Regular Exercise

Summary:
Routine aerobic exercise (e.g., brisk walking, cycling) reduces migraine frequency and intensity through multiple physiological pathways, including endorphin release, improved sleep, and reduced stress.

Biological Plausibility

Exercise improves vascular tone, mitochondrial function, and reduces systemic inflammation—all implicated in migraine. It also reduces key triggers like stress and poor sleep.

Evidence

Multiple RCTs and network meta-analyses show a reduction of 2–3 migraine days/month with regular aerobic exercise, particularly at ≥3 sessions/week.

Effect Size

High, with some studies showing comparable benefits to medications.

⚠️ Risk

Low for most, though overexertion or inconsistent routines may act as triggers in some cases.

Cost

$

Scores

  • Benefit: 5
  • Burden: 2
  • Ratio: 2.5

Clinical Takeaways

  • Best for prevention, especially with consistency.
  • Can be tailored to patient preference and fitness level.
  • Start gradually to avoid exertional headache triggers.

Key References

  • Varkey E, et al. *Exercise as migraine prophylaxis: a randomized study.* Cephalalgia. 2011.
  • Amin FM, et al. *The role of physical exercise in migraine prevention: a systematic review.* Cephalalgia. 2018.
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