Physical activity in migraine: Identifying an engagement threshold and patient clusters in a population-based cohort

Background Physical activity (PA) has been associated with reduced migraine burden, but patients with frequent or comorbid migraine often report difficulty sustaining regular activity. We examined the association between minimal PA and migraine-related outcomes, and explored whether a disease burden threshold limits PA engagement. Methods We analyzed data from 550 participants with migraine in the Negev Migraine Cohort in southern Israel who completed a questionnaire assessing PA (≥2 h/week), migraine-related disability (MIDAS), depressive symptoms (DASS-21), and psychosocial functioning. Between-group comparisons and multivariable linear regression models were conducted to assess the independent associations of PA with key outcomes, adjusting for demographic characteristics. We also explored the probability of engaging in PA by migraine frequency, and conducted unsupervised clustering based on migraine days, depressive symptoms, and PA status to identify patient profiles. Results Physically active participants (46%) reported significantly fewer migraine days per month (median 3.0 vs. 5.0), lower use of triptans per month (mean 2.6 vs. 4.1 pills), and reduced migraine-related disability (median MIDAS score 26.0 vs. 36.0). They also reported fewer days of presenteeism per month (median 3.5 vs. 5.0). In addition, they experienced less impairment in overall life satisfaction (mean 4.49 vs. 5.14). In fully adjusted models, PA remained independently associated with reduced disability (β = −0.14, 95% CI −0.28 to −0.1) and improved life satisfaction (β = −0.46, 95% CI −0.9 to −0.1). Probability modeling showed that individuals with more than three migraine days per month had less than 50% likelihood of meeting PA targets. Clustering analysis identified three subgroups: a high-burden and low-activity group, an intermediate group, and an active and well-functioning group. Conclusions Minimal PA was associated with lower migraine-related disability and better life satisfaction. The identification of an activity engagement threshold and distinct patient clusters suggests a staged care model where pharmacologic stabilization enables PA, which may itself serve as a marker of recovery.