Table 11 Summary of prescription parameters for each exercise modality based on the prescription parameters used in the included studies
From: Prescription of therapeutic exercise in migraine, an evidence-based clinical practice guideline
Type of intervention | Migraine diagnosis | Trials | Type of exercise | Distribution | Frequency | Duration (per session) | Intensity | Exercise testing | Grade of recommendation |
|---|---|---|---|---|---|---|---|---|---|
Moderate intensity continuous aerobic training | Episodic or chronic migraine | N = 12 RCTs (n = 6): Hanssen 2018 [49], Varkey 2011 [67], Hanssen 2017 [50], Oliveira 2017 [62], Oliveira 2019 [63], Ahmadi 2015 [41] Q-RCTs (n = 5): Darabaneanu 2011 [47], Luedtke 2020 [56], Varkey 2009 [66], Overath 2014 [64], Narin 2003 [61] Cohort (n = 1): Hagan 2021 [71] | Supervised modalities: running, jogging, indoor cycling or cross-training Unsupervised modalities: nordic walking, slow running, outdoor cycling, swimming, cycling ergometer, brisk walking, dancing, other activities Supervised exercise (n = 9): Hanssen 2018 [49], Varkey 2011 [67], Hanssen 2017 [50], Oliveira 2017 [62], Oliveira 2019 [63], Darabaneanu 2011 [47], Varkey 2009 [66], Overath 2014 [64], Narin 2003 [61] Supervised and unsupervised exercise (n = 2): Luedtke 2020 [56], Narin 2003 [61] No information concerning supervised/unsupervised (n = 1): Ahmadi 2015 [41] | Warm up from 5 to 15 min with walking, jogging, or easy cycling Main training performed from 20 to 30 min Cool down from 5 to 10 min with easy cycling, jogging, walking or stretching | 2–3 times/week for 5–12 weeks | Total duration of 30 to 50 min | Warm up gradually increased from 11 to 13 Borg Main training performed between 13–16 Borg, 70% HRmax (± 5 bpm) or at the intensity corresponding to participant’s ventilatory threshold Cool down between 11–13 Borg | Initial evaluation of individual anaerobic lactate-threshold, HRmax, VO2 max or ventilatory threshold (calculated with lactate blood test or respiratory gas exchange analysis) Monitoring during exercise with Borg scale, %HRmax and/or speed (m/min) | B in favour of intervention |
Yoga | Episodic migraine | N = 6 RCTs (6): Kumar 2020 [54], Kisan 2014 [52], Boroujeni 2015 [45], John 2007 [51], Mehta 2021 [58], Wells 2021 [68] | Yoga: Full program under supervision; the first session or first month is supervised and the rest of the program is performed at home with audio-visual guidance if possible, or ensuring compliance with the routine with a telephone call every week or two months and/or with a diary checking compliance or self-reported yoga log maintained by the patient, and/or with the possibility of visiting professionals | First part: Starting prayer, breathing, stretching and relaxation exercise (including Instant Relaxation Technique and Quick Relaxation Technique). Eye-related and backward bending exercise Second part: Asanas, savana, pavanmoktasanas, pranayama or pre-pranayama, neti exercise, standing-sitting and lying out screw position, kriya (Jalaneti followed by Kapalbhanti), sukshma vyayama, surya namaskar Final part: Shavasana or relaxation | 3–7 times/week for 6–12 weeks | Total duration of 60–75 min | - | - | B in favour of intervention |
Exercise and lifestyle recommendations | Episodic and chronic migraine | N = 5 RCTs = 2 Bond 2018 [44], Lemstra 2002 [55] Cohort = 3 Seok 2006 [72], Wodeamanuel 2016 [73] Gaul 2011 [70] | Home-based exercise, stretching, light weightlifting training, endurance training (mainly using sport gym equipment), or any modality of daily aerobic exercise that raise the heart rate | - | 3–7 times/week for 6 weeks to more than 6 months | Total duration of 20–60 min | Main training performed at a moderate to submaximal intensity | - | B in favour of intervention |
Relaxation techniques | Episodic and chronic migraine | RCTs (n = 3): Varkey 2011 [67], Meyer 2016 [59], Minen 2020 [60] | - | 6 relaxation exercises based on breathing and stress-management techniques, from 5 to 20 min of duration each exercise, or Progressive Muscle Relaxation including 16 muscle exercises or Smartphone app with Progressive Muscle Relaxation program | 1–6 times/week for 6–12 weeks | Total duration of 15 min to 120 min | - | - | C in favour of intervention |
