Conference Coverage

Lifestyle Regularity May Help Quell Migraine


 

References

VALENCIA, SPAIN—Following a schedule of regular daily mealtimes, bedtimes, and aerobic exercise is an effective yet underused approach for the management of migraine, said Yohannes W. Woldeamanuel, MD, at the 17th Congress of the International Headache Society.

Yohannes W. Woldeamanuel, MD

“We call these three [items] the RLB [regular lifestyle behavior] triumvirate: daily regular sleep times, mealtime hours, and aerobic exercise. This [approach] is something physicians should be advocating ... it provides the patient with a tool to help control his or her own migraine problems. Along with avoidance of daily headache medications, it has added value for clinical practice,” according to Dr. Woldeamanuel, a neurologist and a fellow in the Stanford University Headache and Facial Pain Program in California.

He presented a retrospective study of 100 patients with chronic migraine age 15 and older and 100 age- and gender-matched patients with episodic migraine treated at the headache center. Collectively, the patients with chronic migraine had an average of 2,497 migraine attacks per month, while the episodic migraine group had an average of 578 attacks per month.

Although all patients with migraine seen at the Stanford center are encouraged to pursue RLB, 6% of the chronic migraine group did so regularly, compared with a 10-fold higher rate among those with episodic migraine. The investigators also observed that 9% of patients who adopted RLB had chronic migraine, compared with 70% of those who did not adopt RLB.

An observational study such as this one cannot establish causality. But the data did provide evidence suggestive of a cause-and-effect relationship with regard to RLB, said Dr. Woldeamanuel.

“Among the small cohort of chronic migraineurs who were following RLB, they were progressively month after month converting into episodic migraineurs, while the episodic migraineurs who were not following the RLB were converting to chronic migraine month after month,” he said.

Patients with chronic migraine take headache medications on most days of the month, thus raising the possibility that medication use might be a study confounder. To investigate that possibility, Dr. Woldeamanuel stratified patients who adhered to RLB into a group of those who regularly used rescue or preventive medications and a group of those who did not do so. The two subgroups did not differ significantly in terms of the prevalence of chronic migraine.

“This [finding] supports the genuine impact of RLB as a migraine-management modality. It’s therapeutic,” said Dr. Woldeamanuel. “We have biological rhythms that maintain our health: ultradian, circadian, diurnal, and infradian. RLB promotes the release of endorphins and keeps levels stable, [thus] increasing the threshold for sensory change and peripheral pain,” he explained.

Bruce Jancin

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