BackgroundPeople with migraine often experience disability with serious consequences for their social life and work productivity. The pharmacological prophylactic management of migraine is effective in reducing migraine attacks. However, many people are reluctant to use daily prophylactic medication, leading to a demand for non-pharmacological treatment options. We present the design for and discuss the feasibility of a pragmatic, randomized controlled trial on the effectiveness of a multimodal manual therapy (MT) treatment compared to usual care by the general practitioner (GP) for the prophylactic treatment of migraine.MethodsEligible participants will be recruited in primary care using the International Classification of Headache Disorders III criteria for migraine of the International Headache Society. Participants will be randomized to either multimodal MT treatment or usual care provided by the GP. GPs will be asked to treat the usual care group according to the Dutch GP guideline for headache. The multimodal MT intervention will include manual pressure techniques, neck muscle-strength exercises and mobilization of the cervical and thoracic spine.The trial will consist of a 12-week treatment period and follow-up measurements at 12, 26 and 52 weeks. The primary outcome measure is the number of migraine days per 4 weeks, assessed with a headache diary. Secondary outcome measures are the number of migraine attacks, medication use, disability due to headache, headache intensity, number of participants reporting a 50% migraine reduction, measurement of cervical pressure pain thresholds, presence of allodynia, endurance of cervical flexor muscles, days of absence of work and global perceived effect.DiscussionThe results of the trial will show whether a multimodal MT intervention is an effective non-pharmacological treatment option for people with migraine.Trial registrationDutch Trial Register, NL7504. Registered on 7 February 2019.
Background: Manual pressure in the upper cervical spine is used to provoke and reduce the familiar migraine headache. Information is scarce on the segmental levels, myofascial structure provocation, and reduction occurrences. The required dosage (amount of pressure, number of repetitions, and duration) has not been objectified yet. Methods: Prospective observational study. Thirty patients with migraine were examined interictally. Manual pressure was applied at four sites: the posterior arch of C1, the articular pillar of C2, the rectus capitis posterior major muscle, and the obliquus capitis inferior muscle, bilaterally. On sites where the familiar headache was provoked, the pressure was sustained to induce pain reduction (three repetitions). Provocation of familiar headache (yes/no), headache intensity (numerical pain rating scale), time to obtain a reduction of the headache (seconds), and applied pressure (g/cm2) were recorded. Results: Provocation of the familiar headache occurred at the posterior arches C1 in 92%, and at one of the articular pillars of C2 in 65.3% of cases. At one of the rectus capitis major muscles, the familiar headache was provoked in 84.6% of cases; at one of the oblique capitis inferior muscles, the familiar headache was provoked in 76.9% of cases. The applied mean pressure ranged from 0.82 to 1.2 kg/cm2. Maintaining the pressure reduced headache pain intensity significantly between the start and end of each of the three consecutive trials (p < 0.04). This reduction occurred faster in the third application than in the first application (p = 0.03). Conclusion: Manual pressure at upper cervical segments provokes familiar referred migraine headaches, with low manual pressure. Maintaining the pressure reduces the referred head pain significantly, indicating modulation of central nociceptive transmission.
Background Manual pressure techniques are used in the upper cervical spine to provoke and reduce the familiar headache in patients with migraine. So far, information is scarce on which segmental levels and myofascial structures provocation and reduction occur. Also, the required dosage (amount of pressure, number of repetitions and duration) has not been objectified yet. Therefore, we assessed the controlled application of manual pressure to provoke and reduce headache in patients with migraine. Methods Thirty patients with migraine were examined interictally. Manual pressure was applied at four sites being the posterior arch of C1, the articular pillar of C2, the Rectus Capitis Posterior Major muscle and the Obliquus Capitis Inferior muscle, bilaterally. Pressure was constantly measured via force sensors. On sites where the familiar headache was provoked, the pressure was sustained to induce pain reduction. This was repeated three times. Provocation of familiar headache (yes/no), headache intensity (numerical pain rating scale), time to obtain reduction of the headache (seconds) and applied pressure (g/cm²) were recorded. Results Provocation of the familiar headache occurred on at least one of the posterior arches in 92 % of cases, one of the articular pillars of C2 in 65.3%, one of the Rectus Capitus Major muscles in 84.6% and one of the Oblique Capitis Inferior muscles in 76.9%. The applied mean pressure ranged from 0.82 kg/cm² to 1.2 kg/cm2 across all measurements. Maintaining the pressure resulted in a significant reduction in headache pain intensity between the start and the end of each of three consecutive trials (p<0.04). This reduction was obtained more rapidly in the third application than in the first application (p=0.03).Conclusion Manual pressure at the upper cervical segments provokes familiar referred headache in migraine, with a low pressure. Maintaining the pressure reduces the referred head pain significantly, indicating modulation of central nociceptive transmission. The underlying neurophysiological mechanisms need to be further elucidated.
Background: People with migraine often experience disability with serious consequences for social life and work productivity. The pharmacological prophylactic management of migraine is effective in reducing migraine attacks. However, many people are reluctant to use daily prophylactic medication, leading to a demand for non-pharmacological treatment options. We present the design and discuss the feasibility of a pragmatic, randomized controlled trial on the effectiveness of a multimodal manual therapy (MT) treatment compared to usual care by the general practitioner (GP) for the prophylactic treatment of migraine. Methods: Eligible participants will be recruited in primary care using the International Classification of Headache Disorders III criteria for migraine of the International Headache Society. Participants will be randomized to either multimodal MT treatment or usual care provided by the GP. GPs will be asked to treat the usual care group according to the Dutch GP guideline for headache. The multimodal MT intervention will include manual pressure techniques, neck muscle-strength exercises, and mobilization of the cervical and thoracic spine. The trial will consist of a 12 weeks treatment period and follow-up measurements at 12, 26 and 52 weeks. The primary outcome measure is the number of migraine days per four weeks, assessed with a headache diary. Secondary outcome measures are the number of migraine attacks, medication use, disability due to headache, headache intensity, number of participants reporting a 50% migraine reduction, measurement of cervical pressure pain thresholds, presence of allodynia, endurance of cervical flexor muscles, days of absence of work and global perceived effect. Discussion: The results of the trial will show if a multimodal MT intervention is an effective non-pharmacological treatment option for people with migraine. Trial registration: 7 February 2019 Dutch Trial Register (NL7504) Keywords: manual therapy, migraine, manual pressure techniques
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