High-intensity aerobic interval training | Episodic migraine | N = 3 RCTs = 3 Hanssen 2017 [50] Hanssen 2018 [49] Matin 2022 [57] | Running on a treadmill Bicycle Supervised | Warm-up = 400 m easy running on a treadmill and 2 skipping exercises or 10 min cycling Main training = High-intensity interval running on a treadmill or bicycle Cool down = 400 m easy running on a treadmill and stretching exercises or 5 min cycling | 2–3 times/week for 8–12 weeks | Main training = 10–40 min High intensity – moderate intensity intervals (min) = 4–3 High-moderate intensity intervals were repeated 4 times | High intensity: Progression from Borg 11 to 18 or from 60% VO2 max to 80% in 8 weeks Maximum high-intensity reached 90%-95% HR Max Maximum active rest period intensity reached: 70% HRmax | -Individual anaerobic lactate-threshold -HRmax -VO2 max (supervised) -Borg | C in favour of intervention |
Low-intensity aerobic exercise | Episodic migraine | N = 2 RCT (1): Santiago 2014 [65] Q-RCT (1): Köseglu 2003 [53] | Home active exercise or fast walk outdoors, not supervised | Warm-up exercises for 10 min Main training performed for 20–40 min Resting period performed for 10 min | 3 times/week for 6–12 weeks | Total duration of 40 min | Main training performed at 60% HRmax | HR | C in favour of intervention |
Exercise and relaxation techniques | Episodic and chronic migraine | RCT (n = 2): Dittrich 2008 [48] Mehta 2021 [58] Q-RCTs (n = 1) Butt 2022 [46] | Relaxation exercise and stationary cycling, or gymnastics with music, aerobic and strength training, or stretching, isometric exercise and walking Not reported if supervised or not | Warm up = 5–10 min Main training = 30 min of moderate aerobic exercise or 15–25 min of aerobic training and 10–20 of strength training Or self-stretching of neck muscles (30 s hold 3 repetitions), neck isometric exercise (5 s hold, 10 repetitions) and 30 min walking Progressive muscle relaxation = 15 min Cool down or stretching = 5 min | 2–3 times/week for 6–12 weeks | Total duration of 45–60 min | - | - | C in favour of intervention |
Neck strength exercise | Episodic migraine | RCT (n = 1): Benatto 2002 [43] | Strength exercise for superficial and deep flexor and extensor craniocervical musculature with home exercise for craniocervical musculature and stretching | First stage: deep muscle training, 2 sets of 10 repetitions for deep flexor and extensor musculature, for 6 weeks. Individually progressed in number of series, repetitions and endurance Second stage: deep and superficial muscle training for the next 2 weeks, including 3 sets of 15 repetitions for superficial flexor and extensor musculature | 1 day per week under supervision and 2 times/day everyday with home exercises for 8 weeks | Total duration of 20 min | - | - | C against the intervention |
Tai Chi | Episodic migraine | N = 1 RCTs (n = 1): Xie 2022 [69] | Modified 33-short form of Yang-style Tai Chi Chuan, (including the form “closing”) The protocol included both supervised and unsupervised exercise | Warm-up with stretching for 10 min Main training of 45 min, with the first 5 weeks learning individual exercises of the Tai Chi exercise program The following 6–12 weeks participants perform the whole Tai-Chi exercise program, 3 times per session Cool-down with stretching for 5 min | 5 times/week for 12 weeks | Total duration of 60 min | - | - | C in favour of intervention |
Resistance exercise | Episodic migraine | RCTs (n = 1): Aslani [42] | Resistance exercise with dumbbells, arm pull down, arm pull over, sit up, leg curl machine, and leg extension machine Not reported if supervised or not | Warm up for 15 min with jogging, stretching, and weightlifting Main training performed from 30 to 45 min, 2–3 sets of 8–15 repetitions of arm pull down, arm pull over, sit up, leg extension and leg curl Cool down for 5 min with active cooling and stretching movements | 3 times/week for 8 weeks | Total duration of 30 to 45 min | Main training gradually performed from 45% RM to 75% RM | RM | C in favour of intervention |
Qi-Gong | Episodic migraine | Case series (n = 1): Elinoff 2019 [74] | Supervised exercise Ju Fu (Gentle Wind) method | First face-to-face history of Qi-Gong explanation and exercise sequence = Ju Fu (Gentle Wind) -Qigong exercise DVD duplicating the content of the first and subsequent lessons for home practice Two subsequent face-to-face sessions to reinforce training and add complexity and length to the Kiko sequence | Daily home practice, for 3 months Two subsequent face-to-face sessions every 30 days | Total duration of 10 min at least | - | - | D in favour of intervention |