Table 9 Highlighted phrases to summarize the strength of recommendation for each exercise modality
From: Prescription of therapeutic exercise in migraine, an evidence-based clinical practice guideline
Intervention | Migraine diagnosis | Effect | Grade of recommendation | Studies | Outcomes | Results |
|---|---|---|---|---|---|---|
Moderate-intensity continuous aerobic exercise | Episodic migraine | Moderate-intensity continuous aerobic exercise, from an 8-week onward intervention applied 3 times per week is likely to improve headache frequency, might improve pain intensity, and remotely improve attack duration, disability, and quality of life in patients with episodic migraine | B in favor of intervention | 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] | Frequency (n = 12): Hanssen 2018 [49], Varkey 2011 [67] , Hanssen 2017 [50], Oliveira 2017 [62], Oliveira 2019 [63], Ahmadi 2015[41], Darabaneanu 2011 [47], Varkey 2009[66], Overath 2014 [64], Luedtke 2020 [56], Narin 2003 [61], Hagan 2021 [71] | Positive effect (n = 8): Varkey 2011 [67], Oliveira 2017 [62], Oliveira 2019 [63], Ahmadi et 2015 [47], Darabaneanu 2011 [47], Varkey 2009 [66], Overath 2014 [64], Narin 2003 [61] Without effect (n = 4): Hanssen 2018 [49], Hanssen 2017 [50], Luedtke 2020 [56], Hagan 2021 [71] |
Pain intensity (n = 7): Oliveira 2019 [63], Ahmadi 2015 [41], Varkey 2011 [67], Darabaneanu 2011 [47], Varkey 2009 [66], Narin 2003 [61], Hagan 2021 [71] | Positive effect (n = 4): Ahmadi 2015 [41], Darabaneanu 2011 [47], Varkey 2009 [66], Narin 2003 [61] Without effect (n = 3): Oliveira 2019 [63], Varkey 2011 [67], Hagan 2021 [71] | |||||
Duration (n = 4): Ahmadi 2015 [41], Darabaneanu 2011 [47], Narin 2003 [61], Hagan 2021 [71] | Positive effect (n = 1): Ahmadi 2015 [41] Without effect (n = 3): Darabaneanu 2011 [47], Narin 2003 [61], Hagan 2021 [71] | |||||
Positive effect (n = 1): Narin 2003 [61] Without effect (n = 1): Luedtke 2020 [56] | ||||||
Quality of life (n = 3): Varkey 2011 [67], Varkey 2009 [66], Narin 2003 [61] | Positive effect (n = 1): Varkey 2009 [66] | |||||
Yoga | Episodic migraine | Yoga, including asanas, breathing and relaxation techniques, and meditation is likely to improve headache frequency and disability and remotely improves pain intensity and attack duration, from a 6-week onward intervention applied 3 times per week in episodic migraine | B in favor of intervention | N = 8 SR and MA in RCT (n = 2): Wu 2022 [39], Long 2022 [37] RCT (n = 6): Kumar 2020 [54], Kisan 2014 [52], Boroujeni 2015 [45], John 2007 [51], Mehta 2021 [58], Wells 2021 [68] | Frequency (n = 8): Wu 2022 [39], Kumar 2020 [54], Kisan 2014 [52], Boroujeni 2015 [45], John 2007 [51], Mehta 2021 [58], Wells 2021 [68], Long 2022 [37] | Positive effect (n = 8): Wu 2022 [39], Kumar 2020 [54], Kisan 2014 [52], Boroujeni 2015 [45], John 2007 [51], Mehta 2021 [58], Wells 2021 [68], Long 2022[37] |
Pain intensity (n = 8): Wu 2022 [39], Kumar 2020 [54], Kisan 2014 [52], Boroujeni 2015 [45], John 2007 [51], Mehta 2021 [58], Wells 2021 [68], Long 2022 [37] | Positive effect (n = 4): Kumar 2020 [54], Kisan 2014 [52], John 2007 [51], Long 2022 [37] Without effect (n = 4): Wu 2022 [39], Mehta 2021 [58], Boroujeni 2015 [45], Wells 2021 [68] | |||||
