Neuroscience Education as Therapy for Migraine and Overlapping Pain Conditions: A Scoping Review

Minen, Mia T.; Kaplan, Kayla; Akter, Sangida; Espinosa-Polanco, Mariana; Guiracocha, Jenny; Khanns, Dennique; Corner, Sarah; Roberts, Timothy

doi:10.1093/pm/pnab131

Cited by 13 publications

(5 citation statements)

References 69 publications

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“…The PT þ PNE group had a reduction in neck pain days at follow-up which was not observed in the PT group. This indicates that understanding the pathophysiology strengthens self-efficacy (41), an effect previously demonstrated for other chronic pain conditions following PNE (37,65).…”

Section: Discussionsupporting

confidence: 72%

“…Furthermore, the correlation between the migraine quiz results and headache frequency improvement might be explained by reduced migraine-related fear and modified pain cognitions. In other pain conditions, this has been reported to evoke a “desensitization of overactive alarm systems” and brain areas involved in pain (43,59) and positively influenced emotions and thoughts (37). The one-to-one setting used in this current study allowed to take into account the individual behavioral, psychological, and environmental factors that may contribute to a specific patient’s pain experience and persistence.…”

Section: Discussionmentioning

confidence: 99%

“…Previous research highlighted the added value of combining PT with PNE (37,64,65), therefore this approach was chosen for the current study. The reasoning behind this combination was to modify pain “bottom-up” (by reducing nociceptive afferents) as well as “top-down” through PNE (activating endogenous pain modulation) (66).…”

Section: Discussionmentioning

confidence: 99%

“…Although education in general has been shown to be an important component of migraine management (36), the effectiveness of PNE has not been evaluated in migraine populations. Only recently, a scoping review highlighted that there is a lack of PNE studies in migraine populations (37).…”

Section: Introductionmentioning

confidence: 99%

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Additional effects of pain neuroscience education combined with physiotherapy on the headache frequency of adult patients with migraine: A randomized controlled trial

2023

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Aim To assess the efficacy of pain neuroscience education combined with physiotherapy for the management of migraine. Background Physiotherapy can significantly reduce the frequency of migraine, but the evidence is based only on a few studies. Pain neuroscience education might pose a promising treatment, as it addresses migraine as a chronic pain disease. Methods In this non-blinded randomized controlled trial, migraine patients received physiotherapy + pain neuroscience education or physiotherapy alone, preceded by a three-month waiting period. Primary outcomes were frequency of headache (with and without migraine features), frequency of migraine and associated disability. Results Eighty-two participants were randomized and analyzed. Both groups showed a decrease of headache frequency (p = 0.02, d = 0.46) at post-treatment (physiotherapy: 0.77 days, 95%CI: −0.75 to 2.29 and physiotherapy + pain neuroscience education: 1.25 days, 95%CI: −0.05 to 2.55) and at follow-up (physiotherapy: 1.93, 95%CI: 0.07 to 3.78 and physiotherapy + pain neuroscience education: 3.48 days, 95%CI: 1.89 to 5.06), with no difference between groups (p = 0.26, d = 0.26). Migraine frequency was reduced significantly in the physiotherapy + pain neuroscience education group, and not in the physiotherapy group, at post-treatment (1.28 days, 95%CI: 0.34 to 2.22, p = 0.004) and follow-up (3.05 days, 95%CI: 1.98 to 5.06, p < 0.0001), with a difference between groups at follow-up (2.06 days, p = 0.003). Migraine-related disability decreased significantly in both groups (physiotherapy: 19.8, physiotherapy + pain neuroscience education: 24.0 points, p < 0.001, d = 1.15) at follow-up, with no difference between groups (p = 0.583). Secondary outcomes demonstrated a significant effect of time with no interaction between time and group. No harm or adverse events were observed during the study. Conclusion In comparison to physiotherapy alone, pain neuroscience education combined with physiotherapy can further reduce the frequency of migraine, but had no additional effect on general headache frequency or migraine-related disability. Trial Registration The study was pre-registered at the German Clinical Trials Register (DRKS00020804).

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Section: Discussionsupporting

confidence: 72%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Additional effects of pain neuroscience education combined with physiotherapy on the headache frequency of adult patients with migraine: A randomized controlled trial

2023

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“…Therefore, initially, one of the functions of the physical therapist is to educate the individual about their condition. Individuals need to be the protagonists of their treatment and education aims to increase their knowledge about their health condition, the treatment options, the risks of excessive use of medication, how lifestyle interferes in the onset of crises, the importance of self-care and, in some cases, it is necessary to demystify limiting beliefs 12,13 . These education programs can be carried out individually or in groups, and their delivery formats are diverse, such as dialogues, pamphlets, booklets, e-books, and/or videos.…”

mentioning

confidence: 99%

Physiotherapy for headaches: current situation and challenges in Brazil

DeSantana,

Dantas

2022

BRJP

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Since millennia before Christ there are records about headaches, which was once related to magic or religion, until it reached medical and scientific knowledge 1,2 . Currently, the worldwide prevalence of active headaches reaches 52%, representing a common and almost universal human complaint throughout history 3 . Headaches, according to the International Classification of Headache Disorders, correspond to a group of disorders that affect the head region, with more than 200 categorized types, which can belong to three distinct groups: primary headaches, secondary headaches and the group that includes painful cranial neuropathies, other facial pains and other headaches 4 . In ancient times, there was belief that headaches were caused by evil spirits that took over the bodies, so the treatment used initially consisted of trepanning the skulls, so that these spirits would leave the body 2 . With the advent of technology, and also human evolution, the treatments have been adapted. Nowadays, there are pharmacological and non-pharmacological treatment options for headaches 4 . There are several kinds of pharmacologic options, the choice of which depends on the type of headache, its clinical presentation, the presence or absence of comorbidities, the individual's preferences, and the expertise of the professional who is accompanying the patient. Some of the pharmacological options cited in studies are: changes in lifestyle, physical exercise, mindfulness, cognitive-behavioral therapy and/or other psychotherapeutic interventions and physical therapy modalities [5][6][7] . In general, for headache treatments, especially chronic ones, the involvement of multiprofessional teams (doctors, dentists, physical therapists, psychologists, physical education professionals, nutritionists, among others) 6 is recommended. Specifically regarding the work of physiotherapists in Brazil, there is still no common denomination of specialty recognized by the Conselho Federal de Fisioterapia e Terapia Ocupacional (Federal Council of Physiotherapy and Occupational Therapy) for physiotherapists who work in this area of head and neck disorders, as some call it. Others use the terms buccomaxillofacial, craniocervicomandibular and/or craniomandibular. Although this specialty is not yet recognized, studies have already pointed out evidence of several physiotherapeutic approaches as beneficial in specific types of headaches, especially in cases of cervicogenic headache (the most prevalent secondary headache), tension headache, and migraines (the most prevalent primary headache) [7][8][9][10] . The great objective of most individuals is to get rid of the headache. However, sometimes, and thinking mainly about primary headaches, it is not possible to guarantee that the headache will disappear, but only that periods of remission can exist. Therefore, the goal of physical therapists working in this area should be to reduce the frequency, intensity, and duration of pain, as well as to prevent crisis, reduce disability and the impact caused by headaches...

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