Cervical strengthening exercises linked to modest migraine disability improvement

Meta-analysis found a moderate, statistically significant improvement in migraine-related disability (standardized mean difference [SMD]=0.69; 95% confidence interval [CI], 0.19–1.18), but effects on headache frequency (SMD=0.61; 95% CI, −0.25–1.47) and headache intensity (SMD=0.41; 95% CI, −0.35–1.18) were not statistically significant. Observational studies reported within-group improvements, though intervention durations, supervision levels, and comparison groups varied substantially across studies. The authors graded the evidence as very low to low certainty, limited by risk of bias, heterogeneity in methods, and small sample sizes. They emphasize that current findings are insufficient to establish clear benefit for migraine prevention outcomes.

The disability improvement signal (SMD=0.69) is meaningful but comes from studies with high heterogeneity (I²=70.7%), suggesting substantial variation in how well interventions worked across populations and methods. The lack of significance for headache frequency and intensity is notable because these are often the primary outcomes patients and clinicians care about—the disability metric captures functional capacity, coping ability, or quality-of-life burden rather than direct pain reduction. The review included three conference abstracts (unpublished data) and one case report, both of which are lower-evidence sources; the five RCTs provide the most reliable signal, yet even these differed in exercise type, duration (ranging across studies), supervision (supervised vs. home-based), and control conditions. The 95% confidence intervals for headache frequency and intensity cross zero, meaning the true effect could be null or even harmful. Neck pain was a common co-presentation in these studies, but the review did not isolate whether cervical exercises help specifically in migraine with cervicalgia versus migraine alone.