INTRODUCTION:

Migraine is the most common neurological disorder affecting around 15% of the European population.¹ It is a cyclic disorder characterized by recurrent attacks of headache accompanied by nausea, photo-and phonophobia. Usually the headache is aggravated by physical activity.² In some patients, attacks are accompanied by an aura with focal neurological symptoms.³ Moreover, migraine is a disabling condition causing absenteeism from work and social life and large monetary losses in society.⁴

Furthermore, it is a risk factor for cardiovascular diseases.⁵Although physicians possess several pharmacological options to treat migraine attacks,⁶ these drugs are often not effective for the individual patient, and they may have side effects. In addition, lack of adherence is a phenomenon often observed among patients who are prescribed prophylactic drugs.⁷ Thus, there is an unmet need for evidence-based non-pharmacological approaches to complement pharmacotherapy in migraine prevention. Exercise can be used for management of several chronic pain conditions.⁸ Interestingly, this includes conditions comorbid with migraine such as depression, anxiety and sleep disturbances.⁹ Moreover, exercise has been shown to improve self-esteem which is also associated with alleviating symptoms of migraine.¹⁰

This body of literature addressing exercise and depression also may be particularly helpful for elucidating potential mechanisms linking exercise and migraine improvement, as the anti-depressive effect of exercise may well be conferred through similar biological and psychological mechanisms, and certain antidepressant medications have shown success in reducing migraine frequency and severity.^11,12 Studies thus far have shown that the therapeutic effect of aerobic activity on depression may be mediated through enhanced endorphin levels and neurotransmitter function,¹³ improved hormone regulation,¹⁴ decreased inflammation,¹⁴ and, like antidepressants, increased serotonergic activation and neurogenesis.¹⁵ Improvements in self-efficacy and self-esteem also are associated with improvements in symptoms of both depression and migraine.¹⁶ As it pertains to migraine, the progress documented over the last three decades in the exercise and depression literature provides an excellent model for determining effective guidelines for exercise as a migraine therapy.¹⁷

In addition to decreased feelings of pain, secretion of endorphins leads to feelings of euphoria, modulation of appetite, release of sex hormones, and enhancement of the immune response. With high endorphin levels, we feel less pain and fewer negative effects of stress.¹⁸ Endorphins have been suggested as modulators of the so-called "runner's high" that athletes achieve with prolonged exercise. While the role of endorphins and other compounds as potential triggers of this euphoric response has been debated extensively by doctors and scientists, it is at least known that the body does produce endorphins in response to prolonged, continuous exercise.¹⁹

Even if you don't participate in strenuous athletics, you can also try various activities to increase your body's endorphin levels. Studies of acupuncture and massage therapy have shown that both of these techniques can stimulate endorphin secretion.²⁰ Sex is also a potent trigger for endorphin release. Finally, the practice of meditation can increase the amount of endorphins released in your body.²¹

MECHANISM OF ENDORPHINS:

Beta-endorphin is a peptide with morphine-like effects produced primarily in the anterior lobe of the pituitary gland. After its cleavage from the parent molecule, proopiomelanocortin (POMC), betaendorphin is circulated via the blood stream to interact with specific opioid receptors located throughout the body. The classical function of beta-endorphin is analgesic; in fact, beta-endorphin has been shown to be 20 to 33 times more potent than morphine.²² Beta-endorphin is released during stressful and painful events, and it functions almost exclusively in an inhibitory fashion. The peptide inhibits neuronal firing of peripheral somatosensory fibers, especially those involved in nociception.²³ There is also evidence indicating an inhibitory role for beta-endorphin in visual, acoustic, and olfactory transmission. Other effects include decreased sexual behavior, increased tendency toward a catatonic state, and increased feeding and grooming. In sufficient quantities, beta-endorphin can dilate resistance and capacitance vessels, eventually resulting in orthostatic hypotension. Plasma beta-endorphin is known to increase during exercise, and recently studies have begun to show how it affects various components of the immune system.²⁴

