Purpose of review: This review intends to characterize the recent literature pertaining to the role of aerobic exercise in the prevention of migraine. Areas of consensus within that literature may be used to guide clinical practice, allowing for the promulgation of evidence-based practice recommendations.

Recent findings: The past decade has seen the publication of numerous high-quality studies that explore aspects of exercise's effects on migraine prevention, including its success as a stand-alone prevention strategy, as well as its non-inferiority to some pharmacologic preventive measures. Exercise often tops providers' lists of recommended lifestyle modifications that help reduce migraine burden. Biologically, exercise suppresses inflammatory modulators, including numerous cytokines, and stress hormones, like growth hormone and cortisol. Exercise has also been shown to affect microvascular health, which may be implicated in cortical spreading depression. Psychologically, there is evidence that exercise improves migraine self-efficacy and internalizes the locus of control, leading to reduced migraine burden. Randomized control trials have demonstrated that a sufficiently rigorous aerobic exercise regimen alone is sufficient to yield a statistically significant reduction in migraine frequency, intensity, and duration. Higher-intensity training appears to confer more benefit. Studies have also demonstrated non-inferiority of exercise compared with certain pharmacologic prophylactic interventions, like topiramate. However, the addition of exercise to a traditional preventive regimen may provide added benefit. Special populations, like those with comorbid neck pain or tension headache, may benefit from exercise; and patients who cannot tolerate high-impact exercise may even benefit from low-impact exercise like yoga. Therefore, exercise is a reasonable evidence-based recommendation for migraine prevention.