Abstracts
To compare the preventive treatment benefits of amitriptyline and aerobic exercise or amitriptyline alone in patients with chronic migraine.
Method
Sixty patients, both genders, aged between 18 and 50 years, with a diagnosis of chronic migraine, were randomized in groups called amitriptyline and aerobic exercise or amitriptyline alone. The following parameters were evaluated: headache frequency, intensity and duration of headache, days of the analgesic medication use, body mass index (BMI), Beck Depression Inventory (BDI) and Beck Anxiety Inventory (BAI) scores.
Results
In the evaluated parameters, was observed decrease in headache frequency (p=0.001), moderate intensity (p=0.048), in headache duration (p=0.001), the body mass index (p=0.001), Beck Depression Inventory (p=0.001) and Beck Anxiety Inventory scores (p=0.001), when groups were compared in the end of third month.
Conclusion
In this study, the amitriptyline was an effective treatment for chronic migraine, but its efficacy was increased when combined with aerobic exercise.
chronic migraine; adults; prophylaxis; amitriptyline; aerobic exercise
Comparar os benefícios do tratamento preventivo em pacientes com migrânea crônica utilizando a amitriptilina associada ao exercício aeróbico ou amitriptilina isolada.
Método
Sessenta pacientes de ambos os sexos com idade entre 18 e 50 anos e com diagnóstico de migrânea crônica foram randomizados para receber amitriptilina e orientados a: praticar exercícios aeróbicos ou somente a amitriptilina isolada. Os seguintes parâmetros foram avaliados: frequência, intensidade e duração da cefaleia, dias de uso de medicação analgésica, índice de massa corporal (IMC), e pontuação nas escalas de Beck Depression Inventory (BDI) e Beck Anxiety Inventory (BAI).
Resultados
Nos parâmetros avaliados, houve redução na frequência da cefaleia (p=0,001), intensidade moderada (p=0,048), na duração (p=0,001), no índice de massa corporal (p=0,001), e pontuação nas escalas Beck Depression Inventory (p=0,001) e Beck Anxiety Inventory (p=0,001), quando os grupos foram comparados ao final do terceiro mês.
Conclusão
A amitriptilina foi um tratamento eficaz para a migrânea crônica, mas sua eficácia foi maior quando combinada com exercício aeróbio.
migrânea crônica; adultos; profilaxia; amitriptilina; exercício aeróbio
Chronic migraine is a disabling disease, with a negative impact on the individual's
ability to perform daily activities11 . Diener H-C, Dodick DW, Goadsby PJ, Lipton RB, Olesen J,
Silberstein SD. Chronic migraine: classification, characteristics and treatment.
Nat Rev Neurol. 2012;8(3):162-71.
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affecting 2% to 3% of the general population22 . Aurora SK, Kulthia A, Barrodale PM. Mechanism of chronic migraine.
Curr Pain Headache Rep. 2011;15(1):57-63.
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and with the prevalence in Brazilian population of 5%33 . Queiroz LP, Peres MFP, Kowacs F, Piovesan EJ, Ciciarelli MC, Souza
JA et al. Chronic daily headache in Brazil: a nationwide population-based study.
Cephalalgia. 2008;28(12):1264-9.
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.
The quality of life in patients with chronic migraine have significant impairments
compared to the healthy population and also when compared to other chronic
conditions44 . Mercante JPP, Bernik MA, Zukerman-Guendler V, Zukerman E,
Kuczynski E, Peres F. Comorbidade psiquiátrica diminui a qualidade de vida
de pacientes com enxaqueca crônica. Arq Neuropsiquiatr. 2007;65(3B):880-4.
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, and 85% of these
patients have disabling attacks, justifying the introduction of prophylactic
treatment55 . Bordini CA. Tratamento profilático. In: Speciali JG, Silva
WF, editores. Cefaléias. São Paulo: Lemos; 2002. p.
90-101..
