Sport and migraine-a dynamic relationship

Migraine is the most common primary headache, characterized by a high life and socio-economic burden of disease, with a complex and intriguing pathophysiology: changes in cortical excitability, neurovascular inflammation and endothelial dysfunction, the last linking migraine to cardiovascular risk and comorbidities. Moderate endurance exercise is recommended in prevention of cardiovascular disease, improving cardiorespiratory and muscular fitness, mood and cognitive functions too. Multiple levels of evidence support a role of aerobic exercise in migraine prevention and treatment: exertion reduces pain intensity, frequency, duration of attacks, and medication use; moreover, lower cardiovascular fitness levels increase the lifetime risk of developing migraine. Different biochemical mediators are involved both in physical exertion and in migraine, as serotonin, acetylcholine, and endogenous opioids, playing a crucial role in pain-modulation and inhibition pathways, leading to analgesia. Despite many positive effects, exercise could be harmful, due to predisposing factors as the disfunction of the exercise-induced analgesia, together with other exercise-related factors (short warm up, incorrect rest phases, excessive training) and common migraine triggers. Furthermore, primary exercise headache and other sport headaches, often migraine-like, have been accurately described. In conclusion, aerobic exercise can be a useful tool for migraine therapy; otherwise, exceeding in exercise could lead to a harmful effect with a worsening of pain perception, sometimes acting as a trigger for migraine or migraine-like headaches. Additional studies are needed to better understand the most suitable way of performing exercise, to increase patients' compliance and to gain the maximum beneficial effect.