Prescription of therapeutic exercise in migraine, an evidence-based clinical practice guideline

Abstract

The main objective of this clinical practice guideline is to provide a series of recommendations for healthcare and exercise professionals, such as neurologists, physical therapists, and exercise physiologists, regarding exercise prescription for patients with migraine.This guideline was developed following the methodology and procedures recommended in the Appraisal of Guidelines for Research and Evaluation (AGREE). The quality of evidence and strength of recommendations were evaluated with the Scottish Intercollegiate Guidelines Network (SIGN). A systematic literature review was performed and an established appraisal process was employed to rate the quality of relevant scientific research (Grading of Recommendations Assessment, Development, and Evaluation methodology).The evaluation of the current evidence, the elaboration of the grades of recommendation, and their validation show a B grade of recommendation for aerobic exercise, moderate-continuous aerobic exercise, yoga, and exercise and lifestyle recommendations for the improvement of symptoms, disability, and quality of life in patients with migraine. Relaxation techniques, high-intensity interval training, low-intensity continuous aerobic exercise, exercise and relaxation techniques, Tai Chi, and resistance exercise obtained a C grade of recommendation for the improvement of migraine symptoms and disability.

The Effect of OnabotulinumtoxinA on Headache Intensity and Number of Monthly Headache Days in Individuals with Chronic Migraine with Different Levels of Neck Disability

“…On the other hand, while pharmacological treatments continue in chronic migraine, we think it is important to include non-pharmacological approaches in the process. Physiotherapy and rehabilitation approaches are used as manual and exercise practices in chronic migraine patients [ 39 , 40 , 41 , 42 , 43 , 44 ]. Physiotherapy and rehabilitation approaches applied in addition to OnabotulinumtoxinA application or drug treatments may provide benefits that will increase the quality of life, especially when exercises are transformed into routine programs that can reduce patients’ pharmacological dependence.…”

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

“…A clinical practice guideline has recently been published, and its primary aim is to offer recommendations to healthcare and exercise professionals, such as neurologists, physiotherapists, and exercise physiologists, regarding exercise prescription for patients with migraine 92 . The evidence indicates that speci c exercise modalities are effective in ameliorating symptoms (e.g., headache frequency, disability, and the quality of life in patients with migraine) Modalities with a Grade B recommendation, such as aerobic exercise 19,63,[93][94][95][96][97][98][99][100][101][102][103][104][105][106][107][108][109][110][111] ; continuous moderate-intensity aerobic exercise 64,65,112-121 ; yoga 63,111,[122][123][124][125][126][127][128][129] ; and lifestyle and exercise recommendations 60,62, [130][131][132][133] , display promising bene ts in symptom improvement.…”

“…The evidence indicates that speci c exercise modalities are effective in ameliorating symptoms (e.g., headache frequency, disability, and the quality of life in patients with migraine) Modalities with a Grade B recommendation, such as aerobic exercise 19,63,[93][94][95][96][97][98][99][100][101][102][103][104][105][106][107][108][109][110][111] ; continuous moderate-intensity aerobic exercise 64,65,112-121 ; yoga 63,111,[122][123][124][125][126][127][128][129] ; and lifestyle and exercise recommendations 60,62, [130][131][132][133] , display promising bene ts in symptom improvement. Notably, yoga, including physical postures, breathing techniques, and mindfulness exercises, is likely to reduce the frequency and disability of migraine attacks 92 . Furthermore, it is pivotal to emphasize the recommendation to integrate exercise with other lifestyle recommendations.…”

“…These include maintaining consistent sleep and eating schedules, adequate hydration, stress management relaxation techniques, and abstaining from excessive medication consumption 60,62, [130][131][132][133] . These interventions evidenced a reduction in pain frequency and an improvement in the quality of life of patients with episodic and chronic migraine 92 . Table 1 Total duration at least 10 min -Abbreviations: bpm, beats per minute; HR, heart rate; HRmax, maximal heart rate; m/min, meters/minute; min, minutes; q-RCT, quasirandomized clinical trial; RCT, randomized controlled trial; RM, repetition maximum; VO 2 max, maximal oxygen uptake.…”

“…Modalities that received a Grade C recommendation, such as relaxation techniques 116, [134][135][136] , high-intensity interval training 114,115,137 , continuous low-intensity aerobic exercise 138,139 , Tai Chi 140 , and resistance training 141 , also exhibited bene ts, albeit with a less robust evidence base compared with the Grade B-recommended modalities 92 . For instance, Tai Chi, a balance training program, demonstrated an improvement in migraine frequency in patients with episodic migraine following a 12-week intervention 140 .…”