In episodic migraines, amitriptyline has been used as prophylactic therapy in the last 45
years, and is generally accepted as an effective drug66 . Silberstein SD, Goadsby PJ. Migraine: preventive treatment.
Cephalalgia. 2002;22(7):491-512.
http://dx.doi.org/10.1046/j.1468-2982.2002.00386.x
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.
In addition to reducing the frequency, duration and intensity of headache attacks,
therapy with amitriptyline may improve the response to acute treatment, reduce
disability, and reduce associated economic costs77 . Modi S, Lowder DM. Medications for migraine prophylaxis. Am Fam
Physician. 2006;73(1):72-8.,88 . Gomersall JD, Stuart A. Amitriptyline in migraine prophylaxis.
Changes in pattern of attacks during a controlled clinical trial. J Neurol
Neurosurg Psychiatry. 1973;36(4):684-90.
http://dx.doi.org/10.1136/jnnp.36.4.684
https://doi.org/10.1136/jnnp.36.4.684...
.
The use of amitriptyline for treatment of migraine resulted in 50% reduction in the
headache frequency. Studies demonstrated reduction in headache intensity and frequency
of amitriptyline group compared to the group venlafaxine99 . Bulut S, Berilgen MS, Baran A, Tekatas A, Atmaca M, Mungen B.
Venlafaxine versus amitriptyline in the prophylactic treatment of migraine:
randomized, double-blind, crossover study. Clin Neurol Neurosurg.
2004;107(1):44-8.
http://dx.doi.org/10.1016/j.clineuro.2004.03.004
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, reduction in the frequency and duration of headache
compared to placebo77 . Modi S, Lowder DM. Medications for migraine prophylaxis. Am Fam
Physician. 2006;73(1):72-8.. Others studies
observed similar results1010 . Smitherman TA, Walters AB, Maizels M, Penzien DB. The use of
antidepressants for headache prophylaxis. CNS Neurosci Ther. 2011;17(5):462-9.
http://dx.doi.org/10.1111/j.1755-5949.2010.00170.x
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,1111 . Couch JR. Amitriptyline in the prophylactic treatment of migraine
and chronic daily. Headache. 2011;51(1):33-51.
http://dx.doi.org/10.1111/j.1526-4610.2010.01800.x
https://doi.org/10.1111/j.1526-4610.2010...
.
A significant reduction in the use of analgesic medication was related after prophylaxis with topiramate (50-100 mg/day) associated with amitriptyline (10-20 mg/day) in migraneurs with overuse of analgesic medicines1212 . Valguarnera F, Tanganelli P. The efficacy of withdrawal therapy in subjects with chronic daily headache and medication overuse following prophylaxis with topiramate and amitriptyline. Neurol Sci. 2010;31(1 Suppl):S175-7. http://dx.doi.org/10.1007/s10072-010-0319-0 .
The use of amitriptyline for treatment of migraine requires initial doses of 10 to 25 mg,
and the effective therapeutic dose ranges from 25 to 200 mg1313 . Silberstein SD. Preventive migraine treatment. Neurol Clin.
2009;27(2):429-43. http://dx.doi.org/10.1016/j.ncl.2008.11.007
https://doi.org/10.1016/j.ncl.2008.11.00...
.
Studies with amitriptyline demonstrate limited evidence that the treatment may be
beneficial for patients with chronic migraine1414 . Straube A, Gaul C, Förderreuther S, Kropp P, Marziniak M,
Evers S et al. Therapy and care of patients with chronic migraine. Nervenarzt.
2012;83(12):1600-8. http://dx.doi.org/10.1007/s00115-012-3680-9
https://doi.org/10.1007/s00115-012-3680-...
.
Although several studies addressing prophylactic treatment for episodic migraine66 . Silberstein SD, Goadsby PJ. Migraine: preventive treatment.