Disability (n = 7): Wu 2022 [39], Kumar 2020 [54], Kisan 2014 [52], Boroujeni 2015 [45], Mehta 2021 [58], Wells 2021 [68], Long 2022 [37] | Positive effects (n = 6) Wu 2022 [39], Kumar 2020 [54], Kisan 2014 [52], Boroujeni 2015 [45], Wells 2021 [68], Long 2022 [37] | |||||
Without effects (n = 1): Mehta 2021 [58] | ||||||
Duration (n = 6): Wu 2022, Boroujeni 2015 [45], John 2007 [51], Mehta 2021 [58], Wells 2021 [68], Long 2022 [37] | Positive effect (n = 3): John 2007 [51], Mehta 2021 [58], Long 2022 [37] Without effect (n = 3): Wu 2022 [39] , Boroujeni 2015 [45], Wells 2021 [68] | |||||
Exercise and lifestyle recommendations | Episodic and chronic migraine | Exercise prescription and physical activity in conjunction with other lifestyle recommendations is likely to decrease pain frequency, might improve pain intensity and duration, and remotely decrease disability of patients with episodic and chronic migraine after 6 weeks of intervention with 3–5 sessions per week. Moreover, it remotely improve the function and quality of life of patients with chronic migraine | B in favor of intervention | N = 5 RCT (n = 2): Bond 2018 [44], Lemstra 2002 [55] Cohort (n = 3): Seok 2006 [72], Woldeamanuel 2016 [73] Gaul 2011 [70] | Frequency (n = 5): Bond 2018 [44], Lemstra 2002 [55], Seok 2006 [72], Woldeamanuel 2016 [73], Gaul 2011 [70] | Positive effect (n = 5): Bond 2018 [44], Lemstra 2002 [55], Seok 2006 [72], Woldeamanuel 2016 [73], Gaul 2011 [70] |
Disability (n = 1): Bond 2018 [44] | Positive effect (n = 1): Bond 2018 [44] | |||||
Quality of life (n = 1): Lemstra 2002 [55] | Positive effect (n = 1): Lemstra 2002 [55] | |||||
Relaxation Techniques | Episodic and chronic migraine | Relaxation techniques remotely improve headache frequency after at least 6 weeks, from 1 session per week to daily sessions, in patients with episodic but not chronic migraine. It remotely improves pain intensity after 12 weeks of intervention with 3 sessions per week in patients with episodic migraine | C in favor of intervention | N = 3 RCT (n = 3): Meyer 2016 [59], Minen 2020 [60], Varkey 2011 [67] | Frequency (n = 3): Meyer 2016 [59], Minen 2020 [60], Varkey 2011 [67] | Positive effect (n = 2): Meyer 2016 [59], Varkey 2011 [67] Without effect (n = 1): Minen 2020 [60] |
Pain Intensity (n = 1): Varkey 2011 [67] | Positive effect (n = 1): Varkey 2011 [67] | |||||
Disability (n = 1): Minen 2020 [60] | Without effect (n = 1): Minen 2020 [60] | |||||
Quality of life (n = 1): Varkey 2011 [67] | Without effect (n = 1): Varkey 2011 [67] | |||||
High-intensity aerobic interval training | Episodic migraine | High-intensity aerobic interval training might improve the frequency of pain and remotely improve the intensity of pain, duration, and disability after 8 weeks of intervention with 3 sessions per week in patients with episodic migraine | C in favor of intervention | N = 3 RCT (n = 3): | Frequency (n = 3): Hanssen 2017 [50], Hanssen 2018 [49], Matin 2022 [57] | Positive effect (n = 3) |
Intensity of pain (n = 1): Matin 2022 [57] | Positive effect (n = 1) Matin 2022 [57] | |||||
Duration (n = 1): Matin 2022 [57] | Positive effect (n = 1) Matin 2022 [57] | |||||
Disability (n = 1): Matin 2022 [57] | Positive effect (n = 1) Matin 2022 [57] | |||||
