Additional effect of physical therapy to medication treatment in reducing the frequency and intensity of migraine: a randomized controlled trial

Migraine is related to disorders of the cervical spine structures, afferent impulses that location can be facilitators or even triggers pain. Treatments with cervical manipulation alone and combined medication have been tested, but results are conflicting. The aim of this study was to evaluate the additional effect of physical therapy to drug treatment of migraine in frequency, intensity and duration of headache. Women with migraine were included, aged 18 to 55 years, with a minimum of 06 days of pain per month and report of pain in the craniocervical region. Fifty women were equally randomized to one of the two treatment groups, Physiotherapy Group (manual therapy and medication) and control group (medication). The diagnosis of migraine was performed according to the International Classification of headache by a single neurologist. All subjects received similar medications. 12 sessions of manual therapy, twice per week, during for 50 minutes, were done by same physical therapist. The assessment, revaluation and follow-up were blind. The primary endpoints of frequency, intensity and duration of headache were evaluated through diary pain, and secondary endpoints like pain threshold pressure (algometer), headache related disability (Migraine disability assessment program) and cervical spine (Neck disability index), patient Health Questionnaire eight- item depression scale (PHQ-8), with the severity of Allodynia Sympton Checklist (ASC-12) and patients Global Impression of Change Scale to assess satisfaction and perception of patient changes as its disease condition. The analysis was by intention to treat and we used the linear mixed effects model. To assign the clinical relevance Effect size (ES) and Minimum important change (MID) were used. No differences between groups were observed at baseline. The PG showed a 37% reduction in the frequency of headache days compared to GC showed that 22 % (p<0.05 to ES0.4) and (p<0.05 to ES0.3) respectively. No clinically significant differences were observed between groups regarding the duration and intensity of the headache. Significant increase (p<0.05) pain threshold pressure was also observed, as well as greater satisfaction and changing perception of the disease to the patient (p<0.05) in the PG compared with the CG. No significant differences were observed in the other parameters. The reduction of the pain threshold of cervical muscles with physical therapy promoted a beneficial additional effect to medication, with greater reduction in frequency of headache days and greater satisfaction and perceived improvement of patients. REBEC no RBR - 6kvx74 (AU)