Cephalalgia. 2002;22(7):491-512.
http://dx.doi.org/10.1046/j.1468-2982.2002.00386.x
https://doi.org/10.1046/j.1468-2982.2002...
,77 . Modi S, Lowder DM. Medications for migraine prophylaxis. Am Fam
Physician. 2006;73(1):72-8.,88 . Gomersall JD, Stuart A. Amitriptyline in migraine prophylaxis.
Changes in pattern of attacks during a controlled clinical trial. J Neurol
Neurosurg Psychiatry. 1973;36(4):684-90.
http://dx.doi.org/10.1136/jnnp.36.4.684
https://doi.org/10.1136/jnnp.36.4.684...
,99 . Bulut S, Berilgen MS, Baran A, Tekatas A, Atmaca M, Mungen B.
Venlafaxine versus amitriptyline in the prophylactic treatment of migraine:
randomized, double-blind, crossover study. Clin Neurol Neurosurg.
2004;107(1):44-8.
http://dx.doi.org/10.1016/j.clineuro.2004.03.004
https://doi.org/10.1016/j.clineuro.2004....
,1010 . Smitherman TA, Walters AB, Maizels M, Penzien DB. The use of
antidepressants for headache prophylaxis. CNS Neurosci Ther. 2011;17(5):462-9.
http://dx.doi.org/10.1111/j.1755-5949.2010.00170.x
https://doi.org/10.1111/j.1755-5949.2010...
,1111 . Couch JR. Amitriptyline in the prophylactic treatment of migraine
and chronic daily. Headache. 2011;51(1):33-51.
http://dx.doi.org/10.1111/j.1526-4610.2010.01800.x
https://doi.org/10.1111/j.1526-4610.2010...
,1212 . Valguarnera F, Tanganelli P. The efficacy of withdrawal therapy in
subjects with chronic daily headache and medication overuse following
prophylaxis with topiramate and amitriptyline. Neurol Sci. 2010;31(1
Suppl):S175-7. http://dx.doi.org/10.1007/s10072-010-0319-0 ,1313 . Silberstein SD. Preventive migraine treatment. Neurol Clin.
2009;27(2):429-43. http://dx.doi.org/10.1016/j.ncl.2008.11.007
https://doi.org/10.1016/j.ncl.2008.11.00...
,1414 . Straube A, Gaul C, Förderreuther S, Kropp P, Marziniak M,
Evers S et al. Therapy and care of patients with chronic migraine. Nervenarzt.
2012;83(12):1600-8. http://dx.doi.org/10.1007/s00115-012-3680-9
https://doi.org/10.1007/s00115-012-3680-...
, only topiramate1515 . Silberstein SD, Lipton RB, Dodick DW, Freitag FG, Ramadan N,
Mathew N et al. Efficacy and safety of topiramate for the treatment of chronic
migraine: a randomized, double-blind, placebo-controlled trial. Headache.
2007;47(2):170-80. http://dx.doi.org/10.1111/j.1526-4610.2006.00684.x
https://doi.org/10.1111/j.1526-4610.2006...
and the botulinum toxin1616 . Diener HC, Dodick DW, Aurora SK, Turkel C, DeGryse R, Lipton R et
al. OnabotulinumtoxinA for treatment of chronic migraine: results from the
double-blind, randomized, placebo-controlled phase of the PREEMPT 2 trial.
Cephalalgia. 2010;30(7):804-14.
http://dx.doi.org/10.1177/0333102410364677
https://doi.org/10.1177/0333102410364677...
were effective in placebo-controlled studies for the
prophylactic treatment of patients with chronic migraine.
In addition to the prophylactic drug therapies, multiple studies have shown benefits of
non-pharmacological interventions such as aerobic exercise1717 . Narin SO, Pinar L, Erbas D, Oztürk V, Idman F. The effects of
exercise and exercise-related changes in blood nitric oxide level on migraine
headache. Clin Rehabil. 2003;17(6):624-30.
http://dx.doi.org/10.1191/0269215503cr657oa
https://doi.org/10.1191/0269215503cr657o...
