Saurabh Kumar,
depertment of Faculty of Physiotherapy, SGT University, Gurugram Haryana, India.
M. Ejaz Hussain, depertment of Faculty of Allied Health Sciences, SGT
University, Gurugram Haryana, India. Sonia Pawaria, depertment of Department of
Physiotherapy, Gurugram University, Gurugram Haryana, India. Wrote a research
article, Multimodal Physiotherapy for Migraine Rehabilitation. Entitled, Rehabbing
migraine: A pilot study on multimodal physiotherapy for pain, strength,
disability, posture, and quality of life. This research paper published by the International Journal of Biosciences | IJB. an open access scholarly research journal on
Biosciences. under the affiliation of the International Network For
Natural Sciences| INNSpub. an open access multidisciplinary research journal
publisher
Abstract
Migraine is a severe headache that causes throbbing, pulsing head pain on one side of the head. The headache phase of a migraine usually lasts at least four hours, but it can also last for days. Considering the multitude of contributing factors to migraine, a multimodal treatment may be an effective therapeutic option. The purpose of this study was to evaluate the benefits of the multimodal approach, including cervical spine traction, myofascial release, trigger point release, relaxation exercise, stretching and strengthening exercises, in the treatment of patients with migraine. Sixteen 18-55 years old individuals both male and female diagnosed with migraine were randomly assigned into two groups; Group A (control group, n = 8) who received Active ROM of Cervical and active stretching exercises only the multimodal approach or group B (experimental group, n = 8) who received the multimodal approach. The trial evaluated the cutaneous allodynia, craniovertebral angle (CVA), disability, posture, cervical deep flexor strength and quality of life at baseline, end of 4th weeks and end of 8th weeks after intervention. Following the 8 weeks, multimodal exercise program significant improvements in cervical deep flexor strength, posture, disability and quality of life were observed in intervention group compared to the control group. Finding of the present study showed that a multimodal exercise program improving problems associated with migraine in patients.
Introduction
Migraine is a
neurological disease considered as the second leading cause of disability,
affecting over one billion people globally (de Almeida Tolentino et al., 2021).
It is characterized by severe, recurring headaches on one or both sides of the
head. The headaches can last for hours to days and are often accompanied by
nausea, vomiting, and sensitivity to light and sound (Yan et al., 2012; Cutrer,
2010). Migraine, without aura is a type of headache that occurs in episodes and
tends to recur. It has symptoms and features that make it different from types
of headaches such as cluster headaches or tension type headaches. It's common
for individuals to have a combination of migraines with and without aura
(Sharpe et al., 2019). The International Classification of Headache Disorders
3rd Edition provides criteria, for this condition (HIS 2018). It has an
influence, on the disability of individuals under the age of 50 than any other
condition and it is also acknowledged by the World Health Organization as a primary
contributor, to disability (Carvalho et al., 2020). Migraine attacks can be
different from person to person in terms of how often they occur, how severe
they are, and how long they last. Stress can make migraine attacks worse in all
of these ways. Migraines often lead to disability, can result in missed work.
These attacks are an occurrence, in the brain that can last for hours or even
days happening repeatedly (Ruschel and De Jesus 2023; Lawler et al., 2006)
People with migraines often experience hypersensitivity to touch (allodynia)
and increased pain sensitivity (sensitization), especially in the face, back of
the head, and neck (Lawler et al., 2006). Research shows that 80% of people
with migraines also experience neck pain. This is more common than nausea,
another common migraine symptom. Neck pain can worsen migraines and make
medication less effective. It can also be triggered by tension in the neck
muscles. Studies have shown that people with migraines have imbalances in their
neck muscles, especially when they do activities that require force. Migraines
affect about 10-12% of the population and can significantly impact their
ability to work, live, and participate in social activities (Carvalho et al.,
2020; Luedtke et al., 2020; Ferracini et al., 2017).
Both pharmaceutical and
non-pharmacological treatments are available to reduce headache episodes their
frequency and intensity. Pharmacological therapy appears to be effective for
prophylaxis and some acute cases. However, occasionally treatment is
unsuccessful or has negative effects, and some patients end up with chronic
illnesses. Chronic headaches increase the number of medical visits and can even
result in drug overuse headache, which costs the healthcare system expense.
Physiotherapy, which includes many modalities such aerobic exercise, manual
therapy, electric stimulation, therapeutic pain neuroscience education, and
relaxation therapy, is a non-pharmacological treatment for migraine (Lipton et
al., 2008). After reviewing the literature, more than 90% of patients reporting
migraine have cervical musculoskeletal dysfunction (Carvalho et al., 2020).
