The role of physical exercise in modulating migraine pathophysiology from mechanisms triggering attacks to adaptive regulation of nociceptive responses

Abstract

Background
Migraine is a chronic neurovascular disorder characterized by recurrent headache attacks accompanied by sensory, autonomic, and neuroinflammatory symptoms. Physical exercise has a dual role in migraine, acting both as a trigger and as a non-pharmacological therapeutic intervention.

Materials and methods
A narrative literature review was conducted using PubMed, Scopus, Cochrane Library          and Google Scholar. Studies were selected according to their relevance to migraine               and physical exercise.

State of knowledge
Acute high-intensity exercise may trigger migraine through increased cortical excitability, metabolic stress, and activation of the trigeminovascular system. In contrast, regular exercise may reduce neuroinflammation, improve mitochondrial function, enhance endogenous pain inhibition, and regulate autonomic balance. These adaptations are associated with lower migraine frequency, duration, and intensity and may involve modulation of calcitonin gene-related peptide, serotonergic pathways, endorphin release, and central sensitization.

Conclusions
Regular, individualized physical exercise represents an effective non-pharmacological strategy for migraine prevention. Its benefits depend on exercise type, intensity                       and individual patient characteristics. Understanding the mechanisms underlying both             the triggering and protective effects of exercise may support personalized migraine management.