,1818 . Köseoglu E, Akboyraz A, Soyuer A, Ersoy AO. Aerobic exercise
and plasma beta endorphin levels in patients with migrainous headache without
aura. Cephalalgia. 2003;23(10):972-6.
http://dx.doi.org/10.1046/j.1468-2982.2003.00624.x
https://doi.org/10.1046/j.1468-2982.2003...
,1919 . Donna-Marie C, Lockett MA, Campbell JF. The effects of aerobic
exercise on migraine. Headache. 1992;32(1):50-4.
http://dx.doi.org/10.1111/j.1526-4610.1992.hed3201050.x
https://doi.org/10.1111/j.1526-4610.1992...
,2020 . Varkey E, Sider A, Carlsson J, Linde M. A study to evaluate the
feasibility of an aerobic exercise program in patients with migraine. Headache.
2009;49(4):563-70.
http://dx.doi.org/10.1111/j.1526-4610.2008.01231.x
https://doi.org/10.1111/j.1526-4610.2008...
,2121 . Busch V, Gaul C. Exercise in migraine therapy: is there any
evidence for efficacy? A critical review. Headache. 2008;48(6):890-9.
http://dx.doi.org/10.1111/j.1526-4610.2007.01045.x
https://doi.org/10.1111/j.1526-4610.2007...
,2222 . Domingues RB, Teixeira AL, Domingues SA. Physical practice is
associated with functional disability in medical students with migraine. Arq
Neuropsiquiatr. 2011;69(1):39-43.
http://dx.doi.org/10.1590/s0004-282x2011000100009
https://doi.org/10.1590/s0004-282x201100...
,2323 . Darabaneanu S, Overath CH, Rubin D, Luthje S, Sye W, Niederberger
U et al. Aerobic exercise as a therapy option for migraine: a pilot study. Int J
Sports Med. 2011;32(6):455-560.
http://dx.doi.org/10.1055/s-0030-1269928
https://doi.org/10.1055/s-0030-1269928...
,2424 . Dittrich SM, Gunther V, Franz G, Burtscher M, Holzner B, Kopp M.
Aerobic exercise with relaxation: influence on pain and psychological well-being
in female migraine patients. Clin J Sport Med. 2008;18(4):363-5.
http://dx.doi.org/10.1097/JSM.0b013e31817efac9
https://doi.org/10.1097/JSM.0b013e31817e...
. Exercise of moderate intensity and practiced regularly can
promotes muscle relaxation, improved cardiovascular fitness and also reduces the
frequency, intensity and duration of headache attacks1919 . Donna-Marie C, Lockett MA, Campbell JF. The effects of aerobic
exercise on migraine. Headache. 1992;32(1):50-4.
http://dx.doi.org/10.1111/j.1526-4610.1992.hed3201050.x
https://doi.org/10.1111/j.1526-4610.1992...
.
Hypotheses for the mechanisms by which exercise may reduce headache include decreased
peripheral sensitization and activation of descending inhibitory pathways2525 . Fernandes-de-las-Peñas C. Physical therapy and exercise in
headache. Cephalalgia. 2008;28(1 Suppl):S36-8.
http://dx.doi.org/10.1111/j.1468-2982.2008.01618.x
https://doi.org/10.1111/j.1468-2982.2008...
.
Studies where the exercise was supervised by a physical therapist demonstrated higher
patient compliance1818 . Köseoglu E, Akboyraz A, Soyuer A, Ersoy AO. Aerobic exercise
and plasma beta endorphin levels in patients with migrainous headache without
aura. Cephalalgia. 2003;23(10):972-6.
http://dx.doi.org/10.1046/j.1468-2982.2003.00624.x
https://doi.org/10.1046/j.1468-2982.2003...
