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      The effect of aerobic exercise on the number of migraine days, duration and pain intensity in migraine: a systematic literature review and meta-analysis

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          Abstract

          Background

          In patients with frequent migraine, prophylactic treatments are used. Patients often request non-pharmacological alternatives. One treatment option can be aerobic exercise. The value of aerobic exercise as prophylactic treatment however needs to be determined.

          Methods

          A systematic review and meta-analysis was performed to investigate the result of aerobic exercise on the number of migraine days, duration and pain intensity in patients with migraine. After screening three online databases, PubMed, Cochrane library and Web of Science, using predefined in- and exclusion criteria, six studies were retained. Pooling of data was performed when possible.

          Results

          Significant reductions in the number of migraine days after aerobic exercise treatment were found with a mean reduction of 0.6 ± 0.3 migraine days/month. Other outcomes were too variable to pool due to heterogeneity of outcome measurements. Unpooled data revealed small to moderate reductions in attack duration (20–27%) and pain intensity (20–54%) after aerobic exercise intervention. Various exercise intensities are applied.

          Conclusion

          There is moderate quality evidence that in patients with migraine aerobic exercise therapy can decrease the number of migraine days. No conclusion for pain intensity or duration of attacks can be drawn. Effect sizes are small due to a lack of uniformity. For future studies, we recommend standardized outcome measures and sufficiently intense training programs.

          Trial registration

          CRD42018091178.

          Electronic supplementary material

          The online version of this article (10.1186/s10194-019-0961-8) contains supplementary material, which is available to authorized users.

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          Most cited references39

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          The acute treatment of migraine in adults: the american headache society evidence assessment of migraine pharmacotherapies.

          The study aims to provide an updated assessment of the evidence for individual pharmacological therapies for acute migraine treatment. Pharmacological therapy is frequently required for acutely treating migraine attacks. The American Academy of Neurology Guidelines published in 2000 summarized the available evidence relating to the efficacy of acute migraine medications. This review, conducted by the members of the Guidelines Section of the American Headache Society, is an updated assessment of evidence for the migraine acute medications. A standardized literature search was performed to identify articles related to acute migraine treatment that were published between 1998 and 2013. The American Academy of Neurology Guidelines Development procedures were followed. Two authors reviewed each abstract resulting from the search and determined whether the full manuscript qualified for review. Two reviewers studied each qualifying full manuscript for its level of evidence. Level A evidence requires at least 2 Class I studies, and Level B evidence requires 1 Class I or 2 Class II studies. The specific medications - triptans (almotriptan, eletriptan, frovatriptan, naratriptan, rizatriptan, sumatriptan [oral, nasal spray, injectable, transcutaneous patch], zolmitriptan [oral and nasal spray]) and dihydroergotamine (nasal spray, inhaler) are effective (Level A). Ergotamine and other forms of dihydroergotamine are probably effective (Level B). Effective nonspecific medications include acetaminophen, nonsteroidal anti-inflammatory drugs (aspirin, diclofenac, ibuprofen, and naproxen), opioids (butorphanol nasal spray), sumatriptan/naproxen, and the combination of acetaminophen/aspirin/caffeine (Level A). Ketoprofen, intravenous and intramuscular ketorolac, flurbiprofen, intravenous magnesium (in migraine with aura), and the combination of isometheptene compounds, codeine/acetaminophen and tramadol/acetaminophen are probably effective (Level B). The antiemetics prochlorperazine, droperidol, chlorpromazine, and metoclopramide are probably effective (Level B). There is inadequate evidence for butalbital and butalbital combinations, phenazone, intravenous tramadol, methadone, butorphanol or meperidine injections, intranasal lidocaine, and corticosteroids, including dexamethasone (Level C). Octreotide is probably not effective (Level B). There is inadequate evidence to refute the efficacy of ketorolac nasal spray, intravenous acetaminophen, chlorpromazine injection, and intravenous granisetron (Level C). There are many acute migraine treatments for which evidence supports efficacy. Clinicians must consider medication efficacy, potential side effects, and potential medication-related adverse events when prescribing acute medications for migraine. Although opioids, such as butorphanol, codeine/acetaminophen, and tramadol/acetaminophen, are probably effective, they are not recommended for regular use.
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            Does exercise increase or decrease pain? Central mechanisms underlying these two phenomena

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              Preventive Migraine Treatment.

              This article reviews the evidence base for the preventive treatment of migraine.
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                Author and article information

                Contributors
                joris.lemmens@uantwerpen.be
                joke.depauw@uantwerpen.be
                timia.vansoom@uantwerpen.be
                sarah.michiels@uantwerpen.be
                jan.versijpt@uzbrussel.be
                eric.vanbreda@uantwerpen.be
                r.castien@vumc.nl
                willem.dehertogh@uantwerpen.be
                Journal
                J Headache Pain
                J Headache Pain
                The Journal of Headache and Pain
                Springer Milan (Milan )
                1129-2369
                1129-2377
                14 February 2019
                14 February 2019
                2019
                : 20
                : 1
                : 16
                Affiliations
                [1 ]ISNI 0000 0001 0790 3681, GRID grid.5284.b, Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, , University of Antwerp, ; Antwerp, Belgium
                [2 ]ISNI 0000 0004 0626 3418, GRID grid.411414.5, Department of Otorhinolaryngology, , Antwerp University Hospital, ; Edegem, Belgium
                [3 ]ISNI 0000 0001 0790 3681, GRID grid.5284.b, Department of Translational Neurosciences, Faculty of Medicine and Health Sciences, , University of Antwerp, ; Antwerp, Belgium
                [4 ]ISNI 0000 0001 2290 8069, GRID grid.8767.e, Department of Neurology, , Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), ; Laarbeeklaan 101, 1090 Brussels, Belgium
                [5 ]ISNI 0000 0004 0435 165X, GRID grid.16872.3a, Department of General Practice and Elderly Care Medicine, , Amsterdam Public Health research institute, VU University Medical Center, ; van der Boechorststraat 7, Amsterdam, the Netherlands
                [6 ]Healthcare Center Haarlemmermeer, Waddenweg 1, Hoofddorp, the Netherlands
                Article
                961
                10.1186/s10194-019-0961-8
                6734345
                30764753
                9e7f6cf5-076a-480e-b235-59e19962437b
                © The Author(s). 2019

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

                History
                : 18 November 2018
                : 9 January 2019
                Categories
                Review Article
                Custom metadata
                © The Author(s) 2019

                Anesthesiology & Pain management
                migraine,headache,physical therapy,exercise,treatment,headache characteristics

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