]

More studies with better methodological quality are needed before exercise interventions could be recommended for primary headaches, according to the investigators.