,1919 . Donna-Marie C, Lockett MA, Campbell JF. The effects of aerobic
exercise on migraine. Headache. 1992;32(1):50-4.
http://dx.doi.org/10.1111/j.1526-4610.1992.hed3201050.x
https://doi.org/10.1111/j.1526-4610.1992...
,2020 . Varkey E, Sider A, Carlsson J, Linde M. A study to evaluate the
feasibility of an aerobic exercise program in patients with migraine. Headache.
2009;49(4):563-70.
http://dx.doi.org/10.1111/j.1526-4610.2008.01231.x
https://doi.org/10.1111/j.1526-4610.2008...
. However, even the studies without supervision, with
exercises performed at home, positive results have been reported2020 . Varkey E, Sider A, Carlsson J, Linde M. A study to evaluate the
feasibility of an aerobic exercise program in patients with migraine. Headache.
2009;49(4):563-70.
http://dx.doi.org/10.1111/j.1526-4610.2008.01231.x
https://doi.org/10.1111/j.1526-4610.2008...
,2121 . Busch V, Gaul C. Exercise in migraine therapy: is there any
evidence for efficacy? A critical review. Headache. 2008;48(6):890-9.
http://dx.doi.org/10.1111/j.1526-4610.2007.01045.x
https://doi.org/10.1111/j.1526-4610.2007...
. Despite of positive findings, these studies showed some
limitations as a lack of control groups and subjective endpoints.
The aim of this study was to compare the combination of amitriptyline and aerobic exercise with amitriptyline alone in the prophylactic treatment of patients with chronic migraine, in a randomized controlled open label trial. The following parameters were evaluated: headache frequency, intensity and duration of headache, days of the analgesic medication use, body mass index (BMI), Beck Depression Inventory (BDI) and Beck Anxiety Inventory (BAI) scores.
Method
Over a 2-year period (June 2010 through June 2012), patients newly admitted to the
out-patient Division of Investigation and Treatment of Headaches (DITH) of the
Universidade Federal de São Paulo (Unifesp), both genders,
aged between 18 and 50 years, all diagnosed with chronic migraine by the criteria of
“The International Classification of Headache Disorders (ICHD-II,
2004)”2626 . Headache Classification Subcomitte of the Internacional Headache
Society. The international classification of headache disorders. Cephalalgia.
2004;24(Suppl s1):36-9. http://dx.doi.org/10.1111/j.1468-2982.2003.00824.x
https://doi.org/10.1111/j.1468-2982.2003...
, were included
in the studies.
Inclusion criteria: patients diagnosed with chronic migraine, normal cardiac and neurological examination, who had not been practicing exercise for at least 3 months.
Exclusion criteria: previous use in the last year of medication with action in the central nervous system, including migraine prophylactics, other systemic, neurological and psychiatric disorders, inability to understand verbal commands and to perform aerobic exercise, not treatment compliance during the study.
In neurological evaluation, patients with medication overuse were instructed to perform a washout of all analgesic medicines and an abortive therapy with naproxen sodium 550 mg maximum twice a week and non-pharmacological practices were oriented. In psychological evaluation, patients were instructed to fill out Beck Depression Inventory and Beck Anxiety Inventory. After neurological and psychological evaluation patients were simple randomized, using computer-generated random numbers, in two groups:
-
Amitriptyline alone: patients using amitriptyline (25 mg/day);
-
Amitriptyline and aerobic exercise: patients using amitriptyline (25 mg/day) combined with aerobic exercise.
In the aerobic exercise program patients were instructed to perform a 40 minutes fast walk outdoors with a frequency of 3 times/week for 12 consecutive weeks2727 . American College of Sports and Medicine. ACM's Guideline for exercise testing and prescription. 7th ed. Baltimore: Lippincott Willians and Wilkins; 2006. and daily, fill out a headache questionnaire. All patients received written instructions and performed a training session with physiotherapist.
