Exercise as an abortive treatment for cluster headaches: Insights from a large patient registry

Abstract

Objective

This study aimed to evaluate the potential of exercise as an abortive treatment for patients with cluster headache (CH).

Methods

A cross‐sectional survey was conducted among CH patients at a single center in Korea. Demographics and headache characteristics were compared between those who found exercise effective and those who did not. We analyzed the type and intensity of exercise used. Headache improvement was measured as intensity reduction, with ≥50% improvement defined as a reduction in intensity by half or more. Exercise intensity was categorized as moderate (“possible to talk but hard to sing”) or high (“difficult to speak without pausing”). Case reports of patients exercising during CH attacks were also reviewed.

Results

Among 167 registered CH patients, 136 patients provided responses about exercise during CH attacks; 39.7% (54/136) attempted exercise as treatment. Improvement was reported by 42.6% (23/54), with ≥50% improvement in 29.6% (16/54). Patients who found exercise effective had lower Headache Impact Test‐6 scores. Effective exercises included running (39.1%), squats (30.4%), and stair climbing (21.7%), with high‐intensity exercise effective for 52.2% and moderate intensity for 43.5%. Among the 23 patients who benefited from exercise, 18 reported their most effective treatment, which were exercise alone in 50% (9/18), followed by exercise with triptans in 38.9% (7/18), and oxygen with or without triptans in 5.5% (1/18).

Interpretation

About 40% of CH patients attempted exercise for acute CH management, with 30% experiencing over 50% improvement. While evidence is limited, exercise may help alleviate headaches and could be considered an adjunctive treatment for CH attacks.

Introduction

Cluster headache (CH) is one of the most disabling primary headache disorders, characterized by severe or very severe unilateral pain associated with autonomic symptoms and/or agitation or restlessness. ¹ It not only escalates the risk of depression and reduces the quality of life but also imposes a significant economic and disability burden on affected individuals due to its incapacitating effects. ² , ³ , ⁴ , ⁵

The mainstay management for CH is pharmacotherapy guided by evidence‐based recommendations from the European and American guidelines and an Asian review article. ⁶ , ⁷ , ⁸ Among these treatments, subcutaneous sumatriptan, intranasal and oral zolmitriptan, and oxygen therapy have been validated for acute pain relief. ⁹ Nevertheless, repeated use of triptan multiple times a day over the course of months in a cluster period poses a risk of overdose. Furthermore, accessibility issues for injectable triptans in Asian regions and challenges in the portability of oxygen therapy underscore the need for alternative treatments. ⁹ , ¹⁰ , ¹¹

Therapeutic exercises have been explored for mitigating headache days and severity in other primary headache disorders, ¹² , ¹³ , ¹⁴ with aerobic and strength training showing efficacy in migraines and tension‐type headaches, respectively. ¹⁵ , ¹⁶ , ¹⁷ , ¹⁸ However, research on the role of exercise in CH is sparse. A case series evaluating the preventive efficacy of manual therapy and exercise alongside pharmacological interventions found that headache impact improved in six of seven patients with CH, without significant change in the duration and intensity of pain. ¹⁹ The effectiveness of aerobic exercise as abortive therapy for CH has been reported in one case ²⁰ ; hence, given the general benefits of exercise on overall well‐being and its minimal risk profile, there is a compelling need to explore exercise as a feasible and accessible abortive therapy for CH.

This study aimed to evaluate the effectiveness of exercise in the acute management of CH attacks by identifying the types and intensities of exercise that yield the greatest benefits. In addition, a detailed summary of a self‐initiated exercise therapy of a young patient for coping with severe cluster attacks is presented.

Methods

Study design and patients

This was a cross‐sectional survey based on a registry of patients with CH at a single headache clinic in Korea from September 2016 to April 2023. This study was reviewed and approved by the Institutional Review Board of Dongtan Hallym University Sacred Heart Hospital, Republic of Korea (approval number: 2016‐09‐396), and an amendment to the questionnaire regarding exercise during headache attacks was reviewed and approved (approval number: 2016‐09‐396‐021). All the study procedures complied with the principles of the Declaration of Helsinki.

The diagnosis of CH for patients recruited before 2018 was initially made according to the International Classification of Headache Disorders, third edition (ICHD‐3 beta version), ²¹ published by the Headache Classification Committee of the International Headache Society in 2013 and reevaluated by ICHD‐3 after 2018. No patients were excluded due to updated criteria. ²² For patients recruited after 2018, the diagnosis was based on the final version of the ICHD‐3, which was published in 2018. ¹ Individuals aged 19 years and older diagnosed with CH were enrolled in the study.