Despite the prevalence, functional impairment, and economic consequences of
migraine sufferers, there is a substantial gap in the literature exists,
failing to provide sufficient and high-quality evidence to effectively guide
the conservative management of migraine (Luedtke et al., 2020). From a clinical
perspective, considering the diversity of the contributing factors to migraine,
a multimodal treatment might be considered as an effective therapeutic option.
Nevertheless, there is a lack of randomized clinical trials evaluating the
efficacy of this approach. Therefore, this research aimed to investigate the
effects of a multimodal approach on various clinical outcomes in migraine.
Reference
Benatto MT, Florencio
LL, Bragatto MM, Dach F, Fernandez-de-las-Penas C, Bevilaqua-Grossi D. 2022.
Neck-specific strengthening exercise compared with placebo sham ultrasound in
patients with migraine: a randomized controlled trial. BMC Neurology 22(1).
https://doi.org/10.1186/s12883-022-02650-0
Bevilaqua-Grossi D,
Goncalves MC, Carvalho GF, Florencio LL, Dach F, Speciali JG, Bigal ME, Chaves
TC. 2016. Additional Effects of a Physical Therapy Protocol on Headache
Frequency, Pressure Pain Threshold, and Improvement Perception in Patients with
Migraine and Associated Neck Pain: A Randomized Controlled Trial. Archives of
Physical Medicine and Rehabilitation 97(6), 866–874.
https://doi.org/10.1016/j.apmr.2015.12.006
Carvalho GF, Schwarz A,
Szikszay TM, Adamczyk WM, Bevilaqua-Grossi D, Luedtke K. 2020. Physical therapy
and migraine: musculoskeletal and balance dysfunctions and their relevance for
clinical practice. Brazilian Journal of Physical Therapy 24(4), 306–317.
https://doi.org/10.1016/j.bjpt.2019.11.001
Cutrer F. 2010.
Pathophysiology of Migraine. Seminars in Neurology 30(02), 120–130.
https://doi.org/10.1055/s-0030-1249222
De Almeida Tolentino G,
Lima Florencio L, Ferreira Pinheiro C, Dach F, Fernandez-de-las-Penas C,
Bevilaqua-Grossi D. 2021. Effects of combining manual therapy, neck muscle
exercises, and therapeutic pain neuroscience education in patients with
migraine: a study protocol for a randomized clinical trial. BMC Neurology 21(1).
https://doi.org/10.1186/s12883-021-02290-w
Dittrich SM, Gunther V,
Franz G, Burtscher M, Holzner B, Kopp M. 2008. Aerobic Exercise with
Relaxation: Influence on Pain and Psychological Well-being in Female Migraine
Patients. Clinical Journal of Sport Medicine 18(4), 363–365.
https://doi.org/10.1097/jsm.0b013e31817efac9
Espi-Lopez GV,
Ruescas-Nicolau MA, Nova-Redondo C, Benitez-Martinez JC, Dugailly PM, Falla D.
2018. Effect of Soft Tissue Techniques on Headache Impact, Disability, and
Quality of Life in Migraine Sufferers: A Pilot Study. The Journal of
Alternative and Complementary Medicine 24(11), 1099–1107.
https://doi.org/10.1089/acm.2018.0048
Fernandez-de-las-Penas
C, Cuadrado M, Pareja J. 2006. Myofascial Trigger Points, Neck Mobility and
Forward Head Posture in Unilateral Migraine. Cephalalgia 26(9), 1061–1070.
https://doi.org/10.1111/j.1468-2982.2006.01162.x
Ferracini GN, Chaves
TC, Dach F, Bevilaqua-Grossi D, Fernández-de-Las-Penas C, Speciali JG. 2017.
Analysis of the cranio-cervical curvatures in subjects with migraine with and
without neck pain. Physiotherapy 103(4), 392–399.
https://doi.org/10.1016/j.physio.2017.03.004
Ghorbani A, Chitsaz A.
2011. Comparison of validity and reliability of the Migraine disability
assessment (MIDAS) versus headache impact test (HIT) in an Iranian population.
Iranian Journal of Neurology 10(3-4), 39–42.
Gupta A, Kumar S, Gupta
A, Rishi P. 2022. Effect of aerobic exercises and therapeutic pain neuroscience
education on disability, pain, head posture and QOL in migraine patients.
Comparative Exercise Physiology 19(2), 1–8. https://doi.org/10.3920/cep220029
International Headache
Society. 2018. Headache Classification Committee of the International Headache
Society (IHS) The International Classification of Headache Disorders, 3rd
edition. Cephalalgia 38(1), 1–211. https://doi.org/10.1177/0333102417738202
Lawler SP, Cameron LD. 2006.