Instruments used in the amitriptyline group and aerobic exercise: headache questionnaire, explanatory leaflet about the warm-up exercises, spreadsheet with hours of exercise performance, Borg scale2828 . Borg GVA, Noble BJ. Perceived exertion. In: JN Wilmore, editor. Exercise and sport sciences reviews. New York: Academic Press; 1974. and measurement of heart rate on the initial and final walk.
Instruments used in the amitriptyline group alone: headache questionnaire.
The following parameters were evaluated: headache frequency (days/month), headache intensity 1 (mild), 2 (moderate) and 3 (disabling), duration/day of headache (6h, 12h, 18h e 24h), analgesic medication use (days/month), body mass index, Beck Depression Inventory and Beck Anxiety Inventory at baseline and in the end of the 3rd month. Also the patients were weekly assessed by telephone calls and informed the study authors about the evolution of proposed therapies.
The study was submitted and approved by the local Ethic Committee in Research, and all participants signed an informed consent form, but they were able to leave the study anytime and for any reason.
Statistical analysis
For statistical analysis, Student's t-test was used. The significance level was p≤0.05. The Minitab was Statistical Software utilized.
Results
Sixty patients were randomized for the study, 30 in amitriptyline alone group and 30 amitriptyline and aerobic exercise group.
In amitriptyline alone group 4 withdrew from the study for not using the medication correctly or not could tolerate the medication side effects (drowsiness and dry mouth) and in amitriptyline and aerobic exercise group 6 withdrew for non-adherence to proposed physical treatment.
The comparison of mean age, gender, and onset time of migraine between the groups were shown in Table 1.
Patients in amitriptyline alone (n=30) and amitriptyline and aerobic exercise group (n=30) according to the average age, gender and average onset migraine.
Fifty patients reached the end of study. In the evaluated parameters, was observed decrease in headache frequency (p=0.001), duration of headache attacks (p=0.001) intensity moderate (p=0.048), the body mass index (p=0.006), Beck Depression Inventory (p=0.001) and Beck Anxiety Inventory scores (p=0.001) between the groups amitriptyline alone (n=26) and amitriptyline and aerobic exercise group (n=24), as summarized on Table 2.
Results of headache frequency (days/month), duration and intensity of headache attacks (attacks/month), use of analgesic medication (days/month), body mass index (BMI), Beck Depression Inventory (BDI) and Beck Anxiety Inventory (BAI) scores at baseline and the end of the 3rd month in amitriptyline alone (n=26) and amitriptyline and aerobic exercise group (n=24).
Discussion
This study showed that the combination of a prophylactic drug therapy amitriptyline with a non-pharmacological treatment aerobic exercise was effective as a preventive therapy as compared with amitriptyline alone.
There is no consensus in the literature about how patients with chronic migraine
should be instructed to perform aerobic exercise1919 . Donna-Marie C, Lockett MA, Campbell JF. The effects of aerobic
exercise on migraine. Headache. 1992;32(1):50-4.
http://dx.doi.org/10.1111/j.1526-4610.1992.hed3201050.x
https://doi.org/10.1111/j.1526-4610.1992...
, so the parameters of intensity, frequency and
duration of exercise were based on the parameters used for the healthy
population2727 . American College of Sports and Medicine. ACM's Guideline for
exercise testing and prescription. 7th ed. Baltimore: Lippincott Willians and
Wilkins; 2006..
The regular practice of aerobic exercise seems to benefit patients with migraine1717 . Narin SO, Pinar L, Erbas D, Oztürk V, Idman F. The effects of
exercise and exercise-related changes in blood nitric oxide level on migraine
headache. Clin Rehabil. 2003;17(6):624-30.
http://dx.doi.org/10.1191/0269215503cr657oa
https://doi.org/10.1191/0269215503cr657o...