Data collection

Clinical information and headache characteristics, such as frequency, severity, and duration, were collected from the participants. Questionnaires including the Headache Impact Test‐6 (HIT‐6), Generalized Anxiety Disorder 7‐Item Scale (GAD‐7), and Patient Health Questionnaire‐9 (PHQ‐9) were administered at the time of study enrollment.

An inquiry whether patients ever used exercise as a headache management strategy during CH attacks was conducted at the time of enrollment for patients who were enrolled after the study amendment. For patients who enrolled before the amendment, the survey was administered to those who experienced recurrence during their follow‐up visits, while telephone calls were made to patients who had dropped out. Based on the self‐reports of patients, the exercise attempts, any improvements in headache symptoms, exercise regimen, intensity, and the most effective treatment among exercise, triptans, oxygen administration, or a combination thereof were evaluated. Subsequently, we compared the patients who reported improvements after exercise with those who did not experience improvements.

Participants were asked to complete a questionnaire consisting of the following items: (1) Have you ever exercised to treat a CH attack? (2) What type of exercises do you perform to treat a CH attack? (3) Does exercise during a CH attack lead to improvement (improved, no change, worsened)? (4) Effect of exercise on pain control (pain disappeared, pain decreased, reduction in recurrence); (5) Effective duration of exercise for headache improvement; (6) Effective exercise intensity; and (7) Which method did you find the most effective for pain control (exercise alone, exercise combined with triptan, triptan alone, or other combinations)?

The efficacy of exercise was assessed based on the subjective evaluation of patients on the changes in headache intensity, duration, and recurrence before and after exercise, as recorded in their headache diaries. Headache improvement was defined as a change in pain intensity before and after exercise. The degree of improvement was self‐reported by the patients, with a reduction in headache severity to less than half of the pre‐exercise level classified as a 50% or more improvement. Exercise intensity was categorized as vigorous, moderate, or light, based on the subjective assessment of the patients. Vigorous intensity was defined as the inability to say more than a few words without pausing during the exercise; moderate intensity was defined as being able to talk but not sing during the exercise; otherwise, exercise was considered to be of light intensity. ²³ , ²⁴

Statistical analysis

This observational study relied on available medical data, which determined the sample size. To enhance our findings, we performed a hypothetical sample size calculation at a significance level of 0.05 and a power of 0.80, guided by standard deviations from previous studies on headache frequency, intensity, and duration. ¹⁹ , ²⁵ , ²⁶ This calculation assumed a significant difference in headache changes before and after exercise between patients who found exercise effective and those who did not. The results indicated that a minimum of 17 participants per group would be needed to achieve sufficient statistical power for comparison.

The clinical characteristics of the participants were presented descriptively as counts, percentages, or means (interquartile range [IQR]). Analyses of between‐group differences were performed using the Wilcoxon Mann–Whitney test or the independent samples t‐test for continuous variables or Fisher's exact test for categorical variables, depending on whether the data were normally distributed (according to the Shapiro–Wilk test). An analysis of within‐group differences was not conducted because of the absence of pre‐ and postintervention data as this was a cross‐sectional observational study. All statistical analyses were performed using IBM SPSS version 22. Statistical significance was set at P < 0.05.

Results

Demographics and clinical information of patients

Of the 167 patients diagnosed with CH, we analyzed 136 patients who provided responses about exercise during CH attacks, six patients at initial enrollment, and 130 patients during follow‐up. Among them, 54 (39.7%) reported exercising to relieve pain due to a CH attack (Figure 1). Detailed characteristics of the 54 patients and comparisons between patients with and without exercise effects are shown in Table 1.

Figure 1.

Patient selection and response to exercise in the treatment of cluster headaches.

Table 1.

Comparison of patients with and without exercise effectiveness in managing cluster headaches (CHs).

