Physical Activity Linked With Less Analgesic Use Among Women With Headache Disorders

Results of a cross-sectional study conducted in Germany found both sex-unspecific and sex-specific factors associated with analgesic use among men and women with headache disorders, including migraine and tension-type headache (TTH). Findings were published in Pain and Therapy.

Based on the results, the authors concluded promoting physical activity may reduce analgesic use among women with headache disorders, while education about the therapeutic effects of physical activity for headache may be an important resource for men.

Previous research has indicated aerobic exercise may reduce the number of migraine days among migraineurs, although studies on attack duration and pain intensity have yielded inconclusive results. Furthermore, some studies have suggested exercise serves as a potential trigger for migraine attacks.

“For TTH, findings rather suggest positive effects of strength training on headache days as opposed to aerobic workouts,” the authors wrote.

When it comes to the effects of exercise on acute headache medication use, data are scarce, despite the fact migraine and medication overuse headache (MOH) are associated with high acute treatment costs.

To address this knowledge gap, the researchers analyzed data from a random German population sample, consisting of participants between the ages of 14 and 94. Of the 4838 individuals identified, 2477 were included and completed a cross-sectional questionnaire survey. Physical activity was defined as “on average at least 2-3 times a week for 30 min or longer.”

In total, 39% of participants reported headache during the previous 6 months, with women reporting the condition more often than men. “Of the participants without headache, 42.6% were physically active, while the proportion of physically active persons among those with headache was 35.1%,” the authors wrote.

Analyses revealed:

• Of those with headache, 37.5% of men and 33.6% of women were physically active
• Of the participants with headache, 43.3% reported taking analgesics on fewer than 2 days a month; 40.7%, 2 to 5 days a month; 10.1%, 6 to 10 days a month; and 5.9%, more than 10 days a month
• Frequent headache, severe impact of headache on daily life, and depressive symptoms were associated with higher analgesic use in both men and women
• For women, physical inactivity was associated with the frequency of analgesic use adjusted for sociodemographic and headache-related variables (headache frequency, impact)
• For men, results did not suggest any association between physical inactivity and frequency of analgesic use

The relationship between depression and analgesic use remains unclear, although previous research suggests, “Depression may lower the pain threshold and decrease the response to analgesics. Furthermore, people with depression may use analgesics to treat their emotional pain,” the researchers explained.

They also hypothesized the positive association between physical activity and less analgesic use among women could be due to the pain-reducing effect of physical activity.

Data showed men with headache are less physically active than men in the general population, while no differences were seen between women with headache and the general female population.

One reason women remain physically active despite headache could be “that women with headache are more likely than men with headache to use physical activity as nonpharmacological prophylaxis. This interpretation is supported by the results of previous studies that have shown sex-specific motives for physical activity,” with some evidence suggesting women tend to engage in sports when they feel responsible for their own health.

It is also possible results are due to specific mechanisms of pain processing in men and women.

In the current sample, men reported lower headache frequency and headache-related impairment than women, marking a limitation. No data on analgesic type or dosage were available, while the study’s cross-sectional nature precluded any causal conclusions.

“Our study shows meaningful associations of physical activity and reduced analgesic use in women, further supporting the important role of exercising regularly in headache disorders,” the researchers wrote.

“The relationships are complex and embedded in a multifactorial set of conditions; future experimental research and clinical trials are needed to elucidate these aspects further,” they concluded.

Reference:

Müller B, Gaul C, Glass Ä, et al. Physical activity is associated with less analgesic use in women reporting headache—a cross-sectional study of the German migraine and headache society (DMKG). Pain Ther. Published online February 25, 2022. doi:10.1007/s40122-022-00362-4