While all exercise intervention protocols exhibited superior effectiveness than placebo groups at lowering the migraine frequency, strength/resistance training displayed the highest effectiveness. This was followed by high-intensity and moderate-intensity aerobic exercises, as deciphered from a study published in "The Journal of Headache and Pain". Yohannes W. Woldeamanuel et al. aimed to ascertain if exercise programmes are effective in lowering the monthly migraine frequency.

Numerous clinical studies employing various exercise routines have shown effectiveness in the treatment of migraine. However, there isn't a direct comparison between exercise programmes. Therefore, researchers sought to compare aerobic exercise vs strength training for migraine management.

Search engines including Scopus, PubMed, and Web of Science were explored. Protocols for both aerobic and strength/resistance training were present. The outcome measure was the mean difference (MD) in monthly migraine frequency between the active and control groups from baseline to the end of treatment. A random effects model network meta-analysis was used to incorporate the effectiveness data from direct and indirect comparisons.

The effectiveness of the 3 exercise protocols—resistance/strength training, high-intensity aerobic exercise, and moderate-intensity aerobic exercise—was compared. Studies comparing the effectiveness of exercise and migraine medicines (Amitriptyline, Topiramate) were incorporated. Additionally, the Cochrane Risk of Bias version 2 (RoB2) was used to evaluate the risk of bias in all incorporated studies.

With a female-to-male ratio of 6.7 and a mean age of 35 years, there were a total of 1195 participants in 21 published clinical studies. There were 8 indirect comparisons in addition to the 27 pairwise comparisons. The interventions ranking were as follows: Strength training (MD = -3.55), high-intensity aerobic activity (-3.13), moderate-intensity aerobic exercise (-2.18), Topiramate (-0.98), placebo, and Amitriptyline (3.82).

As found, 85% of the incorporated papers exhibited a low risk of bias, according to the RoB2 evaluation, whereas 15% showed an elevated risk of bias for the intention-to-treat assessment. The handling of missing outcome data and the procedure of randomization were sources of a high risk of bias. Thus, exercise regimens were promising in lowering the monthly migraine frequency.