	Effective n = 23	Not effective n = 31	Total (n = 54)	P value
Age, year	33.0 (27.0, 40.0)	33.0 (28.0, 42.0)	33.0 (28.0, 41.0)	0.413
BMI	23.7 (21.8, 25.6)	23.9 (22.2, 26.2)	23.8 (21.9, 26.1)	0.462
Male, n (%)	20 (87.0)	29 (93.5)	49 (90.7)	0.340
Alcohol, n (%)	14 (60.9)	26 (83.9)	40 (74.1)	0.088
Smoking, n (%)
Current smoker	10 (43.5)	17 (54.8)	27 (50.0)	0.450
Ex‐smoker	6 (26.1)	9 (29.0)	15 (27.8)
Hypertension, n (%)	1 (4.3)	5 (16.1)	6 (11.1)	0.180
Migraine, n (%)	5 (21.7)	1 (3.2)	6 (11.1)	0.128
Precluster period exercise, n (%)	9 (39.1)	11 (35.5)	20 (37.0)	0.503
CH characteristics
Onset age, year	22.0 (17.0, 32.0)	21.0 (17.5, 27.3)	22.0 (17.5, 30.0)	0.590
Disease duration, year	10.0 (5.0, 14.0)	11.0 (5.0, 20.0)	11.0 (5.0, 18.0)	0.551
Average CB duration, week	6.0 (4.0, 8.0)	6.0 (4.0, 8.0)	6.0 (4.0, 8.0)	0.394
CH attack duration, min	75 (60.120)	60 (60,120)	60 (60,120)	0.826
Frequency (times/day)	1.0 (0.9, 1.8)	1.0 (1.0, 2.0)	1.0 (0.9, 1.8)	0.524
NRS	9.0 (8.0, 10.0)	9.0 (7.0, 10.0)	9.0 (8.0 10.0)	0.524
Diurnal rhythmicity, n (%)	16 (69.6)	22 (71.0)	38 (70.4)	0.655
Seasonal rhythmicity, n (%)	15 (48.4)	16 (69.6)	31 (57.4)	0.420
Chronicity, n (%)	1 (3.2)	1 (4.3)	2 (3.7)	0.673
Questionnaire
HIT‐6	67.0 (62.5, 74.0)	76.0 (69.5, 78.0)	71.0 (66.0, 78.0)	0.018
GAD‐7	7.5 (4.0, 10.7)	9.0 (5.0, 16.0)	9.0 (5.0, 15.0)	0.208
PHQ‐9	5.5 (2.8, 12.0)	6.0 (2.5, 13.5)	6.0 (3.0, 12.0)	0.561

BMI, body mass index; CB, cluster bout; GAD‐7, Generalized Anxiety Disorder 7‐Item Scale; HIT‐6, Headache Impact Test‐6; NRS, numeric rating scale; PHQ‐9, Patient Health Questionnaire‐9.

All continuous variables are presented as mean (interquartile range).

The cohort included 49 males (90.7%) and 5 females (9.3%), with a mean (IQR) age of 33 (28.0, 41.0) years. Forty patients (74.1%) were alcohol consumers and 27 (50.0%) were current smokers. Six patients (11.1%) had hypertension, and six patients (11.1%) had migraines. The mean (IQR) age at CH onset was 22.0 (17.5, 30.0) years, and the duration until diagnosis was 11.0 (5.0, 18.0) years. The mean (IQR) duration of CH episodes was 6.0 (4.0, 8.0) weeks, and the headache frequency was 1.0 (0.9, 1.8) per day. The median (IQR) headache severity, assessed using the Numeric Rating Scale (NRS), was 9.0 (8.0, 10.0). Thirty‐eight patients (70.4%) showed diurnal variation, and 31 patients (57.4%) showed seasonal variation. Two (3.7%) patients were diagnosed with chronic CH. The median (IQR) scores for the administered questionnaires were 71.0 (66.0, 78.0) for HIT‐6, 9.0 (5.0, 15.0) for GAD‐7, and 6.0 (3.0, 12.0) for PHQ‐9.

Comparison between patients with and without exercise effectiveness

Among the 54 patients who exercised during a CH episode, 23 (42.6%) reported exercise as effective, with 16 (29.6%) experiencing a 50% or greater reduction in headache intensity. In contrast, 29 patients (53.7%) did not find exercise beneficial, and symptoms worsened in 2 patients (3.7%).

