The Impact of Soft Tissue Techniques in the Management of Migraine Headache: A Randomized Controlled Trial

Myofascial trigger points therapy increases neck mobility and reduces headache pain in migraine patients - pilot study

BACKGROUND

This study aimed to evaluate the effects of Ischemic Compression Myofascial Trigger Points (IC-MTrPs) therapy, applied mainly to the upper trapezius muscle (UTM), on: [1] cervical spine range of motion (CS-ROM), and [2] headache characteristics in migraine patients. Reduced CS-ROM can further contribute to musculoskeletal strain and neurological discomfort in migraine sufferers. The application of IC-MTrPs therapy is of particular interest because it targets these trigger points, potentially normalizing muscle tone and improving local blood flow, which may alleviate pain and restore mobility.

DESIGN

A case series employing a repeated-measures design; pilot study.

METHODS

Fifty-three adult female migraine patients were classified into three groups: episodic migraine without aura (MO, n = 31), episodic migraine with aura (MA, n = 15), and chronic migraine (CM, n = 7). Patients underwent seven sessions of IC-MTrPs therapy targeting the shoulder and neck muscles. Assessments were conducted across five sessions: pre-therapy (baseline), post-1st therapy, post-4th therapy, post-7th therapy, and at a 1-month follow-up. Outcome measures included: CS-ROM (assessed using an accelerometer system), subjective headache pain intensity (evaluated via the Visual Analog Scale (VAS)), and calcitonin gene-related peptide (CGRP) concentrations.

RESULTS

CS-ROM for horizontal rotation and forward flexion improved significantly at the 1-month follow-up compared to pre-therapy (baseline) (P < 0.05). Headache intensity during a migraine attacks, as well as headache frequency and duration, significantly decreased at post-7th therapy compared to baseline across all patients (P < 0.05). The highest CGRP concentrations were recorded in CM patients (240.73 ± 79.51 ng/ml). While no significant changes in CGRP levels were observed in patients with MO, CGRP concentration in patients with MA increased significantly at the 1-month follow-up compared to baseline, rising from 151.70 ± 50.85 ng/ml to 176.17 ± 77.21 ng/ml. In patients with CM, the therapy did not result in statistically significant changes in CGRP levels, although reductions in headache frequency and intensity were noted.

CONCLUSIONS

IC-MTrPs therapy proved effective in increasing CS-ROM and alleviating headache characteristics in all migraine subtypes. However, no significant changes in CGRP levels were observed. Distinct characteristics and responses among different migraine subtypes highlight the need for tailored therapeutic approaches.

TRIAL REGISTRATION

The study protocol was retrospectively registered on December 2, 2022, as a clinical trial in the international clinical trial database ClinicalTrials.gov (identifier: NCT05646160).

CLINICAL TRIAL NUMBER

not applicable.

2023 U.S. Department of Veterans Affairs and U.S. Department of Defense Clinical Practice Guideline for the Management of Headache

DESCRIPTION

Headache medicine and therapeutics evidence have been rapidly expanding and evolving since the 2020 U.S. Department of Veterans Affairs (VA) and U.S. Department of Defense (DoD) clinical practice guideline (CPG) for the management of headache. Therefore, the CPG was revised in 2023, earlier than the standard 5-year cycle. This article reviews the 2023 CPG recommendations relevant to primary care clinicians for treatment and prevention of migraine and tension-type headache (TTH).

METHODS

Subject experts from the VA and the DoD developed 12 key questions, which guided a systematic search using predefined inclusion and exclusion criteria. After reviewing evidence from 5 databases published between 6 March 2019 and 16 August 2022, the work group considered the strength and quality of the evidence, patient preferences, and benefits versus harms on critical outcomes before making consensus recommendations.

RECOMMENDATIONS

The revised CPG includes 52 recommendations on evaluation, pharmacotherapy, invasive interventions, and nonpharmacologic interventions for selected primary and secondary headache disorders. In addition to triptans and aspirin-acetaminophen-caffeine, newer calcitonin gene-related peptide (CGRP) inhibitors (gepants) are options for treatment of acute migraine. Medications to prevent episodic migraine (EM) include angiotensin-receptor blockers, lisinopril, magnesium, topiramate, valproate, memantine, the newer CGRP monoclonal antibodies, and atogepant. AbobotulinumtoxinA can be used for prevention of chronic migraine but not EM. Gabapentin is not recommended for prevention of EM. Ibuprofen (400 mg) and acetaminophen (1000 mg) can be used for treatment of TTH, and amitriptyline for prevention of chronic TTH. Physical therapy or aerobic exercise can be used in management of TTH and migraines.

