Therapeutic Exercise Parameters, Considerations, and Recommendations for Migraine Treatment: An International Delphi Study

Álvaro Reina-Varona, Beatriz Madroñero-Miguel, Charly Gaul, Toby Hall, Arão B. Oliveira, Dale S. Bond, César Fernández De las Peñas, Lidiane L. Florencio, Gabriela F. Carvalho, Kerstin Luedtke, Emma Varkey, Lotte S. Krøll, Debora Bevilaqua-Grossi, Ravikiran Kisan, Roy La Touche*, Alba Paris-Alemany

*Corresponding author for this work


Objective. The goal of this study was to reach consensus about the best exercise prescription parameters, the most relevant considerations, and other recommendations that could be useful for prescribing exercise to patients with migraine. Methods. This was an international study conducted between April 9, 2022 and June 30, 2022. An expert panel of health care and exercise professionals was assembled, and a 3-round Delphi survey was performed. Consensus was reached for each item if an Aiken V Validity Index ≥ 0.7 was obtained. Results. The study included 14 experts who reached consensus on 42 items by the third round. The most approved prescription parameters were 30 to 60 minutes of exercise per session, 3 days per week of moderate-intensity continuous aerobic exercise, and relaxation and breathing exercises for 5 to 20 minutes every day. When considering an exercise prescription, initial exercise supervision should progress to patient self-regulation; catastrophizing, fear-avoidance beliefs, headache-related disability, anxiety, depression, physical activity baseline level, and self-efficacy could influence the patients’ exercise participation and efficacy; and gradual exposure to exercise could help improve these psychological variables and increase exercise efficacy. Yoga and concurrent exercise were also included as recommended interventions. Conclusion. From the experts in the study, exercise prescriptions should be adapted to patients with migraine considering different exercise modalities, such as moderate-intensity aerobic exercise, relaxation, yoga, and concurrent exercise, based on the patients’ preferences and psychological considerations, level of physical activity, and possible adverse effects. Impact. The consensus reached by the experts can help prescribe exercise accurately to patients with migraine. Offering various exercise modalities can improve exercise participation in this population. The evaluation of the patients’ psychological and physical status can also facilitate the adaptation of the exercise prescription to their abilities and diminish the risk of adverse events.

Original languageEnglish
Article numberpzad080
JournalPhysical Therapy
Issue number10
Publication statusPublished - 01.10.2023

Research Areas and Centers

  • Health Sciences

DFG Research Classification Scheme

  • 205-02 Public Health, Health Services Research and Social Medicine

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