Some treatments are proven to work, but it's unknown if exercise is also useful

A migraine is a type of headache that usually causes an intense throbbing pain in one area of the head, and might also bring with it other problems like nausea, vomiting and being sensitive to light or sound. Some people who get migraines have certain symptoms either before or during a migraine episode, such as flashes of light, blind spots or tingling in the arm or leg. These are called aura. Migraines occur in females more often than males, and can last anywhere from 2-72 hours, making life extremely difficult during that time for patients. The most common treatment to prevent migraines is a drug called topiramate, which is considered to be effective for the patient and to not lead to other issues. Some patients, however, prefer not to take medication every day, and other treatments may also be effective. The most popular of these that has been supported with evidence is relaxation therapy, which consists of breathing and relaxation techniques that are meant to relieve stress and lower the rate of migraines. Some doctors also recommend regular exercise and physical activity, but there is not enough evidence to show that it helps to prevent migraines like the other two treatments. Since some professionals believe exercise can work, but there isn't enough evidence to support it, the only way to find out is to compare it with other treatments. For that reason, a study was arranged that compared exercise therapy to topiramate and relaxation therapy to see if it prevented migraines like the others.

Only patients who have regular migraines are used

Patients were sought who had 2-8 migraines per month, and 91 patients were found who fit the necessary requirements to be included in the study. These 91 subjects were then randomly divided into three groups: a relaxation group, an exercise group and a topiramate group. Patients in the relaxation group met with a physical therapist (PT) once a week and went through a series of breathing and relaxation techniques to relieve stress. Exercise group patients met with a PT three times a week for 40 minutes, and primarily worked on a stationary indoor bicycle, but other exercise of a similar level of intensity was also acceptable. Finally, patients in the topiramate group did not go through any relaxation or exercise programs, but instead were put on the medication topiramate regularly for up to 12 weeks, with the amount of the drug increasing every week. All patients were assessed in their physical abilities and how often they got migraines before the treatment started. All treatments lasted for 12 weeks, and patients were evaluated again three months after treatment and six months after treatment to see how many migraines they get.

Topiramate is the best treatment, but exercise is a close second at preventing migraines

After the study was completed, results were interpreted. The topiramate group showed the biggest reduction in migraines, with an average of .97 fewer migraines than before the treatment. The exercise group was a close second with .93 fewer migraines, and relaxation therapy came in at .83 fewer migraine attacks. While the exercise group didn't perform the best, it was clearly shown to be almost as good as the medication topiramate at preventing migraines. For a treatment that didn't have much evidence to support it, this study is very useful in pointing out that it can indeed be helpful for patients with migraines too. While the reduction in migraines was not massive for the exercise group, it was very similar to the other groups. Since the other treatments are considered to be the best out there, this study makes a case for putting exercise therapy in the same category. Most importantly, exercise therapy can be seen as an option for patients who don't like to take medications on a regular basis, and this treatment can help them to not only prevent future migraines, but also to get in better shape. Finally, it may be possible that using both topiramate and exercise could be the best combination for preventing migraines, but more studies need to look into that matter further.

-As reported in the Oct. '11 edition of Cephalalgia