Exercise Is Associated With Fewer Migraines in Patients Using Prophylaxis

Researchers examined the possible synergistic relationship between regular exercise and the use of preventive medication among patients with episodic migraine.

Among patients with episodic migraines who use prophylactic medication for migraines, those who exercise moderately to vigorously at least 3 times weekly have fewer monthly headaches, according to study results published in Headache.1

This study sought to evaluate a potential synergistic effect between regular exercise and the use of preventive medication in episodic migraines. Study researchers conducted a secondary analysis of data from a prospective cohort study published in Neurology that investigated the associations between this amount of exercise and prospective headache frequency, intensity, and duration.2 

Included in the study sample were 98 patients recruited from Beth Israel Deaconess Medical Center, Brigham and Women’s Hospital, and Massachusetts General Hospital who had episodic migraine with or without aura, as defined by the International Classification of Headache Disorders-3 criteria and confirmed by study physicians. Included patients had fewer than 15 headaches per month.

The patients completed online diaries about health behaviors and migraine headaches every morning and evening for 6 weeks. They completed the Headache Impact Test-6 (HIT-6), which assessed the burden of episodic migraine headaches.

In the secondary analysis, the study researchers excluded patients who had incomplete data on both exercise frequency and intensity, leaving 94 participants (women, 82 women [66 of whom were premenopausal]) in the analytic sample. The participants’ mean age was 34.3 years (standard deviation [SD], 11.4 years).

Participants reported a mean of 5 (SD, 3.5) headaches per month and HIT-6 score of 60.8 (SD, 6.1). 25 patients used prescription prophylactic medication, and 59 reported typically completing moderate to heavy exercise at least 3 times weekly.

The relationship between exercise and headache days per month varied by baseline use of migraine prophylaxis (P =.009). Among patients who reported regular migraine prophylaxis use, moderate-vigorous exercise at least 3 times per week correlated with 5.1 fewer headache days (-5.1 headache days per month; 95% CI, -8.2 to -2.0; P =.001) compared with patients who reported of lower levels of exercise. The association between exercise and headache days per month among those not using migraine prophylaxis was not statistically significant.

Limitations of the study included defining exposure according to exercise reported at enrollment, which limited the ability to differentiate participants who changed habit shortly prior to enrollment from those who were active or sedentary for multiple years. Additional limitations include the potential of exposure misclassification and the possibility of other confounding factors influencing the association between migraine and exercise.

Based on their findings, the study researchers concluded that “routine moderate-vigorous exercise may be an important adjunctive strategy for improving headache burden in patients eligible for migraine prophylaxis.”


1. Hagan KK, Li W, Mostofsky E, et al. Prospective cohort study of routine exercise and headache outcomes among adults with episodic migraine. Headache. Published online December 21, 2020. doi:10.1111/head.14037

2. Bertisch SM, Li W, Buettner C, et al. Nightly sleep duration, fragmentation, and quality and daily risk of migraine. Neurology. 2020;94(5):e489-e496. doi:10.1212/WNL.0000000000008740