,1818 . Köseoglu E, Akboyraz A, Soyuer A, Ersoy AO. Aerobic exercise
and plasma beta endorphin levels in patients with migrainous headache without
aura. Cephalalgia. 2003;23(10):972-6.
http://dx.doi.org/10.1046/j.1468-2982.2003.00624.x
https://doi.org/10.1046/j.1468-2982.2003...
,1919 . Donna-Marie C, Lockett MA, Campbell JF. The effects of aerobic
exercise on migraine. Headache. 1992;32(1):50-4.
http://dx.doi.org/10.1111/j.1526-4610.1992.hed3201050.x
https://doi.org/10.1111/j.1526-4610.1992...
,2020 . Varkey E, Sider A, Carlsson J, Linde M. A study to evaluate the
feasibility of an aerobic exercise program in patients with migraine. Headache.
2009;49(4):563-70.
http://dx.doi.org/10.1111/j.1526-4610.2008.01231.x
https://doi.org/10.1111/j.1526-4610.2008...
,2121 . Busch V, Gaul C. Exercise in migraine therapy: is there any
evidence for efficacy? A critical review. Headache. 2008;48(6):890-9.
http://dx.doi.org/10.1111/j.1526-4610.2007.01045.x
https://doi.org/10.1111/j.1526-4610.2007...
,2222 . Domingues RB, Teixeira AL, Domingues SA. Physical practice is
associated with functional disability in medical students with migraine. Arq
Neuropsiquiatr. 2011;69(1):39-43.
http://dx.doi.org/10.1590/s0004-282x2011000100009
https://doi.org/10.1590/s0004-282x201100...
,2323 . Darabaneanu S, Overath CH, Rubin D, Luthje S, Sye W, Niederberger
U et al. Aerobic exercise as a therapy option for migraine: a pilot study. Int J
Sports Med. 2011;32(6):455-560.
http://dx.doi.org/10.1055/s-0030-1269928
https://doi.org/10.1055/s-0030-1269928...
,2424 . Dittrich SM, Gunther V, Franz G, Burtscher M, Holzner B, Kopp M.
Aerobic exercise with relaxation: influence on pain and psychological well-being
in female migraine patients. Clin J Sport Med. 2008;18(4):363-5.
http://dx.doi.org/10.1097/JSM.0b013e31817efac9
https://doi.org/10.1097/JSM.0b013e31817e...
. These benefits could be related to increased
production of beta-endorphins1818 . Köseoglu E, Akboyraz A, Soyuer A, Ersoy AO. Aerobic exercise
and plasma beta endorphin levels in patients with migrainous headache without
aura. Cephalalgia. 2003;23(10):972-6.
http://dx.doi.org/10.1046/j.1468-2982.2003.00624.x
https://doi.org/10.1046/j.1468-2982.2003...
or
changes in levels of nitric oxide during aerobic exercise1717 . Narin SO, Pinar L, Erbas D, Oztürk V, Idman F. The effects of
exercise and exercise-related changes in blood nitric oxide level on migraine
headache. Clin Rehabil. 2003;17(6):624-30.
http://dx.doi.org/10.1191/0269215503cr657oa
https://doi.org/10.1191/0269215503cr657o...
. Controlled studies are needed to define the
optimal frequency and intensity of exercise2020 . Varkey E, Sider A, Carlsson J, Linde M. A study to evaluate the
feasibility of an aerobic exercise program in patients with migraine. Headache.
2009;49(4):563-70.
http://dx.doi.org/10.1111/j.1526-4610.2008.01231.x
https://doi.org/10.1111/j.1526-4610.2008...
.
Studies showed difference in pain intensity between groups1919 . Donna-Marie C, Lockett MA, Campbell JF. The effects of aerobic
exercise on migraine. Headache. 1992;32(1):50-4.
http://dx.doi.org/10.1111/j.1526-4610.1992.hed3201050.x
https://doi.org/10.1111/j.1526-4610.1992...
,2424 . Dittrich SM, Gunther V, Franz G, Burtscher M, Holzner B, Kopp M.
