Changes and Associations between Cervical Range of Motion, Pain, Temporomandibular Joint Range of Motion and Quality of Life in Individuals with Migraine Applying Physiotherapy: A Pilot Study

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.

Effects of Integrating Jaw Opening and Closing Movements with Active Neck Exercises in the Management of Chronic Non-Specific Neck Pain: A Randomized Controlled Trial

Background and Objectives: It has been seen that jaw opening is associated with neck extension and jaw closing is associated with neck flexion. This natural association between the jaw and neck can be used as a novel approach to treat chronic non-specific neck pain, although the effects of this concept have never been previously evaluated as a treatment strategy. This article intends to study the effects of integrating jaw opening and closing movements along with active neck exercises versus active neck exercises alone in the management of chronic non-specific neck pain. Materials and Methods: A total of 80 patients, aged 20 to 50, with chronic non-specific neck pain were included in a double-blind randomized controlled trial, conducted at the Sindh Institute of Physical Medicine and Rehabilitation, Karachi, Pakistan from 2018 to 2022. The patients were divided into two groups: Group A patients were assigned jaw movements with active neck exercises, while Group B patients were assigned only active neck exercises. Both groups were assigned isometric strengthening exercises and self-resisted strengthening exercises for cervical spine muscles as a home plan. The study used various outcome measures, including the numerical pain rating scale (NPRS), neck disability index (NDI), neck flexion endurance (NFE), neck extension endurance (NEE), the neck proprioception error (NPE): neck flexion proprioception error (NFPE), neck extension proprioception error (NEPE), neck right rotation proprioception error (NRRPE), and neck left rotation proprioception error (NLRPE), with measurements taken at week 1 and week 6, respectively; the mean differences between the groups were measured using a two-way repeated ANOVA. Results: The experimental group showed better improvements compared to the control group, NPRS (73%), NDI (57%), NFE (152%), NEE (83%), NFPE (58%), NEPE (65%), NRRPE (65%), and NLRPE (62%), with a significant difference (p < 0.05). Conclusions: Active neck extension and flexion movements combined with jaw opening and closing are more effective in reducing pain and disability, improving neck muscles endurance and normalizing neck proprioception in patients with chronic neck pain.

Occurrence of Cervical Spine Pain and Its Intensity in Young People with Temporomandibular Disorders

Background: The main aim of this cross-sectional study was to compare the occurrence and severity of cervical spine pain in young adults diagnosed with TMDs with a healthy control group (without TMDs). Methods: The study was conducted from June to July 2023. Inclusion criteria were age (18-30 years), cervical spine pain (for at least 1 month), and consent to participate in the study. The study was conducted based on RDC/TMD protocol, an original questionnaire, and a physiotherapeutic examination focused on detecting TMDs. The cervical pain level was assessed using the Visual Analogue Scale (VAS). Thus, a total of 95 subjects were registered for the trials, 51 people (53.7%) constituted the control group (without TMDs), while 44 (46.3%) people constituted the study group (with TMDs). Results: The mean age of people participating in the study was 22.2 ± 2.2 years in the study group and 22.5 ± 3.1 years in the control group. The largest group was people aged 21-25 (n = 51 people, 53.7%). Patients from the study group more often experienced pain in the stomatognathic system during palpation (both in the muscle, joint, and musculoskeletal groups) and had reduced mobility of the temporomandibular joints in every movement (p < 0.001). People from the study group were also characterized by less mobility of the cervical spine (p < 0.05), apart from extension movement (p > 0.05). The analysis showed that of the 95 people participating in the study, 85.4% reported problems in the cervical spine area (n = 81), of which almost all people in the study group struggled with this problem (n = 43, 97.7%). It was found that cervical spine pain was significantly more common in people with TMDs (p < 0.05, chi2 = 10.118, df = 1, rc = 0.31). The level of pain was significantly higher in people from the study group (p < 0.001, chi2 = 45.765, df = 4, rc = 0.57). Conclusions: Our research has shown that the occurrence of cervical spine pain is more common in the group of young people with temporomandibular disorders (TMDs). In young people, this problem is rarely recognized and properly treated.

Non-Pharmacological Treatment for Chronic Migraine

PURPOSE OF REVIEW

Chronic migraine (CM) affects a large proportion of the population and is a significant source of disability and lost productivity. Numerous non-pharmacological approaches have been attempted during the past decades. This review discusses the most recent and evidence-based advances in acute and preventive non-pharmacological therapeutic approaches for CM, offering alternatives to drug treatment.

