Influence of hydrotherapy on clinical and cardiac autonomic function in migraine patients

Abstract

Background:Migraine is associated with autonomic symptoms. The growing body of literature suggests that the dysfunctional autonomic nervous system might play a pivotal role in the pathogenesis of migraine. Thermal therapies have been hypothesized to modulate these changes and alleviate pain. However, data regarding the efficacy of hydrotherapy in migraine remain scant. We evaluated the effect of add on hydrotherapy procedure (a hot arm and foot bath with ice massage to head) in migraine patients.Methods:Forty chronic migraine patients fulfilling the International Classification of Headache Disorders II criteria were recruited from the neurology outpatient clinic. Patients were randomized to receive either hydrotherapy plus conventional pharmacological care (n = 20) or conventional medication only (n = 20). Hydrotherapy group received treatment with hot arm and foot bath (103°F to 110°F) and ice massage to head daily for 20 min for 45 days. Patients were assessed using headache impact test (HIT), visual analog scale for pain and cardiac autonomic function by heart rate variability (HRV) before and after intervention period.Results:There was a significant decrease in HIT score, frequency, and intensity of headaches following treatment in both the groups. However, it was more evident in add on hydrotherapy group compared to pharmacological treatment alone group. There was also significant improvement in the HRV parameters. In particular, there was a significant decrease in heart rate (P = 0.017), increase in high frequency (HF) (P = 0.014) and decrease in low frequency/HF ratio (P = 0.004) in add on hydrotherapy group.Conclusion:Our study shows that add on hydrotherapy enhanced the vagal tone in addition to reducing the frequency and intensity of headaches in migraine patients.

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“…However, as it is not possible to have a total resection of this tumor at a microscopic level, localized radiotherapy at a dose of 40 to 50 Gy is recommended postoperatively. 5 Metastases are seen less frequently and prognosis of calvarial EWS is better than those seen in other areas. 5 When a combination treatment of total excision, radiation, and standard chemotherapy regimen which involves application of vincristine, cyclophosphamide, doxorubicin/ifosfamide, and etoposide; survival in 5-year follow-up ranges from 39 to 65%.…”

“…EWS is a tumor mostly seen in in children and young adults with a peak incidence between ages 5 to 13 years. 5 It is a highly malignant bone tumor 5 that is the second most common primary bone cancer in childhood. Annual incidence of EWS in United State was 2.93 per 1 million between the years 1973 and 2004.…”

“…4 EWS mostly infiltrates frontal, parietal, temporal bones and skull base with the most common involvement being parieto-occipital region. 5 Squamous and petrous part of temporal, ethmoid, and mastoid bone are less frequently observed localizations of the tumor. 3 EWS typically grows extradurally and often reaches a very large size before dural invasion, or clinical detection, or both.…”

“…8 On plain X-ray imaging, calvarial EWS has a lytic appearance with mottling and erosion. 5 Computed tomography (CT) and magnetic resonance imaging (MRI) imaging may show the extent of tumor into the dura and brain parenchyma. 5 On MRI, the tumor is hypoisointense on T1-weighted images and isohyperintense on T2-weighted slices.…”

Giant Calvarial Ewing's Sarcoma: A Case Report

“…EWS is a tumor mostly seen in in children and young adults with a peak incidence between ages 5 to 13 years. 5 It is a highly malignant bone tumor 5 that is the second most common primary bone cancer in childhood. Annual incidence of EWS in United State was 2.93 per 1 million between the years 1973 and 2004.…”