Intentional Avoidance of Physical Activity

Dr. Samantha Farris (Rutgers University) & Dr. Dale Bond (The Miriam Hospital/Alpert Medical School of Brown University)

Scientific evidence supports the positive role of physical activity in the management of migraine. Results of clinical trials show that aerobic physical activity reduces the frequency and severity of migraine attacks. Despite these benefits, individuals with migraine have substantially lower levels of physical activity compared to individuals without migraine. Although reasons are not entirely clear, it is possible that lower levels of physical activity among individuals with migraine might be due in part to beliefs that physical activity could trigger and/or worsen attacks. However, research by our group and others suggested that these beliefs are accurate for only a small subset of individuals. That is, for the majority of individuals with migraine, it seems that exercise does not reliably trigger or worsen migraine attacks. Of concern, misperceptions about exercise contributing to migraine might lead some individuals to intentionally avoid physical activity which could result in more, not fewer, attacks.

Our research group was interested in understanding more about the intentional avoidance of physical activity. We posted an online survey through the Association of Migraine Disorders’ social media sites. A total of 100 women with migraine completed the survey. Given that little prior research has been conducted on this topic, we started by asking several basic questions.

1. How common is intentional avoidance of physical activity, and how often does it occur, among individuals with migraine? Overall, the vast majority (78%) of women reported avoiding physical activity to manage migraine attacks in the past month. Additionally, avoidance occurred regularly, on an average of 4 days in a typical week. These findings suggest that physical activity avoidance is commonly used as a migraine management strategy.

2.  Is there a relationship between intentional avoidance of physical activity and migraine headache frequency? Women who reported intentional avoidance of physical activity had twice as many migraine attacks in the past month compared to women who did not report physical activity avoidance.

3. Is there a relationship between intentional avoidance of physical activity and the frequency and amount of physical activity performed?  More frequent avoidance of physical activity (especially vigorous-intensity activity) was associated with performing physical activity on significantly fewer days/week and for fewer minutes/day.

4. Why do individuals with migraine avoid physical activity? We asked women to estimate the likelihood that physical activity would trigger a migraine attack or worsen an existing migraine. Overall, women on average reported that there was a 51% to 61% likelihood that moderate-intensity and vigorous-intensity physical activity would trigger a migraine attack. They felt even more strongly regarding the potential that physical activity would exacerbate a migraine attack, reporting a 75% to 84% likelihood that moderate-intensity and vigorous-intensity physical activity would worsen migraine pain. Finally, women who intentionally avoided physical activity held significantly stronger beliefs about physical activity as a triggering or worsening factor for migraine, compared to women who did not intentionally avoid physical activity.

The findings from this study illustrate an interesting paradox: on the one hand, physical activity can reduce migraine burden; yet, individuals with migraine commonly report avoidance of physical activity as a strategy to manage migraine, in part because of the belief that physical activity will lead to and/or negatively impact migraine attacks. Misperceptions regarding the negative role of physical activity in migraine management may be reinforced in part by common recommendations to avoid factors that might trigger or worsen migraine. However, avoidance is an inadequate strategy for management of migraine. Avoidance of physical activity could paradoxically decrease one’s tolerance for pain, which would make it more likely that physical activity could actually trigger or worsen pain in the future.

It is important to note that we did not directly measure physical activity behavior in this study, and instead relied on women’s report of their activity levels which may be less accurate. However, these initial findings suggest that it may be important to help individuals with migraine understand the potentially positive role of physical activity in the management of migraine, and teach ways to gradually increase their confidence and comfort.

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Citation for this research

Farris, S. G., Thomas, J. G., Abrantes, A. M., Godley, F. A., Roth, J. L., Lipton, R. B., Pavlovic, J., & Bond, D. S. (2018). Intentional avoidance of physical activity in women with migraine. Cephalalgia Reports, 1, 1–8. doi: 10.1177/2515816318788284

Link to the complete research report: https://journals.sagepub.com/doi/pdf/10.1177/2515816318788284

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