Superior Effects of High-Intensity Interval Training vs. Moderate Continuous Training on Arterial Stiffness in Episodic Migraine: A Randomized Controlled Trial
Question
Whether high-intensity interval treadmill training has superior effects to moderate continuous treadmill training on arterial stiffness, central blood pressure, physical fitness, and migraine days in patients with episodic migraine.
Summary
This randomized controlled trial tested supervised treadmill HIT, moderate continuous treadmill training, and a control group in adults with episodic migraine. HIT used four 4-minute intervals at 90-95% of maximal heart rate with 3-minute active recovery at 70% HRmax, twice weekly for 12 weeks. HIT reduced augmentation index corrected to 75 bpm and migraine days more than moderate training, while pulse wave velocity did not change; no adverse or serious adverse events were reported.
Methodology
- Adults with episodic migraine without aura, no regular exercise in prior 6 months, no cardiovascular disease or acute/chronic inflammatory disease.
- 48 participants.
- Treadmill running.
- Work intervals: 4 minutes at 90-95% HRmax.
- Recovery: 3 minutes active rest at 70% HRmax.
- Intensity: 90-95% HRmax during intervals; target generally reached after 1 minute.
- Main interval set approximately 25 minutes excluding 400 m warm-up, skipping exercises, 400 m cool-down, and stretching.
- 2 sessions per week.
- 12 weeks.
- Three-armed randomized controlled trial with 4-week run-in and 12-week intervention.
- AIx@75, Pulse wave velocity, Central systolic and diastolic blood pressure, and Migraine days per month were tracked.
Outcomes
AIx@75
HIT improved AIx@75 from 22.0 (9.7) to 14.9 (13.0), while MCT changed from 16.6 (8.5) to 21.3 (10.4) and CON from 17.9 (15.9) to 18.8 (12.5).
ANCOVA p=0.06, eta_p2=0.16; HIT vs MCT SMD -0.80 [90% CI -1.56, -0.03], 91% likely beneficial; HIT vs CON SMD -0.45 [90% CI -0.88, -0.02], 85% likely beneficial.
Central systolic blood pressure
HIT lowered central systolic blood pressure from 118.1 (23.4) to 109.8 (15.7) mmHg.
SMD 0.42; HIT vs CON 59% possibly beneficial.
Central diastolic blood pressure
MCT lowered central diastolic blood pressure from 77.8 (6.8) to 73.7 (6.6) mmHg.
SMD 0.61; MCT vs CON 60% possibly beneficial.
Pulse wave velocity
PWV showed no changes in any of the three groups.
ANCOVA p=0.79, eta_p2=0.01.
Migraine days
Migraine days were reduced more successfully by HIT than MCT; HIT changed from 3.8 (3.0) to 1.4 (1.2) days/month, MCT from 4.2 (2.2) to 3.1 (2.9), CON from 3.2 (2.4) to 2.0 (1.6).
ANCOVA p=0.13, eta_p2=0.13; HIT vs MCT SMD -0.54 [90% CI -0.95, -0.12], 92% likely beneficial.
VO2max and individual anaerobic threshold
HIT improved VO2max and IAT more than control and generally more than MCT.
VO2max ANCOVA p=0.13, eta_p2=0.12; HIT vs CON SMD 0.79 [90% CI 0.04, 1.54], 91% likely beneficial. IAT ANCOVA p=0.08, eta_p2=0.15; HIT vs CON SMD 1.07 [90% CI 0.52, 1.61], 99% very likely beneficial.
Adverse and serious adverse events
No adverse and serious adverse events were reported.
Insights
- A 4x4-minute treadmill HIT structure at 90-95% HRmax, twice weekly, is a reproducible protocol with measurable vascular and migraine outcomes in a screened clinical population.
- Warm-up, active recovery, cool-down, individualized HR targets, and supervision/monitoring are part of the protocol context and should not be stripped away in translation.
- For migraine-related content, HIT can be framed as a potential complementary strategy only for appropriately screened users, not as a universal replacement for medical care.
Limitations
- Pilot sample size was low.
- 23% dropout during 12 weeks.
- Healthier and physically fitter patients may have self-selected into the exercise trial.
- Baseline differences in migraine days, AIx, and AIx@75 remained a concern despite adjustment.
- No long-term post-intervention follow-up.
- Magnitude-based inference was used for practical-benefit probabilities; several conventional p-values did not reach P <0.05.
Safety
- No adverse and serious adverse events were reported.
- 11 of 48 patients dropped out due to injury, lack of motivation, or personal reasons; injury details and group allocation were not reported.
- Participants were screened with PAR-Q and exercise test, and training was supervised with heart-rate monitoring.