Abstract
Background/Objectives: Exercise has gained attention as a potentially beneficial non-pharmacological intervention, but whether this type of intervention presents a higher dropout rate compared to other interventions is still unknown. This systematic review, with a meta-analysis of randomized controlled trials, aims to determine whether exercise or comparators present lower or higher attrition in patients with migraine. Methods: A search was conducted in PubMed, Scopus, Web of Science, and Cochrane Library until March 2025. The methodological quality was evaluated using the JBI scale for randomized trials. Proportion meta-analysis calculated the dropout rate. Results: Odds ratio meta-analysis under 1 indicated lower attrition in experimental participants. Subgroup meta-analyses sorted by type of exercise, control, and migraine were conducted to explore variability in results based on the mentioned moderators. The overall pooled dropout rate was 6.7%, 11.6% for the exercise groups, and 10.1% for the comparators. No statistical difference was found between groups of studies, type of migraine, type of exercise, and type of comparator (p ≥ 0.05). Only the odds ratio results for migraine with auras showed a lower pooled dropout rate in favor of control participants, OR = 1.18. Conclusions: Although there is no statistically significant difference, the meta-analysis of proportions shows a higher loss rate in exercise-based interventions. However, the high heterogeneity found in the included studies prevents us from drawing firm conclusions. Furthermore, adequate adherence to the CONSORT guidelines in reporting losses and their reasons could help design appropriate retention strategies for studies and interventions based on exercise in patients with migraines.