Neck-specific strengthening exercise compared with placebo sham ultrasound in patients with migraine: a randomized controlled trial

Abstract

Background Migraine patients have musculoskeletal disorders and pain in the cervical. And, despite the pathophysiology demonstrating the relationship between migraine and the cervical spine, the effectiveness of craniocervical exercises in these patients has not been verified. So, the aimed of this study was verify the effectiveness of craniocervical muscle-strengthening exercise (CMSE) in reducing the frequency and intensity of headache in migraine patients. Methods A two-armed, parallel-group randomized controlled trial with a 3-month follow-up was performed. For eight weeks, the volunteers in the intervention group (n = 21) performed a protocol of CMSE, while those in the sham ultrasound group (n = 21) received the application of disconnected therapeutic ultrasound in the upper trapezius and guideline for home-stretching. The primary outcomes were the frequency and intensity of the headache. The secondary outcomes were questionnaires about migraine and neck disability, and satisfaction with the treatment, cervical range of motion, the pressure pain threshold, craniocervical flexion test (CCFT), cervical muscle strength and endurance test, and the cervical muscle activity during the physical tests. Results No differences were observed for the changes observed in primary outcomes after eight weeks and at the 3-months follow up (p > 0.05). For the secondary outcomes, craniocervical exercises improved the sensitivity of the frontal muscle (p = 0.040) and promoted a reduced amplitude of muscle activity of the anterior scalene and upper trapezius in the last stages of CCFT (p ≤ 0.010). There was also reduced muscle activity of the anterior scalene and splenius capitis in the endurance test (p ≤ 0.045), as evaluated by surface electromyography. Conclusion CMSE were insufficient in reducing the frequency and intensity of headache, improving the performance of the cervical muscles, or reducing migraine and neck pain-related disabilities. This was found despite a decreased electromyographic activity of the cervical muscles during the last stages of CCFT and increased median frequency during the endurance test. Trial registration Accession code RBR-8gfv5j, registered 28/11/2016 in the Registro Brasileiro de Ensaios Clínicos (ReBEC).

Exercise interventions in migraine patients: a YouTube content analysis study based on grades of recommendation

“…However, more research regarding the effects of resistance training for migraine treatment is needed to reduce the uncertain evidence in these patients. Moreover, strengthening of the neck muscles appears to be ineffective for reducing migraine pain, obtaining a C grade of recommendation against this intervention ( Benatto et al, 2022 ).…”

“…However, the current classification into grades of recommendation has shown that neck strengthening is not an effective intervention for migraine pain improvement, with a C grade of recommendation. Only one study evaluated the efficacy of neck strengthening in migraine treatment ( Benatto et al, 2022 ). If research in this field progresses, the grade of recommendation could change in the future.…”

What is the efficacy of aerobic exercise versus strength training in the treatment of migraine? A systematic review and network meta-analysis of clinical trials

“…Page 2 of 12 Woldeamanuel and Oliveira The Journal of Headache and Pain (2022) 23:134 type of planned, structured, and repetitive movement/ physical activity performed to improve and/or maintain one or more components of physical fitness (e.g., aerobic fitness, muscle strength, etc.) [5,6] provides therapeutic effects on migraine [7][8][9][10]. Several clinical trials have demonstrated the efficacy of exercise interventions in the management of migraine [10][11][12][13][14][15][16].…”

“…[5,6] provides therapeutic effects on migraine [7][8][9][10]. Several clinical trials have demonstrated the efficacy of exercise interventions in the management of migraine [10][11][12][13][14][15][16]. However, the exercise interventions involved different types of exercise modalities, i.e., aerobic exercise (highintensity aerobic exercise, moderate-intensity aerobic exercise), strength training, or even multimodal exercise training (i.e., aerobic, strength, flexibility) protocols [10][11][12][13][14][15][16][17].…”

Comment regarding: what is the efficacy of aerobic exercise versus strength training in the treatment of migraine? A systematic review and network meta‑analysis of clinical trials

“…The data used from a study by Varkey et al included the mean differences in attack frequency instead of monthly migraine days [ 3 ]. Similarly, the data incorporated from another report by Benatto et al comprised the mean differences in headache frequency instead of monthly migraine days [ 4 ].…”