Prophylactic Effect Of Aerobic Exercise Combined With Topiramate On Migraine

Background:Efficacious prophylaxis against migraine can lower attack frequency,reduce migraine-related disability,and improve the quality of patients’ life.Currently,the preventive treatment against migraine mostly relied on medications,which lead to inevitable adverse effects and economic burden as well.Clinical trials have verified that aerobic exercise was effective against migraine.In general,headache frequency,headache intensity and duration were improved by regular aerobic exercise.Possible underlying mechanisms included β-endorphine,endocannabinoid,neuroinflmmation,etc,which need further investigation.Present studies mainly concentrate on the prophylactic effect of aerobic exercise alone,rather than its synergistic effect with medications.Object:Using topiramate as control,to investigate the prophylactic effect of aerobic exercise combined with topiramate on migraine.Methods:Patients diagnosed as migraine were randomized into two groups:topiramate(TPM,n=34)or aerobic exercise combined with topiramate(AE+TPM,n=33).General information,baseline headache indexes,International Physical Activity Questionnaire(IPAQ)scores,Headache Impact Test-6(HIT-6)scores,The Migraine Disability Assessment questionnaire(MIDAS)scores,Patient Health Questionnaire-9(PHQ-9)scores,Generalized Anxiety Disroder-7(GAD-7)scores were collected before treatment.Patients were asked to keep headache diaries during the treatment period of three months.HIT-6 scores,MIDAS scores,PHQ-9 scores,GAD-7 scores were collected again at the end of the third month.Headache indexes at the third month were also collected.Then the extent of improvement of headache indexes and scores of the questionnaires were compared between the two groups.Results:The reduction of attack numbers and headache days per month of AE+TPM group is greater than TPM group(P<0.05).No significant difference was found between two groups regarding to the improvement of headache intensity and duration(P>0.05).No significant difference was observed between two groups in the improvement of HIT-6 scores(P>0.05).A reduction of PHQ-9 scores was found in AE+TPM group after treatment(P<0.05),while TPM group didn’t show significant improvement(P>0.05).No significant improvement of MIDAS scores and GAD-7 scores was observed after treatment in both groups(P>0.05).The response rate(more than 50%improvement of migraine attack numbers per month)were 67.9%for TPM group and 88.9%for AE+TPM group,respectively,and no significant difference between the two groups was found(P>0.05).Using logistic binary regression analysis to compare the difference of baseline characters between responders and non-responders,no significant difference was found(P>0.05).The drop-out rates of TPM group and AE+TPM group were 17.6%and 18.1%,respectively(P>0.05).Reasons for discontinuation of medication included intolerance to adverse effects,choosing other therapies and forgetting to take medicine.Reasons for stopping exercise included lack of motivation and time.Conclusion:Aerobic exercise can improve the prophylactic effect of topiramate on migraine,further lowering the attack frequency and has a potential role in improving depression of migrainuers.