The median (IQR) HIT‐6 score was lower in patients with exercise effectiveness than in those without exercise effectiveness (67.0 [62.5, 73.0] vs. 76.0 [69.5, 78.0], P = 0.018). There were no statistically significant differences in age, body mass index, proportion of males, comorbidities, or CH characteristics. Despite having no statistically significant difference, individuals with exercise effectiveness tended to have a lower proportion of alcohol consumers (60.9% vs. 83.9%, P = 0.088) and lower GAD‐7 (7.5 [4.0, 10.7] vs. 9.0 [5.0, 16.0], P = 0.208) and PHQ‐9 (5.5 [2.8, 12.0] vs. 6.0 [2.5, 13.5], P = 0.561) scores.

Details about the exercise regimen and intensity of 23 patients with CH

Twenty‐three patients reported the types of exercise they attempted to perform during a CH attack (Table 2). Some patients reported performing two or more exercises. Running was the most frequently reported type in nine patients (39.1%), followed by squats in seven patients (30.4%), stair climbing in five patients (21.7%), and vigorous walking, flanks, and push‐ups in four patients (17.4%). The effective intensity was vigorous for 12 patients (52.2%), moderate for 10 patients (43.5%), and light for one patient (4.3%). The exercise resulted in a reduction in the intensity of pain in 16 patients (80.0%), disappearance of pain in three patients (15.0%), and a decrease in recurrence in one patient (5.0%). Among the 23 patients who reported a positive effect of exercise, 18 responded that it was the most effective treatment for pain relief. The most effective treatment was exercise alone in nine patients (39.1%), followed by a combination of exercise and triptans in seven patients (30.4%). A combination of exercise, oxygen, and triptans and a combination of oxygen and triptans without exercise were reported by one patient each (4.3%).

Table 2.

Exercise types and details among patients reporting improvement in cluster headaches (n = 23).

Exercise type a	n, (%)
Running	9 (39.1)
Squats	7 (30.4)
Stair climbing	5 (21.7)
Vigorous walking	4 (17.4)
Flanks	4 (17.4)
Push‐ups	4 (17.4)
Etc	3 (13.0)
Exercise intensity	n, (%)
Vigorous	12 (52.2)
Moderate	10 (43.5)
Light	1 (4.3)
Exercise duration	minutes
Effective exercise duration	30.0 (15.0, 60.0)
Exercise outcome b	n, (%)
CH attack pain abolition	4 (17.4)
CH attack pain alleviation	19 (82.6)
CH attack relapse reduction	4 (17.4)
Most effective treatment c
Exercise only	9 (50.0)
Exercise with triptan	7 (38.9)
O2 with triptan	1 (5.5)
O2 and exercise, triptan	1 (5.5)

^a Represent multi‐response data, indicating that each patient may have attempted two or more different exercises.

^b Represent multi‐response data, indicating that each patient may have two or more different exercises effects. Two patients experienced pain alleviation and relapse reduction, while one patient experienced pain abortion, alleviation, and relapse reduction.

^c 5 patients did not provide a response.

Case description

A 29‐year‐old male patient presented with CH in his fourth cluster period. His cluster periods began around the onset of autumn, each lasting approximately 3 weeks, since he was 25 years old. He experienced 1.5 attacks per day, each lasting approximately 90 min. He also had a history of migraines since his teenage years. He maintained an active lifestyle, exercising 2–3 days per week, which were focused on various muscle groups, denied using tobacco or alcohol, and did not have other medical conditions.

Before visiting the headache clinic, he managed the pain through exercise during the cluster periods due to the inefficacy of over‐the‐counter medications. He engaged in intense physical activities, such as running, squats, and push‐ups, which helped reduce pain intensity and provided distraction from the pain.

Oxygen therapy was not readily available during cluster bouts. He recorded the efficacy of each treatment in his headache diary for the four attacks. For the two attacks with NRS score of 4–5, exercise alone resolved the pain within 37 min, with a maximum pulse rate of 167 beats per minute, and oral sumatriptan resolved the pain within 35 min, with no change in pulse rate. For the two attacks with NRS 7–8, exercise with oral sumatriptan resolved the pain within 103 min with a maximum pulse rate of 168 beats per minute, and oral sumatriptan with additional acetaminophen resolved the pain within 85 min with no change in pulse rate (Table 3). He reported that exercise alone was the most effective method for pain control.

Table 3.

Efficacy of treatment modalities during cluster headache episodes for case 1.

