How much aerobic exercise is needed to reduce migraine? A dose-response meta-analysis of pain intensity and frequency.

Background: Evidence suggests that exercise has clinically relevant benefits for migraine, but an optimal prescription standard remains undefined. We aimed to assess the effectiveness of aerobic exercise on migraine intensity and frequency through a dose-response meta-analysis.

Methods: A data search was performed in PubMed, PEDro, Google Scholar, and EBSCO from inception to September 1, 2024. Randomized controlled trials and quasi-experimental studies of aerobic exercise in patients with a clinical diagnosis of migraine were included. The outcome measures were pain intensity and migraine frequency. The dose-response relationship was evaluated using a dose-response meta-analysis.

Results: Fifteen studies (253 participants) were included. Meta-analysis showed a statistically significant decrease in pain intensity between pre and post intervention (standardized mean differences [SMD], -1.1; 95% confidence interval [CI], -1.72 to -0.47). The spline model showed a U-shape statistically significant association (χ² = 112.03, df = 2, p < 0.001) between total minutes of aerobic exercise and reduction in pain intensity. A minimum dose of 200 min was required for moderate effects, with a maximum effect at 900 min (SMD, -2.4; 95% CI, -2.85 to -1.95). Meta-analysis showed a statistically significant decrease in migraine frequency between pre and post intervention (SMD, -0.79; 95% CI, -1.1 to -0.47). The spline model showed a U-shape statistically significant association (χ² = 86.41, dl = 2, p < 0.001) between total minutes of aerobic exercise and reduction in migraine frequency. A minimum dose of 300 total minutes of aerobic exercise program duration was required to obtain a moderate effect in reducing migraine frequency, with a maximum effect at 950 min (SMD, -1.55; 95% CI, -1.87 to -1.22).

Conclusions: This meta-analysis suggests that aerobic exercise may be effective in reducing both pain intensity and migraine frequency in people with migraine. The greatest observed effect on both variables was observed at a cumulative dose of approximately 900-950 total minutes of aerobic exercise during the program, and higher doses may not present additional benefits. These findings support a preliminary recommendation of 3 weekly 30-min sessions over 10-11 weeks, to be confirmed in future high-quality trials.