Dr. Yohannes W. Woldeamanuel
Strength training is the most effective form of exercise to reduce migrainewith high-intensity aerobics coming in second, and both beating out first-line migraine drugs topiramate Y amitriptylinesuggests new research.
The new results should encourage doctors to recommend that migraineurs perform strength-training exercises whenever possible, said study investigator Yohannes W. Woldeamanuel, MD, a physician-scientist and instructor in the Department of Neurology and Neurological Sciences. from Stanford University School of Medicine, California. , saying Medscape Medical News.
“Exercise is something that patients can do throughout their lives and use it to prevent migraine attacks instead of taking daily medications or repetitive injections that have various adverse effects.”
The findings were posted online October 13 in the diary of Headache and pain.
head to head comparison
Several clinical trials have shown that exercise is effective for migraine control, but to date, there have been no direct comparisons between strength training and aerobic exercise, Woldeamanuel said.
This new study used a systematic review with network meta-analysis (NMA), which compares multiple interventions and ranks the efficacy of each.
After a literature search, the investigators included 21 clinical trials with an exercise regimen group and a comparison control group. All study data reported the monthly frequency of migraine at baseline and at the end of the intervention.
The total pooled sample size was 1195 migraineurs, who had a mean age of 35.5 years, with a female-to-male ratio of 6.7:1. All studies used the International Classification of Headache Disorders (ICHD) criteria for the diagnosis of migraine.
The NMA provided 27 pairwise comparisons and eight indirect comparisons. Pairwise comparisons provided direct evidence between the different interventions.
The researchers combined strength training, including weight lifting, with resistance training. Both modalities focus on muscles, while aerobic exercise focuses on cardiovascular health.
The mean number of weeks was 9.3, 9.3, and 10.7, and the mean number of hours per session for the strength/resistance training, high-intensity aerobic exercise, and moderate-intensity aerobic exercise interventions were 50, 56 and 45.3, respectively.
The analysis showed that all exercise interventions were more effective than the placebo groups in reducing migraine frequency. In terms of ranking, strength training ranked first, with a mean difference in monthly migraine days of −3.55 (95% CI, −6.15 to −0.95) between the active groups. and placebo.
Next up was high intensity aerobic exercise (−3.13; 95% CI, −5.28 to −0.97) and moderate intensity aerobic exercise (−2.18; 95% CI, −3 .25 to −1.11), followed by topiramate, placebo, and then amitriptyline.
The strength/resistance training was superior possibly because it focuses on strengthening the muscles, particularly the major muscles in the neck and shoulder area, which can be a source of the pain trigger, Woldeamanuel said. He added that neck pain is highly comorbid with migraine.
Interestingly, patients who do exercises that target unaffected muscles, such as squats, still reap the benefits of less migraine burden, Woldeamanuel said.
training recommendations
Strength training also increases or preserves lean muscle mass, which is associated with decreased migraine frequency. Research shows that preservation of lean body mass combats central sensitization in various pain syndromes, Woldeamanuel said.
The superior effects of high versus moderate intensity aerobic exercise may be due to the recruitment of endogenous molecules involved in exercise-mediated hypoalgesia (pain reduction).
The most common pathways are the opioid and endocannabinoid systems, although other systems are likely involved as well, Woldeamanuel said. He noted that migraine has been linked to both opioidergic and endocannabinoidergic signaling deficiency.
Woldeamanuel commented on the difficulty of comparing exercise interventions for people with chronic versus episodic migraine, as many studies include both.
However, the two studies with moderate-intensity aerobic exercise exclusively involving chronic migraineurs showed large effect sizes (Cohen’s d) of 0.80 and 1.10 in the reduction of the monthly frequency of headache.
Based on these new results and their own experience, the researchers recommend that strength training begin with a 50% repetition maximum (RM) with 2-3 sets of 12-15 repetitions three times per week along with a 10-minute warm-up. , stretching, and cool down, totaling 45-60 minutes per session. Weight loading/resistance can be increased weekly by 5% RM if the patient is able to successfully complete three sets.
They also recommend including active recovery days (low-intensity exercise) in between your training days. All major muscles, including the muscles of the neck, shoulders, and upper extremities, must be trained in one rotation.
For high-intensity aerobic exercise, the authors recommend starting with interval training at 55% VO2 max (maximum respiratory capacity), or 50% CFmaximum (maximum heart rate) for 45 to 60 minutes per session, including a 10-minute warm-up and cool-down, three times a week. The intensity can then be increased by 5-10% each week to reach a maximum goal of 80-90% by week 12.
It’s best for patients to start with a trainer for guidance and supervision, but once they master the routines, they can do the exercises independently, Woldeamanuel said.
Outbreak management
Headache flare-ups are normal during exercise, which can be caused by “boom and bust cycles” — exercising excessively when you feel good, then stopping altogether when you feel bad, Woldeamanuel said. He noted that these flare-ups don’t mean “there’s something wrong with the brain or that there’s some injury to the muscles.”
The best way to manage these flare-ups is to use a pacing strategy that involves “not overdoing it on good days and avoiding excessive rest on bad days,” the researchers note.
Woldeamanuel noted that exercise is a lifestyle-based intervention; not only helps reduce migraine attacks but also helps control other comorbidities known as obesity Y hypertension.
commenting for Medscape Medical News, Elizabeth Loder, MD, vice chair for academic affairs in the Department of Neurology at Brigham and Women’s Hospital and professor of neurology at Harvard Medical School in Boston, Massachusetts, said, “It’s helpful to collect and summarize all of these studies and focus on helping patients and physicians to understand the potential value of different types of exercise.
The review was “well done,” Loder said, adding that the researchers “looked carefully at the quality of the included studies.”
The study was supported by the National Institute of Neurological Disorders and Race from the National Institutes of Health. woldeamanuel has did not report any relevant financial conflict of interest.
J Headache Pain. Published online on October 13, 2022. Text complete
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