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. 2018 Oct;38(11):1707-1715.
doi: 10.1177/0333102417747231. Epub 2017 Dec 13.

Pain worsening with physical activity during migraine attacks in women with overweight/obesity: A prospective evaluation of frequency, consistency, and correlates

Samantha G Farris  1   2   3 , J Graham Thomas  1   4 , Ana M Abrantes  1   3 , Richard B Lipton  5   6 , Jelena Pavlovic  5   6 , Todd A Smitherman  7 , Megan B Irby  8 , Donald B Penzien  8 , Julie Roth  1   9 , Kevin C O'Leary  1   4 , Dale S Bond  1   4
Affiliations

Pain worsening with physical activity during migraine attacks in women with overweight/obesity: A prospective evaluation of frequency, consistency, and correlates

Samantha G Farris et al. Cephalalgia. 2018 Oct.

Abstract

Background Migraine is a neurological disease involving recurrent attacks of moderate-to-severe and disabling head pain. Worsening of pain with routine physical activity during attacks is a principal migraine symptom; however, the frequency, individual consistency, and correlates of this symptom are unknown. Given the potential of this symptom to undermine participation in daily physical activity, an effective migraine prevention strategy, further research is warranted. This study is the first to prospectively evaluate (a) frequency and individual consistency of physical activity-related pain worsening during migraine attacks, and (b) potential correlates, including other migraine symptoms, anthropometric characteristics, psychological symptoms, and daily physical activity. Methods Participants were women (n = 132) aged 18-50 years with neurologist-confirmed migraine and overweight/obesity seeking weight loss treatment in the Women's Health and Migraine trial. At baseline, participants used a smartphone diary to record migraine attack occurrence, severity, and symptoms for 28 days. Participants also completed questionnaires and 7 days of objective physical activity monitoring before and after diary completion, respectively. Patterning of the effect of physical activity on pain was summarized within-subject by calculating the proportion (%) of attacks in which physical activity worsened, improved, or had no effect on pain. Results Participants reported 5.5 ± 2.8 (mean ± standard deviation) migraine attacks over 28 days. The intraclass correlation (coefficient = 0.71) indicated high consistency in participants' reports of activity-related pain worsening or not. On average, activity worsened pain in 34.8 ± 35.6% of attacks, had no effect on pain in 61.8 ± 34.6% of attacks and improved pain in 3.4 ± 12.7% of attacks. Few participants (9.8%) reported activity-related pain worsening in all attacks. A higher percentage of attacks where physical activity worsened pain demonstrated small-sized correlations with more severe nausea, photophobia, phonophobia, and allodynia (r = 0.18 - 0.22, p < 0.05). Pain worsening due to physical activity was not related to psychological symptoms or total daily physical activity. Conclusions There is large variability in the effect of physical activity on pain during migraine attacks that can be accounted for by individual differences. For a minority of participants, physical activity consistently contributed to pain worsening. More frequent physical activity-related pain worsening was related to greater severity of other migraine symptoms and pain sensitivity, which supports the validity of this diagnostic feature. Study protocol ClinicalTrials.govIdentifier: NCT01197196.

Keywords: Migraine; ecological momentary assessment; exercise; physical activity; women.

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Conflict of interest statement

Declaration of conflicting interests

The authors declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: J Graham Thomas received research support from the National Institutes of Health (NIH) R42 DK103537 (principal investigator), R01 DK095779 (principal investigator), R41 HL114046 (principal investigator), R01 NS077925 (co-investigator), and Weight Watchers International Inc, and serves as a consultant to Applied VR, KetoThrive, and Weight Watchers International Inc. Ana M Abrantes received research support from the National Institutes of Health (NIH) R21 CA214102 (multiple principal investigator), R01 CA173551 (principal investigator, R01 NR014540 (co-investigator), R01 HL127695 (multiple principal investigator), R34 AA024295 (principal investigator), R21 DA041153 (multiple principal investigator), R21 DA041553 (multiple principal investigator), and R01 NR015977 (co-investigator). Jelena Pavlovic received consulting honoraria from Allergan Inc. Richard B Lipton received research support from the NIH (PO1 AG03949 (program director), P01AG027734 (project leader), RO1AG025119 (investigator), RO1AG022374–06A2 (investigator), RO1AG034119 (investigator), RO1AG12101 (investigator), the National Headache Foundation, and the Migraine Research Fund; serves on the editorial board of Neurology and as senior advisor to Headache; has reviewed for the National Institute on Aging (NIA) and National Institute of Neurological Disorders and Stroke (NINDS), holds stock options in eNeura Therapeutics, and serves as consultant, advisory board member, or has received honoraria from: Allergan, the American Headache Society, Autonomic Technologies, Boston Scientific, Colucid, Eli Lilly, Endo, eNeura Therapeutics, Novartis, and Teva. Todd A Smitherman serves as a consultant for Alder Biopharmaceuticals. Dale S Bond received research support from the NIH, R01 NS077925 (principal investigator), R01 DK108579 (multiple principal investigator), R01 DK112487 (co-investigator), R01 DK112585 (co-investigator), R03 DK114254 (co-investigator), travel support from the American Headache Society, and serves as a member of the Slimming World, Inc. Special U.S. advisor group. Samantha G Farris, Julie Roth, Megan A Irby, Donald B Penzien and Kevin O’Leary declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Histogram of within-subject reported proportion (percent) of attacks in which PA-related worsening occurred.
Figure 2.
Figure 2.
Frequency of worse, unchanged, and improved migraine from PA.
See this image and copyright information in PMC

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