Neck treatment compared to aerobic exercise in migraine: A preference-based clinical trial

Abstract

Objectives: The main objective of this study was to compare the effectiveness of aerobic exercise with physiotherapy. A second objective was to evaluate whether patients with pain referred to the head during manual palpation will benefit more from physiotherapy than patients with local or no pain. Methods: A total of 103 patients with migraine received physiotherapy ( n = 79) or supervised aerobic exercise ( n = 24) according to their preference as an add-on treatment. Both groups had the same contact time with a specialized physiotherapist. The primary outcome measure was headache frequency during the 4 weeks after the intervention. Eighty-seven patients were analyzed at the primary end point ( n = 69 in the physiotherapy group; n = 18 in the aerobic exercise group). A follow-up assessment was conducted 3 months after the final intervention. Results: During the initial assessment of the upper cervical spine, 17 patients reported no pain, 45 local pain, and 25 referred pain to the head. Patients in the physiotherapy group had a mean reduction of 1.8 days (standard deviation (SD) 6.07), while patients in the aerobic exercise group had a mean reduction of 1.2 days (SD 4.27) at the primary end point. This difference was not statistically significant ( p = 0.8). The largest improvement was noted in the group that showed referred pain to the head and received physiotherapy (2.13 days (SD 7.82)). Only patients in the physiotherapy group reported a subjectively perceived general improvement. Conclusions: Patients had a strong preference for physiotherapy. Both groups showed small reductions in headache frequency. Effects were superior after physiotherapy but not statistically significant. Patients with pain referred to the head responded best to a physiotherapy intervention.

Minimal important change and responsiveness of the Migraine Disability Assessment Score (MIDAS) questionnaire

“…Our results need to be considered in relation to the sample characteristics [ 9 ]. Since included patients presented chronic or high frequent episodic migraine, the MIC values are likely to be smaller than for patients with lower migraine frequency.…”

“…This study is a secondary analysis of a published preference-based clinical trial, which aimed to assess the effectiveness of non-pharmacological interventions based on physiotherapy and aerobic exercise in patients with migraine [ 9 ]. A total of 103 patients with chronic migraine or frequent episodic migraine received physiotherapy ( n = 79) or supervised aerobic exercise ( n = 24) according to their preference as an add-on to the pharmacological treatment.…”

“…Among selected primary and secondary outcomes, the MIDAS and the global rating of self-perceived change (GRoC) were included. Further details on study treatment and outcomes can be found in the published report [ 9 ].…”

“…The total score is composed by the sum of the five items [ 1 ]. In the clinical trial, patients completed the questionnaire at all four timepoints using a one-month recall period for the MIDAS [ 9 ], as also suggested and employed in previous research trials [ 4 , 5 ].…”

Cervical musculoskeletal impairments in migraine

“…However, systematic reviews have found very limited evidence to support the use of cervical interventions in these patients [ 7 , 8 ]. Despite this lack of evidence, a recent study revealed that most migraine patients preferred cervical interventions (manual therapy and exercise) over aerobic exercise in addition to usual migraine treatment [ 9 ]. Unfortunately, even recent trials of spinal manipulation [ 10 ] and multimodal cervical interventions [ 9 , 11 ] have failed to demonstrate any benefit for the migraine population.…”