Aerobic exercise with relaxation: influence on pain and psychological well-being
in female migraine patients. Clin J Sport Med. 2008;18(4):363-5.
http://dx.doi.org/10.1097/JSM.0b013e31817efac9
https://doi.org/10.1097/JSM.0b013e31817e...
and this study also showed a significant reduction in
these evaluated groups.
Despite of findings of decreased intensity, duration and frequency of headache in
physically active people, there are few studies about the real influence of exercise
in patients with headache2121 . Busch V, Gaul C. Exercise in migraine therapy: is there any
evidence for efficacy? A critical review. Headache. 2008;48(6):890-9.
http://dx.doi.org/10.1111/j.1526-4610.2007.01045.x
https://doi.org/10.1111/j.1526-4610.2007...
.
Many patients with chronic migraine report that exercise exacerbates their
headaches2020 . Varkey E, Sider A, Carlsson J, Linde M. A study to evaluate the
feasibility of an aerobic exercise program in patients with migraine. Headache.
2009;49(4):563-70.
http://dx.doi.org/10.1111/j.1526-4610.2008.01231.x
https://doi.org/10.1111/j.1526-4610.2008...
. However, in this
study was not observed worsening of headache in chronic migraine patients.
Obesity is a risk factor to migraine chronicity2929 . Bigal ME, Lipton RB, Holland PR, Goadsby PJ. Obesity, migraine,
and chronic migraine: possible mechanisms of interaction. Neurology.
2007;68(21):1851-61.
http://dx.doi.org/10.1212/01.wnl.0000262045.11646.b1
https://doi.org/10.1212/01.wnl.000026204...
. Despite the weight gain, the amitriptyline group
alone had a reduced frequency of headache attacks. The combination of amitriptyline
and aerobic exercise resulted in no increase in body mass index, therefore, in
addition to resulting in greater efficacy of headache prevention, exercise can also
prevent the adverse effect of weight gain associated with the use of
amitriptyline.
This study had some limitations such as the small samples of patients evaluated, the
aerobic exercise have been done by patients without supervision. However other
studies without supervision and with the exercises performed at home led to similar
results1818 . Köseoglu E, Akboyraz A, Soyuer A, Ersoy AO. Aerobic exercise
and plasma beta endorphin levels in patients with migrainous headache without
aura. Cephalalgia. 2003;23(10):972-6.
http://dx.doi.org/10.1046/j.1468-2982.2003.00624.x
https://doi.org/10.1046/j.1468-2982.2003...
,1919 . Donna-Marie C, Lockett MA, Campbell JF. The effects of aerobic
exercise on migraine. Headache. 1992;32(1):50-4.
http://dx.doi.org/10.1111/j.1526-4610.1992.hed3201050.x
https://doi.org/10.1111/j.1526-4610.1992...
,2020 . Varkey E, Sider A, Carlsson J, Linde M. A study to evaluate the
feasibility of an aerobic exercise program in patients with migraine. Headache.
2009;49(4):563-70.
http://dx.doi.org/10.1111/j.1526-4610.2008.01231.x
https://doi.org/10.1111/j.1526-4610.2008...
,2121 . Busch V, Gaul C. Exercise in migraine therapy: is there any
evidence for efficacy? A critical review. Headache. 2008;48(6):890-9.
http://dx.doi.org/10.1111/j.1526-4610.2007.01045.x
https://doi.org/10.1111/j.1526-4610.2007...
.
In conclusion, the therapy with amitriptyline was effective as a prophylactic treatment for patients with chronic migraine, however the combination of amitriptyline and aerobic exercise resulted in an even greater reduction in the frequency, duration and intensity of headache, in body mass index, Beck Depression Inventory and Beck Anxiety Inventory scores.
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Publication Dates
-
Publication in this collection
Nov 2014
History
-
Received
17 Mar 2014 -
Reviewed
11 July 2014 -
Accepted
31 July 2014