Cluster bouts	1	2	3	4
Acute treatment	Sumatriptan Tylenol 650 mg	Sumatriptan	Exercise alone‐ Treadmill: 10 km/h for 15 min—Pull‐ups: 12, 8, and 5 times	Sumatriptan + exercise—Treadmill: 10 km/h for 15 min—Weighted squats: 15 kg, 40 and 30
Treatment after headache
Exercise	Not	Not	3 min	2 min
Medication	5 min: sumatriptan 65 min: tylenol	9 min: sumatriptan	Not	2 min: sumatriptan 65 min: tylenol
Duration of headache	115 min	35 min	37 min	103 min
Headache intensity (NRS)/O2 saturation (%)/heart rates (/min)
Baseline	8/97/69	5/97/84	4/97/77	7/97/72
After 15 min	8/97/74	4/NA/NA	3/98/164	7/98/167
After 30 min	7/98/89	0/97/75	2/97/109	6/97/114
After 60 min	7/97/82	0/NA/NA	0/97/77	5/97/78
After 120 min	0/NA/NA	0/NA/NA	0/NA/NA	0/NA/NA

min, minutes; NRS, numeric rating scale; Pd, prednisolone.

Discussion

In our study, 43% of the patients with CH attempted exercise to alleviate pain during CH attacks, with 30% experiencing more than 50% improvement. Patients who experienced relief through exercise exhibited lower HIT‐6 scores than did those who did not experience relief. Moderate‐to‐vigorous intensity exercises were reported to be effective regimens for CH attacks.

We explored the efficacy of exercise alone and exercise in combination with other treatments, including triptans, for the management of CH attacks. A significant proportion of the participants found exercise to be the most effective treatment. Notably, 50.0% of the patients (9/18) reported that exercise alone offered the greatest relief, while 38.9% (7/18) found that a combination of exercise and triptans were the most beneficial.

In patients with CH, restlessness and agitation are prominent features of the attacks. They may pace or rock during attacks and attempt to reduce pain intensity by applying pressure to the affected area, while patients with migraine typically avoid motion or exercise. ²⁷ , ²⁸ In a previous survey, 20% of patients with CH reported always pacing or rocking, while 55% reported pacing or rocking sometimes. Approximately 50% of patients engaged in self‐injurious behavior during CH attacks as a strategy for distraction and counter‐irritation. ⁴ These results suggest that exercise serves as an alternative distracting approach, not necessarily for pain relief. It remains unknown whether exercise controls headache or merely serves as a manifestation complimentary to restlessness or agitation. However, there were no differences in agitation between the patients who did and did not exercise (Table S1).

Participants who noticed improvements after exercise had lower HIT‐6 scores, suggesting that their headaches affected their daily lives less severely. A literature review indicated that younger individuals with an earlier onset of CH often report higher HIT‐6 scores, indicating a connection between age, headache onset, and overall headache impact. ²⁹ High HIT‐6 scores were also related to mental health issues. ³⁰ Interestingly, we did not observe significant differences in headache intensity, frequency, or age of headache onset among the participants, regardless of the benefits of exercise. However, those who benefited from exercise tended to have lower anxiety and depression scores based on their GAD‐7 and PHQ‐9 scores, respectively, suggesting that exercise may help with both headaches and mental health. This implies two possibilities: either exercise directly reduces the negative impact of headaches and improves mental health or people with less severe headaches are more likely to exercise. Reduced headache‐related disability may encourage more exercise, which could help better control headache symptoms.

The possible mechanisms contributing to the hypoalgesic effect of exercise in CH and other primary headaches are uncertain; however, one suggested mechanism involves the effects of exercise on neurotransmitters, including serotonin, dopamine, and norepinephrine. ³¹ Exercise has been shown to increase serotonin levels in the brainstem and dorsal horn of the lumbar spinal cord in animal studies. The serotonergic system plays a crucial role in modulating pain thresholds and contributes to the pathophysiology of CH and migraine. ³² , ³³ , ³⁴ , ³⁵ , ³⁶

Another potential mechanism is exercise‐induced increase in beta‐endorphin, an endogenous opioid that regulates nociceptive signals. Studies have shown acute central changes in opioid peptides with exercise and increased secretion of peripheral beta‐endorphins after high‐intensity exercise. ³⁷ , ³⁸ This beta‐endorphin secretion is mainly driven by increased acidosis, an effect of high‐intensity anaerobic exercise, ³⁹ which is an effect of vigorous‐intensity anaerobic exercise. ⁴⁰ In addition, endocannabinoids and anti‐inflammatory effects are proposed contributors to exercise‐induced pain relief. ⁴¹ , ⁴² , ⁴³ , ⁴⁴

A recent case report supported the efficacy of aerobic exercise for acute CH attack treatment, ²⁰ and two case studies highlighted its effectiveness in treating migraines. ¹⁶ , ¹⁷ Aerobic exercise enhances the efficacy of the oxygen transport system, potentially increasing oxygen concentration. ³⁷ A hypoxic mechanism has been proposed to be involved during cluster CH attacks, ⁴⁵ and high flow rates of oxygen appear to be effective in treating these attacks. ⁴⁶ These findings suggest that increasing oxygen supply may affect both types of primary headaches.