To summarize thus far, beta-endorphin is a multifunctional hormone that is derived from POMC. Most notably, it acts in response to stress and pain as an analgesic by binding to mu receptors on neurons involved in nociception. Naloxone is a potent inhibitor of both morphine and beta-endorphin because of its high affinity for opioid receptors.²⁵

A recent study conducted by Varkey, Cider, Carlsson, and Lindy (2011)²⁶ found that exercise, regular relaxation exercises, or the use of topiramate were equally effective in reducing the rate of migraines. Those participants in the exercise group exercised for 40 minutes three times a week. Therefore, exercise can be an effective intervention in the preventive treatment of migraines. Although engagement in regular exercise routinely is recommended as a means of managing and preventing migraine, the empirical support for this recommendation is well less than definitive, and we have at best a weak understanding of the relationship between aerobic exercise and migraine let alone the optimal parameters of exercise regimens for migraine (eg, when to recommend, who will benefit, level of anticipated benefit, optimal types and doses/intensities of exercise).²⁷ These fundamental knowledge gaps critically limit our capacity to competently deploy exercise as an intervention for migraine. Definitive information is needed regarding the genuine and unique contributions of aerobic exercise for migraine management as well as the capacity for this intervention strategy to be administered as a complement to extant, well-validated pharmacologic and non-pharmacologic migraine therapies.²⁸

ASPECT OF SEX IN CURTAILING MIGRAINE AND STRESS:

It’s a natural pain reliever:

Sex causes increased production of oxytocin, which is often referred to as the “love hormone”. Before orgasm, oxytocin, released from the brain, surges and is accompanied by the release of endorphins, our natural pain-killing hormones.²⁹ The area of the brain involved in pain reduction is highly activated during arousal and endorphins are released; endorphins soothe nerve impulses that cause menstrual cramps, migraines or joint pain. Oxytocin also affects the way we feel, helping us form strong emotional bonds as well as reduce pain.³⁰ According to a study by Beverly Whipple, professor emeritus at Rutgers University and a famed sexologist and author, when women have an orgasm, pain tolerance threshold and pain detection threshold increases significantly, by up to 74.6 percent and 106.7 percent respectively.³¹

It’s a stress reliever:

The endorphins released during sexual intercourse and orgasms are natural mood-boosters and stress relievers. Regular sex can also boost your self-esteem and increase intimacy between partners. For those in a monogamous relationship, studies have found that semen does contain several mood-altering hormones that can reduce depression and elevated mood.

It boosts immunity:

Endorphins released during intimacy have been found to stimulate immune system cells that fight disease. Researchers have found higher levels of Immunoglobulin A in individuals who have regular sex.³² Immunoglobulin A is a type of antibody that helps to protect us from infections. It is normally found in high levels in the mucous membranes of the digestive and respiratory tracts.³³

It’s good for your heart:

Intercourse, depending on your level of enthusiasm, can be considered aerobic exercise, burning up to 200 calories per session. Among other benefits, women who engage in regular sexual activity with their partners have higher levels of estrogen, which protects against heart disease.³⁴ Research has found that men who have sex two times per week have fewer heart attacks than those who do not. The hormones released during sex cause an increase in blood pressure and heart rate, and it can engage almost every muscle in the body.³⁵

It gives you a glow:

The glow of good sex is real. Women who have more sex have higher levels of estrogen, which is essential to enjoying healthier, smoother skin.³⁶ This increase in estrogen also helps to protect us from heart disease, osteoporosis and Alzheimer’s disease. It also promotes the production of collagen, which keeps the skin supple and gives you a healthy glow.³⁷

CONCLUSION:

Regular exercise can curtail the frequency and intensity of headaches and migraines. When one exercises, the body releases endorphins, which are the body’s natural painkillers. Exercise curtails stress and helps individuals to sleep at night. Stress and inadequate sleep are two migraine triggers.

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Received on 18.12.2019 Modified on 21.01.2020

Res. J. Pharmacology and Pharmacodynamics.2020; 12(1):25-28.

DOI: 10.5958/2321-5836.2020.00006.3