Comparison of Craniosacral Therapy and Myofascial Relaxation Techniques in People with Migraine Headache: A Randomized Controlled Study

Objective

The primary objective of this study was to investigate the impact of myofascial release and craniosacral therapy on the quality of life, pain levels, and range of motion (ROM) in patients with chronic migraine headaches. The secondary aim of this study was to develop a migraine treatment protocol using current craniosacral techniques.

Methods

Patients with chronic migraine in the Neurology Department of ALKU Hospital were randomly allocated to 3 therapy groups: (1) Craniosacral Treatment Craniosacral Techniques (CST) + Medical Treatment (MT) (CST group) (n = 24), (2) myofascial treatment (MFT) (n = 24) + MT (MFT group), and (3) MT (control group) only (n = 26). Visual Analog Scale (VAS) for pain, FONSECA for temporomandibular disorder symptom intensity, 24 Hours Quality of Life Questionnaire Scales for quality of life, and Migraine Disability Assessment Score for impairment, Goniometer for Cervical ROM were used for the disability level. Follow-up scores were collected 4 times: at pretreatment (T0), immediately post-treatment (T1), 1 month (T2), and 3 months after treatment ended (T3).

Results

Changes were found in T0 to T1 treatment results, VAS, and ROM angles between the groups. In intragroup evaluations, 24 Hours Quality of Life Questionnaire changes were observed only in the CST group at T0 to T1 to T2 periods (P = .011) while Migraine Disability Assessment Score scores were significantly changed in all groups. Significant changes were also observed in both VAS scores and FONSECA scores of the CST and MFT groups whereas VAS scores decreased significantly, especially in the T0 to T1 to T2 to T3 periods (P < .05). In the evaluation of FONSECA scores both within and between groups, it was observed that the most significant decrease was in the T2 period and there was a difference between the groups (P = .015).

Conclusion

For the participants in this study, CST and MFT techniques reduced migraine headache, temporomandibular disorder level, drug consumption, and functional disability levels, and increased cervical region ROM. These results suggest that CST techniques could be considered in migraine treatment as one of the clinical practical applications within the framework of a certain protocol.

Myofascial Trigger Points therapy decreases myotonometric tone and stiffness of trapezius muscle, benefits headaches and muscle pain in migraine

BACKGROUND

Migraine is a primary headache disorder. Studies have shown that 93% of people with migraine have an increased number of active Ischemic Compression Myofascial Trigger Points (IC-MTrPs) therapy.

OBJECTIVE

To examine the effects of the IC-MTrPs therapy on: (1) mechanical properties of the upper trapezius muscle (UTM), (2) shoulder girdle and neck (SGN) muscles pain and (3) headaches characteristics in episodic migraine patients without aura.

METHODS

Thirty-one adult, female, migraine patients without aura underwent seven IC-MTrPs therapy sessions and were tested during maximally five measurement sessions (pre- and post-1'st, post-4'th, post-7'th therapy and 1-month follow-up). Myotonometric measurements of the UTM's tone, stiffness and elasticity, subjective SGN muscles pain, as well as headache's level, frequency and duration were analyzed.

RESULTS

Myotonometric tone and stiffness of the UTM significantly decreased in post-1'st, post-4'th therapy and in 1-month follow-up measurements versus pre-1'st therapy testing session. The scores for the SGN muscles' pain significantly decreased: (i) in post-4'th and post-7'th therapy versus post-1'st therapy session, and (ii) in post-7'th versus post-4'th therapy measurements. Headache's level, frequency and duration significantly decreased in post-7'th therapy versus pre-1'st therapy measurement session.

CONCLUSION

IC-MTrPs therapy resulted in a decrease of upper trapezius muscle tone and stiffness, with simultaneous alleviation of shoulder girdle and neck muscle pain and the headaches characteristics in episodic migraine patients without aura.

The impact of myofascial release and stretching techniques on the clinical outcomes of migraine headache: A randomized controlled trial

Background

Migraine patients often have painful trigger points, especially in the area of head and neck. Thus, we aimed to investigate the effect of myofascial release and stretching techniques in the management of migraine headache.

Materials and Methods

This was a randomized controlled trial study on 40 migraine patients. The subjects in the experimental group received three sessions with a duration of 20 min per session techniques. Databases were analyzed using 2 × 3 repeated-measures analyses of variance (P < 0.05).

Results

Experimental group showed a significant reduction in pain intensity (P < 0.001) and the neck disability index score (P < 0.001) and an increase in cervical range of motion (P < 0.001) in all time points after the intervention as compared with baseline and control group (P < 0.001).

Conclusion

Myofascial release and stretching techniques were effective in improving symptoms in patients with migraine headache.