A Neuroscience Perspective of Physical Treatment of Headache and Neck Pain

Castien, René; Hertogh, Willem De

doi:10.3389/fneur.2019.00276

Cited by 51 publications

(42 citation statements)

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“…The pathophysiological mechanism of migraine is still not fully understood, but sensitization of the trigemino-cervical complex has been suggested to play an important role [14–18]. Bartsch and Goadsby [19] showed convergence of nociceptive afferent input by cervical dorsal roots of C1–C3 and trigeminal afferent input onto second-order neurons at the trigemino-cervical complex.…”

Section: Introductionmentioning

confidence: 99%

Manual therapy as a prophylactic treatment for migraine: design of a randomized controlled trial

Amons¹,

Castien²,

Wouden³

et al. 2019

Trials

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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.

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Section: Introductionmentioning

confidence: 99%

Manual therapy as a prophylactic treatment for migraine: design of a randomized controlled trial

Amons¹,

Castien²,

Wouden³

et al. 2019

Trials

Self Cite

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“…The interrelation of neck pain and migraine might be explained by the concept of the trigemino-cervical complex (TCC), which suggests that peripheral sensitization of trigemino-cervical neurons may influence central nociception by a potential convergence of cervical and dural nociceptive afferents in the caudal nuclei of the trigeminal nerves in the brain stem [17][18][19] . Myofascial trigger points (mTrPs) in migraineurs could be regarded key components related to muscular pain and hyperalgesia as well as headache symptoms, and mTrPs have shown to respond positively to local treatment and, thus, could be promising sites for targeted intervention [20][21][22][23][24][25] . Hence, mTrPs in the neck and shoulder region seem to be a gateway to enter and influence the TCC with the aim of achieving symptom alleviation in migraineurs 20 .…”

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confidence: 99%

Alleviation of migraine symptoms by application of repetitive peripheral magnetic stimulation to myofascial trigger points of neck and shoulder muscles – A randomized trial

Renner

Sollmann

Heinen

et al. 2020

Sci Rep

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Migraine is a burdensome disease with an especially high prevalence in women between the age of 15 and 49 years. Non-pharmacological, non-invasive therapeutic methods to control symptoms are increasingly in demand to complement a multimodal intervention approach in migraine. Thirty-seven subjects (age: 25.0 ± 4.1 years; 36 females) diagnosed with high-frequency episodic migraine who presented at least one active myofascial trigger point (mTrP) in the trapezius muscles and at least one latent mTrP in the deltoid muscles bilaterally prospectively underwent six sessions of repetitive peripheral magnetic stimulation (rPMS) over two weeks. Patients were randomly assigned to receive rPMS applied to the mTrPs of the trapezius (n = 19) or deltoid muscles (n = 18). Whereas the trapezius muscle is supposed to be part of the trigemino-cervical complex (TCC) and, thus, involved in the pathophysiology of migraine, the deltoid muscle was not expected to interfere with the TCC and was therefore chosen as a control stimulation site. The headache calendar of the German Migraine and Headache Society (DMKG) as well as the Migraine Disability Assessment (MIDAS) questionnaire were used to evaluate stimulation-related effects. Frequency of headache days decreased significantly in both the trapezius and the deltoid group after six sessions of rPMS (trapezius group: p = 0.005; deltoid group: p = 0.003). The MIDAS score decreased significantly from 29 to 13 points (p = 0.0004) in the trapezius and from 31 to 15 points (p = 0.002) in the deltoid group. Thus, rPMS applied to mTrPs of neck and shoulder muscles offers a promising approach to alleviate headache frequency and symptom burden. Future clinical trials are needed to examine more profoundly these effects, preferably using a sham-controlled setting. According to the Global Burden of Disease Study more than one billion people were suffering from migraine in 2016, making migraine one of the most prevalent neurological disorders worldwide 1. Especially women between the age of 15 and 49 years are concerned-in this group migraine is also the first cause of disability worldwide 1-4. Further, migraineurs show a considerably reduced health-related quality of life (QoL) and considerable loss in work productivity 5-7. The high impact of migraine on QoL is reflected by percentages as high as 85%

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“…Sensitization of the trigeminocervical nucleus appears to be a common feature in migraine, TTH and CGH [31]. Although such sensitization may have arisen through different means in each of the headache forms, desensitization of this nucleus by manual therapy and exercise may theoretically be a viable treatment option [12].…”

Section: Introductionmentioning

confidence: 99%

Effectiveness of Mulligan manual therapy over exercise on headache frequency, intensity and disability for patients with migraine, tension-type headache and cervicogenic headache – a protocol of a pragmatic randomized controlled trial

Satpute

Bedekar

Hall

2021

BMC Musculoskelet Disord

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Background Non - pharmacological management of migraine, tension-type headache (TTH), and cervicogenic headache (CGH) may include spinal manual therapy and exercise. Mulligan Manual Therapy (MMT) utilizes a protocol of headache elimination procedures to manage headache parameters and associated disability, but has only been evaluated in CGH. There is little evidence for its effectiveness in migraine and TTH. This study aims to determine the effectiveness of MMT and exercise over exercise and placebo in the management of migraine, TTH, and CGH. Methods This pragmatic trial is designed as a prospective, three-armed randomised controlled trial in a clinical setting provided at a general hospital physiotherapy department. Two hundred ninety-seven participants with a diagnosis of migraine, TTH or CGH based on published headache classification guidelines will be included. An assessor blind to group allocation will measure outcomes pre-and post-intervention as well as 3 and 6 months after commencement of treatment. Participants will be allocated to one of the three groups: MMT and exercise; placebo and exercise; and exercise alone. The primary outcome measure is headache frequency. Secondary outcome measures are headache duration and intensity, medication intake, pressure pain threshold (PPT), range of motion recorded with the flexion rotation test, and headache disability recorded with Headache Activities of Daily Living Index (HADLI). The intention-to-treat principle will be followed for statistical analysis. Between groups differences for all outcome measures at baseline and at reassessment points and 95% confidence intervals will be calculated using a mixed model ANOVA. Post hoc tests will be conducted to identify any significant difference between groups and over time. Discussion This pragmatic study will provide evidence for the effectiveness of MMT when compared with a placebo intervention and exercise on headache frequency, intensity, and disability. Limitations are that baseline evaluation of headache parameters may be affected by recall bias. External validity will be limited to the population with a minimum 1-year history of headache. The HADLI is not yet extensively evaluated for its psychometric properties and association between PPT and headache parameters is lacking. Performance bias is inevitable as a single therapist will be delivering all interventions. Trial registration The trial was registered prospectively under the Clinical Trial Registry India (Registration number: CTRI/2019/06/019506, dated on 03/06/2019). .

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A Neuroscience Perspective of Physical Treatment of Headache and Neck Pain

Cited by 51 publications

References 93 publications

Manual therapy as a prophylactic treatment for migraine: design of a randomized controlled trial

Manual therapy as a prophylactic treatment for migraine: design of a randomized controlled trial

Alleviation of migraine symptoms by application of repetitive peripheral magnetic stimulation to myofascial trigger points of neck and shoulder muscles – A randomized trial

Effectiveness of Mulligan manual therapy over exercise on headache frequency, intensity and disability for patients with migraine, tension-type headache and cervicogenic headache – a protocol of a pragmatic randomized controlled trial

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