The overall aims of this thesis were to investigate the effects of an aerobic exercise program and the impact of migraine and co-existing TTH and NP in persons with these combined conditions. This thesis is based on four studies.
In study I, a new questionnaire, Impact of Migraine, TTH and NP (Impact M-TTH-NP), was developed. This questionnaire covered pain, triggers, psychosocial,
socioeconomic and work related aspects. Face and content validity were
investigated together with five additional questionnaires; the International Physical Activity Questionnaire (IPAQ short form), Migraine-Specific Quality of Life
Questionnaire (MSQ v. 2.1), The World Health Organization five-item
Psychological Well-Being Index (WHO-5), Major Depression Inventory (MDI) and
Neck Disability Index (NDI). Face validity was assessed by group interviews of
nine persons with migraine and co-existing TTH and NP. Content validity was
assessed by the degree of relevance by 13 headache experts. Impact M-TTH-NP
showed acceptable face validity and excellent content validity. MSQ, WHO-5, MDI
and NDI showed acceptable face validity, and WHO-5, MDI and NDI showed excellent content validity.
In study II, the prevalence of co-existing TTH and NP in a clinical sample of persons with migraine was investigated. Also, we investigated level of physical activity, psychological well-being, perceived stress and self-rated health in persons with migraine and co-existing TTH and NP, their perceived ability to engage in physical activity and which among the three conditions (migraine, TTH or NP) was rated as the most burdensome condition. A survey of 148 persons with migraine and 100 healthy controls was conducted. The prevalence of co-existing TTH and NP in persons with migraine was 67%; this group had a low level of physical activity, low psychological well-being, high level of perceived stress and poor self-rated health compared to healthy controls. They reported reduced ability to engage in physical activity owing to migraine (high degree), TTH (moderate degree) and NP (low degree). The most burdensome condition was migraine, followed by TTH and NP.
In studies III and IV, the effect of a 12-week aerobic exercise program, with follow-up six months from baseline, in persons with migraine and co-existing TTH and NP was investigated in a prospective, open-label, randomized, clinical trial. Fifty-two persons (26 in exercise group and 26 in control group) completed the six-month study period. The exercise group showed a significant improvement in the ability to engage in daily activities because of reduced impact of migraine compared to controls. Migraine frequency, pain intensity and duration were significantly reduced in the exercise group compared to baseline, although not significant compared to the control group (Study III). The effect of the aerobic exercise program on pain perception was measured in Study IV. We did not identify any significant effect on muscle tenderness and pain thresholds. We concluded that aerobic exercise had positive effects on migraine severity and migraine burden, but these results could not be explained by the applied tests of muscle tenderness and pain thresholds. Thus, the positive effect on migraine burden may rather be explained by positive alteration of avoidance behaviour.