Physical therapy and migraine: musculoskeletal and balance dysfunctions and their relevance for clinical practice

Abstract

Background: Migraine is a primary headache with high levels of associated disability that can be related to a variety of symptoms and comorbidities. The role of physical therapy in the management of migraine is largely unknown. Therefore, the aim of this review is to highlight and critically discuss the current literature and evidence for physical therapy interventions in individuals with migraines. Methods: A narrative review of the literature was performed. Results: Physical therapists assessing and treating patients with migraine should focus on two primary aspects: (1) musculoskeletal dysfunctions, and (2) vestibular symptoms/postural control impairment. Signs and symptoms of musculoskeletal and/or vestibular dysfunctions are prevalent among individuals with migraines and different disability levels can be observed depending on the presence of aura or increment of the migraine attacks. Conclusion: A proper physical examination and interview of the patients will lead to a tailored treatment plan. The primary aim regarding musculoskeletal dysfunctions is to reduce pain and sensitization, and physical therapy interventions may include a combination of manual therapy, exercise therapy, and education. The aim regarding postural control impairment is to optimize function and reduce vestibular symptoms, and interventions should include balance exercises and vestibular rehabilitation. However, consistent evidence of benefits is still lacking due to the lack of and therefore need for tailored and pragmatic clinical trials with high methodological quality.

A pilot study on non-invasive treatment of migraine: The self-myofascial release

“…Therefore, this could support the hypothesis that SMFR could become an important technique to manage altered balance that is one of the accompanying symptoms. 28 Values detected for cervical ROM showed a lightly trend in increase for the left rotation (p= 0.09). It is known that migraine is associated with muscle pain in the neck region and patient who suffered of this disorder adopt an antalgic posture modifying the cranio-cervical posture.…”

Predicting the outcome of the greater occipital nerve block – an observational study on migraine patients with and without musculoskeletal cervical impairment

“…Peripheral and central sensitisation are states of the nervous system that are frequently discussed in relation to chronic pain conditions including migraine (52–54) and altered sensory responses of migraine patients in the cervical musculoskeletal region have been reported (6,55,56). In the previous stratification study (22), a correlation was found between headache frequency and pain provocation on palpation indicating that patients with a pain response were more affected.…”

The presence of aura is not related to changes in the cervical performance and mobility of patients with migraine

“…The presence of pain and dysfunction in the cervical area are often veri ed in patients with migraine. [1][2][3][4] Evidence has shown that these patients present a reduction of the cervical range of motion, 4-8 motor control alterations and changes in the performance of the cervical muscles. 9,10 However these aspects may not be equally observed for all migraineurs.…”

“…It is established that patients with chronic migraine present a greater prevalence of neck dysfunction including articular, muscular and sensitivity aspects compared to episodic migraine. 3,[8][9][10] According to the International Headache Society, 11 migraine can also be classi ed according to the presence of aura. This phenomena is present in one-third of the patients, preceding or accompanying a migraine attack.…”