What Helps with Migraines? Exercise, Prevention, and Botox

At a Glance

• Regular endurance exercise is recommended for prevention; studies do not indicate a target heart rate that is suitable for everyone.
• Sumatriptan is an example of an acute treatment; prophylaxis is intended to reduce the number of migraine days over the long term.
• Depending on the situation, exercise, relaxation, beta-blockers, or CGRP antibodies may be considered.
• OnabotulinumtoxinA is an option for chronic migraine; reimbursement under statutory health insurance must be clarified in advance for the specific treatment pathway.

01 · Emergency Assistance

What can help during a migraine attack without taking medication?

During a migraine attack, noise, light, and movement are often experienced as particularly distressing. A darkened, quiet room—as quiet as possible—a break from screens and strong odors, or a cool compress can be soothing. If it helps, lie down and drink in small sips. These measures can alleviate symptoms, but they do not reliably stop an attack. You don’t have to force yourself to move if movement makes the pain worse during an attack.

A headache calendar helps you track the frequency and duration of attacks, accompanying symptoms, and any acute medications you’ve taken. This makes it easier for your doctor to assess during your appointment whether a pattern is emerging and whether preventive treatment might be appropriate.

02 · Acute Medications

What role do triptans such as sumatriptan play?

If rest and reducing stimuli are not enough, medication may be considered for an acute attack. Triptans are often used for moderate to severe migraine attacks. Sumatriptan is one example. Triptans are acute-relief medications, not preventive treatments; the appropriate medication depends, among other factors, on comorbid conditions, previous experience, and individual tolerance. Talk to your doctor about which medication is right for you and when to take it.

The frequency of use is also important: Using acute-relief medications too often can itself contribute to medication-overuse headaches. If you need medication frequently or want to consciously take fewer pills, discuss a comprehensive plan that includes both acute treatment and prevention.

03 · Exercise as a Preventive Measure

Can regular endurance exercise help prevent migraines?

Yes, regular endurance exercise is recommended as a preventive measure in the DGN/DMKG guidelines on migraine. That does not mean that every type of exercise or training intensity has the same effect on everyone. The guidelines are based on several relatively small studies; the results suggest a potential benefit, but do not provide any guarantees and do not specify a heart rate limit that applies to everyone.

One example is a randomized study involving 91 adults: The exercise program consisted of three 40-minute sessions per week. In the exercise group, the number of migraine attacks during the final month of treatment decreased by an average of just under one attack compared to baseline. The differences compared to relaxation training and topiramate were not statistically significant. This suggests that regular exercise may be a potential preventive measure—but it does not prove that a specific dose is effective for every person. Varkey et al. (2011) report the study details. A small pilot study involving nine individuals with chronic migraine examined three 30-minute sessions per week at 60–70% of the estimated maximum heart rate and found no measurable change in migraine burden. Due to the very small sample size, it is not possible to conclude either a definite effect or a lack of effect (Navalta et al. (2024)).

The study relied on a structured ergometer workout with warm-up and cool-down phases, as well as a more strenuous middle section. However, the study did not examine a general target heart rate of over 150 beats per minute. Such a heart rate cannot be applied to everyone: age, fitness level, medical conditions, and medications—including beta-blockers, which can affect heart rate—all influence the appropriate range. If your doctor has personally set such a target for you, follow that recommendation. As a general guideline, it makes more sense to exercise regularly and at a level appropriate to your own fitness level, and to adjust the intensity in consultation with your doctor as needed.

If more intense exercise triggers symptoms or isn’t feasible, that doesn’t mean exercise has no place in your routine. The guideline also suggests less strenuous activities, such as yoga, as a possible supplement. Start with a realistic routine, gradually increase the intensity, and keep track of how your exercise and migraine days progress in your headache diary.

04 · Additional Prevention Measures

What other preventive measures are there besides exercise?

Migraine prevention may be considered if attacks are frequent or particularly debilitating, or if acute medication is insufficient. The goal is to reduce the number of migraine days and the associated impairment. In addition to exercise and relaxation techniques, medications may be used depending on the situation. These include beta-blockers such as propranolol or metoprolol, as well as, for example, topiramate or amitriptyline. If the patient meets the appropriate criteria, monoclonal antibodies against CGRP or the CGRP receptor may also be considered. The choice depends on the diagnosis, comorbidities, previous treatments, and personal preferences.

These treatments are not interchangeable. A headache diary helps assess effectiveness and tolerability over several weeks. A doctor can discuss with you whether traditional preventive treatment is appropriate to start with or if another option makes more sense. If you experience headaches very frequently, your doctor will also evaluate whether you have chronic migraine.

05 · Chronic Migraine

When might Botox be considered as a preventive measure?

“Botox” is a brand name for products containing botulinum toxin. In cases of chronic migraine, the active ingredient onabotulinumtoxinA is used prophylactically. Migraine is considered chronic when headaches occur on at least 15 days per month for more than three months, with migraine features present on at least eight of those days. The DGN/DMKG guideline recommends considering this treatment if two oral prophylactic treatments have been ineffective or were not tolerated. Diagnosis and treatment should be performed by or under the supervision of a neurologist with experience in chronic migraine.

The injections are administered according to a fixed schedule at several sites in the head and neck area, typically at 12-week intervals. The preventive mechanism: OnabotulinumtoxinA influences the release of certain neurotransmitters at peripheral nerve endings and can thereby dampen the transmission of pain signals. The mechanism of action has not yet been fully elucidated. In the PREEMPT studies, the number of headache days decreased on average more significantly than with placebo; the extent to which an individual benefits varies. The effect is often not assessed until after two to three treatment cycles. If the treatment is suitable for you and is effective, it can help reduce the number of headache days and make your daily life more predictable.

