Impact of promoting physical exercise on migraine – A video-based randomized clinical trial

Introduction

Migraine significantly impacts quality of life, and a substantial proportion of subjects experience refractory migraine. Non-pharmacological strategies, such as physical exercise, have shown potential benefits in headache control. This study aims to evaluate the effectiveness of a video-based educational intervention in promoting physical activity and improving migraine-related outcomes.

Methods

A single-centre, single-blinded randomized clinical trial included 65 migraine subjects from a tertiary hospital in Porto, Portugal. Participants were stratified by age and randomized into an intervention group, receiving seven educational videos on exercise benefits over three months, or a control group, receiving usual care. Assessments were conducted at baseline (T0) and six months later (T6; three months after intervention). Primary outcome included the Headache Impact Test – 6 item (HIT-6) score; secondary outcomes included migraine frequency, acute medication use, and three Physical Activity Indices. Preventive treatments followed standard clinical practice, with physicians blinded to group allocation. Statistical analyses included between-group and within-group comparisons (p ≤ 0.05).

Results

Among 105 randomized subjects, 65 completed the study (61.9 %; 32 out of 53 in the intervention group vs. 33 out of 52 in the control group). Baseline sociodemographic and headache characteristics were comparable between groups, including the number and the type of preventive medication used. A negative correlation between leisure-time physical activity and HIT-6 score was observed at baseline. The intervention group showed significant reductions in monthly headache frequency (p = 0.003) and acute medication intake (p = 0.005), but no significant improvements in HIT-6 score or physical activity indices.

Conclusions

This study shows that a low-cost, accessible video-based educational intervention can reduce migraine frequency and acute medication use, even without significantly changing physical activity levels. By increasing awareness and promoting self-management, such tools may complement conventional care. Future studies should explore personalized, multimodal strategies combining education, behavioural support, and pharmacological treatments to optimize migraine outcomes.