The effectiveness of physiotherapy on migraines has been studied. Carrying out studies on physiotherapy is not easy because there are a variety of approaches, succeeding depends on the patient’s co-operation and there is no placebo. (See this post). Studies that have been carried to date show that some approaches are as effective as preventive medications. Physiotherapy may play an important role in the treatment of headaches.

Migraine is a neurological disease. How can physiotherapy have an impact on migraine?

The neck contains ligaments, muscles, joints, and tendons. All of these structures can cause pain. The pain networks of the head and neck are connected. (LINKIN 401). Neck pain can therefore trigger migraines in some people. Pain can in turn cause reflex muscle tension. When the muscle is persistently contracted, it can develop what are called “trigger points». This may create a vicious circle. 

Persistent pain makes the brain more irritable. Painful thresholds are reduced, and the person becomes more sensitive to pain. This process is called sensitization. Both nerves and the brain structures can become sensitized.

Some people suffering from migraine may get better by breaking this neck pain vicious circle (See this post). The same principles apply to the jaw and eye muscles. 

Are there different approaches to physiotherapy?

Absolutely. Given the different mechanisms involved, various approaches can be considered. Here’s a list:

Physiotherapy approachObjective
Manual therapyFocuses on the structural connections between the head and neck
Therapeutic exercises /Postural approachStrengthen and stretches neck and shoulder muscles that are considered a cornerstone in the treatment of headaches
Temporomandibular rehabilitationWorks on the jaw and associated muscles, treats bruxism and swallowing disorders 
Cranial approachFocuses on the skull and cranial nerves
Oculomotor rehabilitationWorks on muscle dysfunctions associated with eye movements (convergence)
Dry needlingReduces muscle tension by acting on trigger points
TENS (electrotherapy)Modulates nerves electrically to influence pain networks

Is one approach better than another?

The approaches have often been studied individually, without comparing them. People living with migraine are all unique and each person will react differently to the various therapeutic approaches. The current trend suggests that the best approach is to focus on treating specific dysfunctions that were identified during the assessment and use the appropriate technique. 

A person who reports having regular migraine attacks after reading a few pages will require a careful evaluation of the reading posture and eye movements. Another person could complain about headache and neck pain after certain movements, for which suitable exercises may be recommended.

How personalized should the assessment and treatment be?

There is no standardized protocol. Different aspects were considered more important than others by an international group of experts, but a detailed assessment of each of the aspects would be too cumbersome. Your physiotherapist will use clinical judgement to determine which tests are relevant and which approach should be used. 

What can I expect from a physiotherapy assessment for migraine?

You should expect to make a variety of body and eye movements, including strength and range of motion testing. Head, neck and shoulders will be examined as well as your jaw and mouth. Some neurological tests will be performed. You will be asked questions about different aspects of your health, medications and lifestyle. The evaluation might be limited during a migraine attack. 

How can I find a skilled physiotherapist?

All physiotherapists are not experts at headache management. Choosing a physiotherapist with experience in the treatment of headaches is important. 

Look for training certificates in manual therapy, cranial therapy, TMJ physio etc. A professional who masters different approaches may be better able to tailor the treatment plan to you. A thorough evaluation is a good sign. Be cautious if only passive approaches (TENS, ultrasound, needling) are recommended. Long term improvement will usually require some active efforts on your part. 

Once the assessment is done, different treatments will be proposed, including exercises. To learn more about this, read our article! (See this post)

References

[1] Luedtke K, Allers A, Schulte LH, May A. Efficacy of interventions used by physiotherapists for patients with headache and migraine-systematic review and meta-analysis. Cephalagia 2016;36:474-92.

[2] Luedtke K, Boissonnault W, Caspersen, 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

[3] Fernandez-de-las-Penas C, Chaitow L, Schoenen J. Multidisciplinary Management of Migraine. 2013; Jones & Bartlett Learning.

[4] von Piekartz H. Craniofacial Pain: Neuromusculoskeletal Assessment, Treatment and Management. 2007; Butterworth-Heinemann. 

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