Why is a headache diary so important?

A headache diary helps you track how often symptoms occur and whether preventive treatment is worthwhile. It also helps doctors determine whether the criteria for chronic migraine are met and, later on, assess the success of treatment. Make a note of the following every day, if possible:

• whether you experienced headaches and how long they lasted;
• Severity and accompanying symptoms, such as nausea and sensitivity to light or noise;
• which acute medications you took on which days and whether they helped;
• Preventive treatments that have been started, their duration of use, and any observed effects or intolerance.

When evaluating chronic migraine, documentation spanning several months is particularly helpful because the diagnosis requires at least three months of symptoms occurring with the appropriate frequency. A high number of headache days does not automatically mean that pain relievers are being taken excessively: this is assessed separately based on the type and number of days acute medications are taken. The guideline specifies the following thresholds for a possible medication-overuse headache: at least ten days of use per month for triptans or combination medications, and at least 15 days for individual simple pain relievers; additionally, the symptoms must have persisted for more than three months. Bring your calendar and a list of previous preventive treatments to your neurology appointment. You can use either a paper calendar or a digital version for this. Important: Medication overuse does not automatically rule out botulinum toxin. The guideline describes onabotulinumtoxinA as effective for chronic migraine with or without overuse; the doctor will evaluate both issues and develop a treatment plan together with you.

How does coverage work?

Within the neurological care pathway for physicians contracted with statutory health insurance, the statutory health insurance provider may cover the treatment of chronic migraine if the medical criteria are met. These include the diagnostic criteria—at least 15 days of headaches per month, including at least eight days of migraine, over a period of more than three months—and an assessment of whether previous preventive treatments have been sufficiently effective or well-tolerated. The guideline recommends onabotulinumtoxinA, particularly after two courses of oral prophylaxis that were either insufficiently effective or not well tolerated. Additionally, the specific treatment plan must be billable as a health insurance benefit; the Berlin Association of Statutory Health Insurance Physicians (KV Berlin) lists migraine as a billable indication when it meets the appropriate severity criteria. This is not a blanket guarantee of coverage for every practice. Ask the neurology practice to explain which documents and prior treatments they need for the assessment and how medications, injections, and follow-up visits are billed.

For episodic migraines, tension headaches, or other types of headaches, use of the medication falls outside the approved indication. Reimbursement by statutory health insurance for off-label use is only possible in very limited exceptional cases and should not be assumed (information from the G-BA on off-label uses). For private health insurance, reimbursement depends on the plan and an individual review; clarify this in writing in advance.

At ORVĒA, migraine Botox is offered as a self-pay service. The price listed on the pricing page currently starts at 599 euros. This is a separate billing process, and the cost is not covered by statutory health insurance. Before booking an appointment, you should clarify who will make the neurological diagnosis, who will administer the injections, and how the necessary specialist experience in treating chronic headaches is ensured. The ORVĒA page on botulinum toxin treatment describes the service.

06 · Consultation and Next Steps

How do you find the right treatment plan?

If you suffer from frequent migraines, bring your headache diary and a list of any previous acute and preventive treatments to your neurology appointment. There, the diagnosis can be clarified and an appropriate preventive treatment discussed. If you’re inquiring about a potential Botox treatment at ORVĒA, clarify in advance exactly who will determine the neurological indication, who will administer the injections, and whether your appointment will be covered by public health insurance or billed privately. The ORVĒA page on botulinum toxin treatment describes the services offered; you’ll find the listed price on the pricing page. If your diagnosis is not yet confirmed, a neurological headache consultation is the right first step.

New, sudden, or unusually severe headaches, as well as neurological symptoms that occur for the first time, should be evaluated by a doctor. This article is intended to provide general guidance and is not a substitute for an individual diagnosis or treatment recommendation.

Sources

1. Diener H.-C. et al. (DGN/DMKG). Treatment of Migraine Attacks and Migraine Prevention. S1 Guideline, Version 7.1 (2025), particularly pp. 95–96, p. 51, and pp. 136–138.
2. Varkey E. et al. Exercise as a Migraine Preventive: A Randomized Study Using Relaxation and Topiramate as Controls. Cephalalgia. 2011;31(14):1428–1438. DOI: 10.1177/0333102411419681.
3. Dodick DW et al. OnabotulinumtoxinA for the treatment of chronic migraine: pooled results from the PREEMPT clinical program. Headache. 2010;50(6):921–936. DOI: 10.1111/j.1526-4610.2010.01678.x.
4. International Headache Society. ICHD-3: Chronic Migraine (2018).
5. BOTOX® Prescribing Information (as of August 2026). Indications and clinical expertise for chronic migraine.
6. AbbVie Care. BOTOX® for Chronic Migraine: Criteria and Recommendations for Determining Coverage in Advance.
7. Joint Federal Committee. Off-Label Use: Prescribability Under Statutory Health Insurance (Exceptions and Requirements).
8. Social Code Book V, Section 31: Medicines and Medical Supplies.
9. International Headache Society. ICHD-3: Medication-overuse headache.
10. Berlin Association of Statutory Health Insurance Physicians. FAQs on Prescriptions and Billing, Question 457 (Botulinum toxin for migraine in cases of appropriate severity).
11. ORVĒA. Botulinum Toxin, Prices, and Contact Information.

Research and source verification: October 23, 2026. A review by a qualified medical professional is required prior to publication.