Physiotherapy has been studied for its potential to improve migraine, despite the challenges in conducting such studies due to the variety of approaches and the reliance on patient cooperation without a placebo option. Some studies suggest that physiotherapy can be as effective as preventive medications in managing migraine. By focusing on neck structures involved in migraine, such as muscles and joints, physiotherapy aims to disrupt pain cycles and reduce sensitivity, potentially improving migraine frequency and severity.
How Physiotherapy Impacts Migraine
Although migraine is primarily a neurological condition, the neck’s structures, such as ligaments, muscles, joints, and tendons, can influence migraine pain. Neck pain can trigger migraine, creating a cycle or ping pong effect where pain leads to muscle tension and the formation of “trigger points,” which can perpetuate the pain. This cycle can increase the brain’s sensitivity to pain, a process known as sensitization, affecting both nerves and brain structures. Breaking this cycle through physiotherapy may help reduce migraine frequency and severity.
Approaches to Physiotherapy
Various physiotherapy approaches can target different aspects of migraine-related pain:
- Manual Therapy: Focuses on structural connections between the head and neck.Therapeutic Exercises/Postural Approach: Strengthens and stretches neck and shoulder muscles.
- Temporomandibular Rehabilitation: Addresses jaw and associated muscle issues, treating bruxism and swallowing disorders.
- Cranial Approach: Targets the skull and cranial nerves.
- Oculomotor Rehabilitation: Works on muscle dysfunctions related to eye movements.
- Dry Needling: Reduces muscle tension by acting on trigger points.
- Transcutaneous electrical nerve stimulation (TENS) (Electrotherapy): Uses electrical modulation to influence pain networks.
Personalizing Physiotherapy
There is no one-size-fits-all approach in physiotherapy for migraine. Individual responses vary, and the best approach often involves treating specific dysfunctions identified during a personalized assessment. For example, someone with migraine triggered by reading might need a detailed evaluation of their reading posture and eye movements, while another person might need exercises tailored to their neck and shoulder movements.
Physiotherapy Assessment for Migraine
A comprehensive physiotherapy assessment will include various tests and questions:
- Body and eye movements, including strength and range of motion tests.
- Examination of the head, neck, shoulders, jaw, and mouth.
- Neurological tests.
- Questions about health, medications, and lifestyle.
This assessment might be limited during an active migraine attack.
Finding a Skilled Physiotherapist
Not all physiotherapists specialize in headache management. To find a skilled physiotherapist:
- Look for certifications in manual therapy, cranial therapy, TMJ (temporomandibular joint) physiotherapy, etc.
- Choose a physiotherapist experienced in treating headache.
- Be wary of professionals who only recommend passive treatments (TENS, ultrasound, needling). Long-term improvement usually requires active patient participation.
Conclusion
Physiotherapy can play a significant role in managing migraine by addressing neck pain and related muscle issues. A personalized approach, tailored to individual needs and dysfunctions, can help break the cycle of pain and potentially reduce the frequency and severity of migraine attacks.
For more information, see our post on physiotherapy exercises for migraine.
References:
- Luedtke K, et al. Efficacy of interventions used by physiotherapists for patients with headache and migraine-systematic review and meta-analysis. Cephalalgia 2016;36:474-92.
- Luedtke K, et al. International consensus on the most useful physical examination tests used by physiotherapists for patients with headache: A Delphi study. Man Ther 2016;23:17-24.
- Fernandez-de-las-Penas C, et al. Multidisciplinary Management of Migraine. 2013; Jones & Bartlett Learning.
- von Piekartz H. Craniofacial Pain: Neuromusculoskeletal Assessment, Treatment and Management. 2007; Butterworth-Heinemann.
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