Exercise may also influence the release of calcitonin gene‐related peptide (CGRP) and pituitary cyclase‐activating polypeptide (PACAP) from nociceptive terminals, which are neuropeptides closely linked to the pathophysiology of CH and migraine. ⁴⁷ , ⁴⁸ , ⁴⁹ CGRP levels increase during headache attacks, and blocking CGRP receptors has been shown to effectively reduce CH and migraine symptoms. In an experimental neuropathic pain rat model, PACAP mRNA levels in the spinal cord were altered with decreased hyperalgesia during forced exercise. ⁵⁰ The modulation of CGRP or PACAP release through exercise suggests a potential mechanism for pain relief given the beneficial outcomes of anti‐CGRP therapies in CH treatment. ⁴⁸ , ⁴⁹

The case reported in this article shows that exercise helped manage CH pain when over‐the‐counter medications were ineffective. Although exercise alone resolved some attacks, more severe episodes required the combination of exercise and sumatriptan therapy, which suggests that exercise can be part of a multimodal approach but may not be sufficient for higher‐intensity attacks. This case also highlights the issue of delayed diagnosis of CH, which often lead patients to develop their own coping strategies, such as exercise. This emphasizes the need for improved diagnostic and treatment approaches that incorporate both pharmacological and nonpharmacological methods.

These findings highlight exercise as a potential nonpharmacological option for managing CH. Identifying the optimal types and intensities of exercise, such as aerobic, anaerobic, and moderate‐to‐vigorous exercise, could lead to tailored strategies that complement pharmacological treatments and improve the quality of life of patients. Future research should explore the synergistic effects of exercise and triptans, as nearly one‐third of the participants reported this combination to be the most effective treatment. Exercise may enhance pharmacological treatments or vice versa, indicating a potential for multimodal approach for CH management. Given the complexity of CH and the subjective nature of pain, understanding how exercise provides relief, both independently and in combination with drugs, is crucial. Investigating the effects of exercise is vital for developing comprehensive, evidence‐based strategies that incorporate both nonpharmacological and pharmacological treatments, moving toward personalized patient care.

This study had some limitations. We retrospectively examined the exercise experiences of patients during CH attacks. Data on exercise details and their effects were self‐reported, introducing a potential recall bias. The efficacy of exercise cannot be established in patients who have not attempted it, which could have led to an underestimation or overestimation of its effectiveness. Nevertheless, 39.7% of the participants in our study voluntarily engaged in exercise, which is a high percentage. We did not further analyze the exercise data of patients who did not report effectiveness; thus, a comparison between the two groups was not possible.

Conclusion

Exercise as an abortive therapy for CH attacks might be associated with lower headache disability, and the risk of headache aggravation by exercise is low in patients with CH; hence, exercise could be considered as an adjunctive treatment option, with or without conventional therapy, for patients with CH.

Author contributions

Conceptualization, S.‐J. C. and M.‐K. K.; methodology, S.‐J. C., M.‐K. K., and Y. H.; investigation, S.‐J. C., M.‐K. K., and Y. H.; data curation, M.‐K. K.; writing—original draft preparation, M.‐K. K.; writing—review and editing, M.‐K. K., Y. H., and S.‐J. C. supervision, S.‐J. C. All authors have read and agreed to the published version of the manuscript.

Funding Information

This research was supported by Hallym University Research Fund 2024(HURF‐2024‐13).

Conflict of Interest

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Consent to Participate

All participants provided written informed consent prior to participating.

Supporting information

Table S1. Comparison of patients who has exercised and not exercised during cluster headache attack.

Funding Statement

This work was funded by Hallym University grant HURF‐2024‐04500001.

Data Availability Statement

The datasets generated and/or analyzed during the current study are available from the corresponding author on reasonable request.