Date of Award

May 2023

Degree Type


Degree Name

Doctor of Philosophy



First Advisor

Melinda S Kavanaugh

Second Advisor

Han Joo Lee

Committee Members

Melinda S Kavanaugh, Han Joo Lee, Matthew J Zawadzki, W. Hobart Davies, Shawn P Cahill


exercise intervention, health education, migraine self-management, physical activity education, sleep education


Migraine is the second most disabling illness in the world, characterized by pulsing or throbbing pain in the head, usually on one side, and often associated with nausea, vomiting, and/or sensitivity to light and/or sound. Biological, as well as psychological, social, and lifestyle factors, including exercise and critical sleep practices, are all part of the biopsychosocial model underpinning the complex nature of migraines, yet prior research has largely focused on the biomedical model. Few studies have evaluated lifestyle interventions to improve migraine, and even fewer have included migraine comorbidities. For this study, we implemented a phone-delivered educational intervention aimed to inform migraine patients of best sleep practices with weekly sleep hygiene goals in addition to an exercise intervention and compared it to a control group. Participants completed surveys measuring depression, anxiety, quality of life, migraine disability, and several sleep measures at baseline and after the intervention, as well as tracking their migraine frequency, duration, intensity, and sleep using ecological momentary assessment over 4 weeks. Results showed a significant difference in physical activity minutes in weeks 2, 3, and 4 compared to week 1 for the intervention group. Further, people with migraines showed acceptable compliance to the EMA procedure (93% overall, 84% minimum individually) and exercise intervention (completing at least 6 of the 9 exercise sessions). Depression and anxiety scores significantly improved post intervention compared to baseline for those in the intervention group. Results showed a significant difference in daily sleep duration in week 4 compared to week 1 for the intervention group compared to the control group. Survey measures of daytime dysfunction (fatigue) and Global PSQI (total sleep scores) showed significant within-person improvements pre- and post-intervention for the intervention group, but there were no significant between-group differences. There were no significant findings for other PSQI sleep measures, quality of life, or migraine disability. Daily migraine results are discussed for future evaluation. These results show 1) feasibility for using this intervention with migraine patients, 2) efficacy in measuring migraines using EMA, and 3) preliminary findings that the physical activity intervention and the sleep intervention are successful in increasing physical activity and sleep duration. Future work can utilize this intervention for a longer duration with more participants to assess its efficacy in improving migraine health, depression, and anxiety. These results add to the growing body of literature showing the safety and potential health benefits of aerobic exercise among people with migraines. Given these findings, clinicians should educate and support migraine patients in adopting 120 minutes of aerobic exercise per week with proper warmups for health benefits without adverse effects in concurrence with improved sleep hygiene habits.

Included in

Psychology Commons