Effects of Different Therapeutic Exercise Modalities on Review and Meta-Analysis with a Replicability Analysis

The primary aim of this study was to review the effect of exercise in comparison with a non-active treatment on pain intensity, frequency of headache episodes, headache duration, quality of life, medication use, and psychological symptoms, in patients with migraine or tension-type head-ache (TTH). A systematic search was conducted in various electronic databases to identify all relevant studies: Medline (PubMed), PEDro, EBSCO and Google Scholar. Clinical trials assessing the effects of exercise interventions in patients with primary headaches were selected. Methodological quality was evaluated using the Cochrane Risk of Bias Tool and PEDro scale and qualitative analysis was based on classifying the results into levels of evidence according to the GRADE. 19 studies (2776 participants; 85% female) were included. The meta-analysis showed statistically significant differences in pain intensity for aerobic training in patients with migraine (SMD =-0.65; 95% CI =-1.07 to-0.22, very low certainty evidence) and for strength training in patients with TTH (SMD =-0.84; 95% CI =-1.68 to-0.01,very low certainty evidence). Statistically significant differences were also found in the medica-tion use (SMD =-0.51; 95% CI =-0.85 to-0.17, low certainty evidence). Low transparency, replicability and high risk of bias were found. Aerobic training has a small to moderate clinical effect on pain intensity and medication use on migraine patients, with very low to low certainty of evidence. Strength training showed a moderate clinical effect with very low quality of evidence in patients with TTH. Exercise could be considered as clinically relevant for the management of patients with primary headaches, but the presence of low certainty of evidence and low transparency and replicability limited its clinical application. Perspective: This article presents current evidence about exercise interventions in patients with primary headaches, including migraine and tension-type headache. Existing findings are reviewed, and relevant data are provided on the effectiveness of each exercise modality, as well as its certainty of evidence and clinical applicability. (C) 2021 The Author(s). Published by Elsevier Inc. on behalf of United States Association for the Study of Pain, Inc.

Automated summary

The aim of this study was to evaluate the effects of exercise on pain intensity, medication use, and other factors in patients with migraine and tension-type headache. The results showed that aerobic training had a small to moderate clinical effect on pain intensity and medication use in migraine patients, while strength training had a moderate clinical effect on pain intensity in tension-type headache patients. However, there were limitations in terms of transparency, replicability, and risk of bias in the studies.