A randomized, controlled trial of massage therapy as a treatment for migraine.
Annals of Behavioral Medicine 32(1), 50–59.
https://doi.org/10.1207/s15324796abm3201_6
Lemstra M, Stewart B,
Olszynski WP. 2002. Effectiveness of Multidisciplinary Intervention in the
Treatment of Migraine: A Randomized Clinical Trial. Headache: The Journal of
Head and Face Pain 42(9), 845–854.
https://doi.org/10.1046/j.1526-4610.2002.02202.x
Lipton RB, Bigal ME,
Ashina S, Burstein R, Silberstein S, Reed ML, Serrano D, Stewart WF. 2008.
Cutaneous allodynia in the migraine population. Annals of Neurology 63(2),
148–158. https://doi.org/10.1002/ana.21211
Luedtke K, Starke W,
Korn K, Szikszay TM, Schwarz A, May A. 2020. Neck treatment compared to aerobic
exercise in migraine: A preference-based clinical trial. Cephalalgia Reports 3,
251581632093068. https://doi.org/10.1177/2515816320930681
Mosallanezhad Z,
Rezaeian T, Ahmadi M, Nourbakhsh M. 2021. The impact of myofascial release and
stretching techniques on the clinical outcomes of migraine headache: A
randomized controlled trial. Journal of Research in Medical Sciences 26(1), 45.
https://doi.org/10.4103/jrms.jrms_745_18
Munoz-Gomez E, Ingles
M, Serra-Ano P, Espi-Lopez GV. 2021. Effectiveness of a manual therapy protocol
based on articulatory techniques in migraine patients. A randomized controlled
trial. Musculoskelet Sci Pract 54, 102386.
https://doi.org/10.1016/j.msksp.2021.102386
Piovesan EJ, Di Stani
F, Kowacs PA, Mulinari RA, Radunz VH, Utiumi M, Muranka EB, Giublin ML, Werneck
LC. 2007. Massaging over the greater occipital nerve reduces the intensity of
migraine attacks: evidence for inhibitory trigemino-cervical convergence
mechanisms. Arq Neuropsiquiatr 65(3A), 599–604.
https://doi.org/10.1590/s0004-282×2007000400010
Rendas-Baum R, Bloudek
LM, Maglinte GA, Varon SF. 2012. The psychometric properties of the
Migraine-Specific Quality of Life Questionnaire version 2.1 (MSQ) in chronic
migraine patients. Quality of Life Research 22(5), 1123–1133.
https://doi.org/10.1007/s11136-012-0230-7
Rezaeian T,
Mosallanezhad Z, Nourbakhsh MR, Ahmadi M, Nourozi M. 2019. The Impact of Soft
Tissue Techniques in the Management of Migraine Headache: A Randomized
Controlled Trial. Journal of Chiropractic Medicine 18(4), 243–252.
https://doi.org/10.1016/j.jcm.2019.12.001
Ruschel MAP, Jesus OD.
2023. Migraine Headache (In StatPearls.). StatPearls Publishing.
https://www.ncbi.nlm.nih.gov/books/NBK560787/
Sharpe L, Dudeney J,
Williams AC, Nicholas M, McPhee I, Baillie A, Welgampola M, McGuire B. 2019.
Psychological therapies for the prevention of migraine in adults. Cochrane
Database of Systematic Reviews. https://doi.org/10.1002/14651858.cd012295.pub2
Simons DG. 2008. New
Views of Myofascial Trigger Points: Etiology and Diagnosis. Archives of Physical
Medicine and Rehabilitation 89(1), 157–159.
https://doi.org/10.1016/j.apmr.2007.11.016
Sohn JH, Choi HC, Lee
SM, Jun AY. 2010. Differences in cervical musculoskeletal impairment between
episodic and chronic tension-type headache. Cephalalgia 30(12), 1514–1523.
https://doi.org/10.1177/0333102410372096
Tsai CT, Hsieh LF, Kuan
TS, Kao MJ, Chou LW, Hong CZ. 2010. Remote Effects of Dry Needling on the
Irritability of the Myofascial Trigger Point in the Upper Trapezius Muscle.
American Journal of Physical Medicine & Rehabilitation 89(2), 133–140.
https://doi.org/10.1097/phm.0b013e3181a5b1bc
Yan J, Melemedjian OK,
Price TJ, Dussor G. 2012. Sensitization of Dural Afferents Underlies
Migraine-Related Behavior following Meningeal Application of Interleukin-6
(IL-6). Molecular Pain 8, 1744–80698–6. https://doi.org/10.1186/1744-8069-8-6
