Incorporating therapeutic education and exercise in migraine management: a biobehavioral approach

Abstract

We aimed to describe the potential bio-behavioral factors influencing disability in patients with migraine and present a multimodal physiotherapy treatment proposal incorporating therapeutic education and exercise prescription employing a bio-behavioral approach. This manuscript highlights the complex interplay between migraine and physical activity, with many migraine sufferers performing reduced physical activity, even during headache-free intervals. The presence of kinesiophobia in a significant portion of patients with migraine exacerbates functional disability and compromises quality of life. Psychological elements, including pain catastrophizing, depression, and self-efficacy, further compound migraine-related disability. Addressing these issues necessitates a multidisciplinary approach that integrates physical activity and behavioral interventions. We propose a therapeutic education model of motor behavior, emphasizing the enhancement of therapeutic exercise outcomes. This model consists of 4 phases: 1) education about exercise benefits; 2) biobehavioral analysis of movement; 3) movement education; and 4) goal setting. A notable feature is the incorporation of motivational interviewing, a communication strategy that amplifies intrinsic motivation for change. Recent clinical guidelines have advocated for specific exercise modalities to ameliorate migraine symptoms. However, we emphasize the importance of an individualized exercise prescription, given that not all exercises are universally beneficial. The integration of exercise with other lifestyle recommendations, such as maintaining consistent sleep patterns and employing stress management techniques, is pivotal for improving outcomes in patients with migraine. Although evidence supports the benefits of these interventions in various painful conditions, further research is needed to establish their efficacy specifically for migraine management.