What is the efficacy of aerobic exercise versus strength training in the treatment of migraine? A systematic review and network meta-analysis of clinical trials

Abstract

Background Multiple clinical trials with different exercise protocols have demonstrated efficacy in the management of migraine. However, there is no head-to-head comparison of efficacy between the different exercise interventions. Methods A systematic review and network meta-analysis was performed involving all clinical trials which determined the efficacy of exercise interventions in reducing the frequency of monthly migraine. Medical journal search engines included Web of Science, PubMed, and Scopus spanning all previous years up to July 30, 2022. Both aerobic and strength/resistance training protocols were included. The mean difference (MD, 95% confidence interval) in monthly migraine frequency from baseline to end-of-intervention between the active and control arms was used as an outcome measure. Efficacy evidence from direct and indirect comparisons was combined by conducting a random effects model network meta-analysis. The efficacy of the three exercise protocols was compared, i.e., moderate-intensity aerobic exercise, high-intensity aerobic exercise, and strength/resistance training. Studies that compared the efficacy of migraine medications (topiramate, amitriptyline) to exercise were included. Additionally, the risk of bias in all included studies was assessed by using the Cochrane Risk of Bias version 2 (RoB2). Results There were 21 published clinical trials that involved a total of 1195 migraine patients with a mean age of 35 years and a female-to-male ratio of 6.7. There were 27 pairwise comparisons and 8 indirect comparisons. The rank of the interventions was as follows: strength training (MD = -3.55 [− 6.15, − 0.95]), high-intensity aerobic exercise (-3.13 [-5.28, -0.97]), moderate-intensity aerobic exercise (-2.18 [-3.25, -1.11]), topiramate (-0.98 [-4.16, 2.20]), placebo, amitriptyline (3.82 [− 1.03, 8.68]). The RoB2 assessment showed that 85% of the included studies demonstrated low risk of bias, while 15% indicated high risk of bias for intention-to-treat analysis. Sources of high risk of bias include randomization process and handling of missing outcome data. Conclusion Strength training exercise regimens demonstrated the highest efficacy in reducing migraine burden, followed by high-intensity aerobic exercise.

Response to the letter to the editor by Treleaven et al., May 14, 2023

“…This has not been reported in a recent review concluding strength exercise regimens have the highest efficacy in reducing migraine frequency. 8 In addition, Treleaven et al criticize the fact that our participants with chronic headache were considered as a homogenous group with respect to cervical muscle function. However, we used physical measurements to evaluate the effects of training on functional parameters and not for diagnostic or classification purposes.…”

“…This has not been reported in a recent review concluding strength exercise regimens have the highest efficacy in reducing migraine frequency. 8…”

Physiotherapie bei Kopfschmerzen vom Spannungstyp und Migräne

“…Obwohl es positive Berichte zu der Effektivität von regelmäßigem Training gibt [36], wird dieses Thema sehr kontrovers diskutiert [37]. Offen ist bei Migräne vor allem die Therapiesteuerung und die Intensität mit der trainiert werden sollte [38], wobei es Hinweise gibt, dass ein hochintensives Intervalltraining wirksamer als ein niedriger dosiertes Ausdauertraining ist [29].…”

“…Als klinische relevante Verbesserung wurde in diesem Review eine Reduktion der Schmerzfrequenz und -dauer um 30 % vorausgesetzt. Ein weiterer systematischer Review hat dem Krafttraining eine bessere Wirksamkeit als dem Ausdauersport zugeschrieben 29 . Im Durchschnitt konnten durch Kräftigungsübungen 3,5 Migränetage reduziert werden.…”

Comment regarding: what is the efficacy of aerobic exercise versus strength training in the treatment of migraine? A systematic review and network meta‑analysis of clinical trials

“…I congratulate Woldeamanuel and Oliveira (2022) on their article about the efficacy of exercise in the treatment of migraine [ 1 ]. The importance of exercise as a non-pharmacological preventive therapy should be emphasized in daily practice [ 2 ], and I believe this article encourages strength training as well as aerobic exercise for migraine prevention.…”