RECENT FINDINGS

A growing number of non-pharmacological treatment options, including non-invasive or invasive neuromodulation, acupuncture, psychotherapy, and physiotherapy, have shown promising efficacy in CM. There is strong evidence for the effectiveness of non-invasive neuromodulation such as transcranial magnetic stimulation, transcranial direct current stimulation, and transcutaneous electrical nerve stimulation (TENS) in CM, but less evidence for approaches such as invasive neuromodulation, physical therapy, or dietary approaches. Acupuncture for migraine remains controversial, with the main point of contention still being the placebo effect. Non-pharmacological approaches can be offered as a reliable alternative for patients with CM, and more research is being done to evaluate the efficacy of non-invasive neuromodulation with different parameters and the combination of different treatments in CM.

Effects on neuromodulation, acupuncture, and aerobic exercises on migraine and tension-type headache outcomes: A systematic review and meta-analysis

BACKGROUND

Headache disorders are common diseases that cause a social burden. This systematic review and meta-analysis aimed to evaluate the effects of various non-pharmacological treatments to address or prevent acute headaches, including neuromodulation, acupuncture, and aerobic exercises in patients with episodic migraine and tension-type headache (TTH).

METHODS

We performed a systematic search of the electronic databases PubMed, Cochrane Library, Embase, China National Knowledge Infrastructure, WANFANG MEDICINE ONLINE, and Chinese Medical Journal database using Stata/SE 14.0 to obtain weighted mean differences (WMDs). The outcomes included monthly headache days, headache intensity, headache duration, days per month of acute medication use, and the Medical Outcomes Study 36-Item Short-Form Health Survey.

RESULTS

Of 872 identified articles, 27 were included in the meta-analysis. Neuromodulation was associated with reduced headache days (WMD: -1.274, 95% CI [-1.914, -0.634], P < .001), duration (WMD: -2.2, 95% CI [-3.32, -0.107], P < .001) and medication consumption (WMD: -1.808, 95% CI [-2.546, -1.071], P < .001) in cases of migraine. Acupuncture was associated with the alleviation of headache days (WMD: -0.677, 95% CI [-0.932, -0.422], P < .001) and intensity (WMD: -0.893, 95% CI [-1.573, -0.212], P = .01) in cases of migraine and acute medication use (WMD: -3.29, 95% CI [-4.86, -1.72], P < .001) in cases of TTH. Aerobic exercise was associated with reduced headache duration (WMD: -5.1, 95% CI [-8.97, -1.22], P = .01) in cases of TTH. The risk of bias for included articles was moderate.

CONCLUSIONS

There is low- and moderate-quality evidence that neuromodulation, acupuncture, and aerobic exercises are associated with attenuated headache symptoms in patients with episodic migraine or TTH. However, high-quality studies are needed to draw more detailed conclusions.

[Effectiveness of physiotherapeutic treatment interventions on pain intensity, duration, frequency, and quality of life of patients with migraine : A systematic review]

BACKGROUND

According to the current guidelines preventive treatment of migraine should consist of a combination of pharmacological and nonpharmacological forms of treatment. Physiotherapeutic modalities could be an option for nonpharmacological migraine management.

OBJECTIVE

The aim was to assess the efficacy of physiotherapeutic interventions on pain intensity, duration and frequency as well as the quality of life of patients with migraine.

METHODS

A systematic literature search was carried out in four databases: the Physiotherapy Evidence Database (PEDro), Web of Science, Medline via PubMed and the Cochrane Library. Randomized controlled trials (RCTs) that were published up to the end of July 2021 and examined the effectiveness of physiotherapeutic treatment in migraine patients were eligible for inclusion. Studies that did not examine an adult population, interventions not carried out by a physiotherapist or not reporting an appropriate outcome were excluded. The assessment of the risk of bias was carried out with the revised version of the Cochrane risk of bias tool 2.0. A descriptive and quantitative synthesis using mean difference with a random effects model and 95% confidence intervals were used.

RESULTS

The present review included 13 RCTs reporting on a total of 595 patients. The risk of bias was high for four studies, low for two studies and the remaining seven studies had some concerns. The interventions examined were multimodal physiotherapy programs, various mobilization techniques, trigger point therapy, manual lymphatic drainage, massage and various stretching techniques. All interventions examined had a significantly positive effect on the selected parameters compared to the baseline values. Especially combinations of various physiotherapeutic modalities showed clinically relevant results.

CONCLUSION

The evidence suggests that multimodal physiotherapy treatment is a good supplement to medication and should therefore be considered as a nonpharmacological treatment for patients with migraine; however, further RCTs with a low risk of bias are necessary in order to confirm the effectiveness with high quality evidence.