Low-intensity aerobic exercise | Episodic migraine | Low-intensity aerobic exercise remotely improves headache frequency, intensity of pain, and total duration per month of migraine, after 6 weeks of intervention with 3 sessions per week in patients with episodic migraine | C in favor of intervention | N = 2 RCT: Santiago 2014 [65] q-RCT: Köseoglu [53] | Frequency, intensity, and duration (n = 2): Köseoglu [53] Santiago 2014 [65] | Positive effect in all outcomes (n = 2): Köseoglu [53] Santiago 2014 [65] |
Exercise and relaxation techniques | Episodic and chronic migraine | Exercise and relaxation techniques might improve pain intensity and remotely improve frequency and disability of patients with episodic and chronic migraine after 6 weeks of intervention with at least 2 days per week of sessions | C in favour of intervention | N = 3 RCT (n = 2): Dittrich 2008 [48], Mehta 2021 [58] q-RCT (n = 1): Butt 2022 [46] | Positive effect (n = 1): Mehta 2021 [58] Without effect (n = 1): Dittrich 2008 [48] | |
Pain intensity (n = 3): Butt 2022 [46], Dittrich 2008 [48], Mehta 2021 [58] | Positive effect (n = 3): Butt 2022 [46], Dittrich 2008 [48], Mehta 2021 [58] | |||||
Disability (n = 2): | ||||||
Quality of life (n = 1): Dittrich 2008 [48] | Without effect (n = 1): Dittrich 2008 [48] | |||||
Neck strength exercise | Episodic migraine | Neck resistance exercise might not improve migraine frequency, pain intensity, or disability of patients with episodic migraine after 8 weeks of intervention with at least 1 supervised session per week and daily home exercises done twice a day | C against the intervention | N = 1 RCT: Benatto 2022 [43] | Frequency, intensity, and disability (n = 1): Benatto 2022 [43] | Without effect in all outcomes (n = 1): Benatto 2022 [43] |
Tai-Chi | Episodic migraine | Tai Chi remotely improves migraine frequency in episodic migraine patients after 12 weeks of intervention with 5 sessions per week Tai Chi might not improve pain intensity or attack duration in episodic migraine patients | C in favor of intervention | N = 1 RCT (n = 1): Xie 2022 [69] | Frequency (n = 1): Xie 2022 [69] | Positive effect (n = 1): Xie 2022 [69] |
Pain intensity (n = 1): Xie 2022 [69] | Without effect (n = 1): Xie 2022 [69] | |||||
Duration (n = 1): Xie 2022 [69] | Without effect (n = 1): Xie 2022 [69] | |||||
Resistance exercise | Episodic migraine | Resistance exercise remotely improves pain frequency, intensity, and quality of life of patients with episodic migraine after 8 weeks of intervention with at least 3 sessions per week | C in favor of intervention | N = 1 RCT: Aslani 2021 [42] | Frequency, intensity, and disability (n = 1): Aslani [42] | Positive effect in all outcomes (n = 1): Aslani [42] |
Qi-Gong | Episodic migraine | Qi-Gong remotely improves pain frequency and disability of patients with episodic migraine after 3 months of intervention with daily sessions. It might not improve pain intensity of patients with episodic migraine | D in favor of intervention | N = 1 Case series: Elinoff 2019 [74] | Frequency and disability (n = 1): Elinoff 2009 [74] | Positive effects (n = 1): Elinoff 2009 [74] |
Pain intensity (n = 1): Elinoff 2019 [74] | Without effect (n = 1): Elinoff 2019 [74] |