title: Additional Effects of a Physical Therapy Protocol on Headache Frequency, Pressure Pain Threshold, and Improvement Perception in Patients With Migraine and Associated Neck Pain: A Randomized Controlled Trial.
abstract: To evaluate the additional effect provided by physical therapy in migraine treatment.
  
  
  
  Randomized controlled trial.
  
  
  
  Tertiary university-based hospital.
  
  
  
  Among the 300 patients approached, 50 women (age range, 18-55y) diagnosed with migraine were randomized into 2 groups: a control group (n=25) and a physiotherapy plus medication group (n=25) (N=50).
  
  
  
  Both groups received medication for migraine treatment. Additionally, physiotherapy plus medication patients received 8 sessions of physical therapy over 4 weeks, comprised mainly of manual therapy and stretching maneuvers lasting 50 minutes.
  
  
  
  A blinded examiner assessed the clinical outcomes of headache frequency, intensity, and self-perception of global change and physical outcomes of pressure pain threshold and cervical range of motion. Data were recorded at baseline, posttreatment, and 1-month follow-up.
  
  
  
  Twenty-three patients experienced side effects from the medication. Both groups reported a significantly reduced frequency of headaches; however, no differences were observed between groups (physiotherapy plus medication patients showed an additional 18% improvement at posttreatment and 12% improvement at follow-up compared with control patients, P>.05). The reduction observed in the physiotherapy plus medication patients was clinically relevant at posttreatment, whereas clinical relevance for control patients was demonstrated only at follow-up. For pain intensity, physiotherapy plus medication patients showed statistical evidence and clinical relevance with reduction posttreatment (P<.05). In addition, they showed better self-perception of global change than control patients (P<.05). The cervical muscle pressure pain threshold increased significantly in the physiotherapy plus medication patients and decreased in the control patients, but statistical differences between groups were observed only in the temporal area (P<.05). No differences were observed between groups regarding cervical range of motion.
  
  
  
  We cannot assume that physical therapy promotes additional improvement in migraine treatment; however, it can increase the cervical pressure pain threshold, anticipate clinically relevant changes, and enhance patient satisfaction.
authors.affiliation: Ribeirao Preto Medical School, Department of Biomechanics, Medicine and Locomotor Aparattus Rehabilitation, University of São Paulo, Ribeirao Preto, SP, Brazil. Electronic address: deborabg@fmrp.usp.br.
authors.forename: Débora
authors.initials: D
authors.lastname: Bevilaqua-Grossi
authors.affiliation: Physiotherapy School, University of Maranhao Center, Sao Luis, MA, Brazil.
authors.forename: Maria Claudia
authors.initials: MC
authors.lastname: Gonçalves
authors.affiliation: Ribeirao Preto Medical School, Department of Biomechanics, Medicine and Locomotor Aparattus Rehabilitation, University of São Paulo, Ribeirao Preto, SP, Brazil.
authors.forename: Gabriela Ferreira
authors.initials: GF
authors.lastname: Carvalho
authors.affiliation: Ribeirao Preto Medical School, Department of Biomechanics, Medicine and Locomotor Aparattus Rehabilitation, University of São Paulo, Ribeirao Preto, SP, Brazil.
authors.forename: Lidiane Lima
authors.initials: LL
authors.lastname: Florencio
authors.affiliation: Ribeirao Preto Medical School, Department of Neuroscience and Behavioral Sciences, University of São Paulo, Ribeirao Preto, SP, Brazil.
authors.forename: Fabíola
authors.initials: F
authors.lastname: Dach
authors.affiliation: Ribeirao Preto Medical School, Department of Biomechanics, Medicine and Locomotor Aparattus Rehabilitation, University of São Paulo, Ribeirao Preto, SP, Brazil.
authors.forename: José Geraldo
authors.initials: JG
authors.lastname: Speciali
authors.affiliation: Global Clinical Development, Teva Pharmaceutical Industries, Frazer, PA.
authors.forename: Marcelo Eduardo
authors.initials: ME
authors.lastname: Bigal
authors.affiliation: Ribeirao Preto Medical School, Department of Biomechanics, Medicine and Locomotor Aparattus Rehabilitation, University of São Paulo, Ribeirao Preto, SP, Brazil.
authors.forename: Thaís Cristina
authors.initials: TC
authors.lastname: Chaves
mesh_terms: D000293:Adolescent; D000328:Adult; D000700:Analgesics / Q000627:therapeutic use*; D001945:Breathing Exercises / Q000379:methods; D002574:Cervical Vertebrae / Q000503:physiopathology*; D005260:Female; D006801:Humans; D008875:Middle Aged; D008881:Migraine Disorders / Q000150:complications / Q000628:therapy*; D026201:Musculoskeletal Manipulations / Q000379:methods*; D019547:Neck Pain / Q000209:etiology / Q000628:therapy*; D017288:Pain Threshold; D026741:Physical Therapy Modalities; D016059:Range of Motion, Articular; D016037:Single-Blind Method; D061028:Trigger Points / Q000503:physiopathology; D055815:Young Adult
chemical_list: D000700:Analgesics
keywords: Controlled clinical trial; Headache; Rehabilitation