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De Hertogh W1, Michiels S1, Truijen S1, Van daele L1, Vanbaelen E1, De Pauw J1, Amons A2, Castien R2,3
1University of Antwerp, Rehabilitation Sciences and Physiotherapy, Antwerp, Belgium, 2Headache Center Haarlemmermeer, Hoofddorp, Netherlands, 3VU Medical Center, General Practice and Elderly Care Medicine. Amsterdam Public Health Research Institute, Amsterdam, Netherlands
Background: Migraine is a common primary headache disorder with a high personal and socio-economic impact. In chronic migraine, i.e. when patients experience two or more migraine attacks per month, prophylactic treatment is recommended. This to reduce the number of migraine attacks. Prophylactic treatment is largely pharmacological. It is however not always efficient and side effects such as fatigue and dizziness are reported frequently. This has led to a growing demand for non-pharmacological prophylactic treatments, including physical therapy.
Musculoskeletal physical therapy can be considered as a prophylactic treatment since evidence is emerging that it may reduce the frequency and intensity of migraine. Manual Pressure Techniques (MPT) are relatively new techniques where a continuous pressure is applied to provoke the familiar headache and is consequently maintained until the provoked headache disappears. The dosage of MPT (amount of pressure, number of repetitions and duration) to obtain this provocation and reduction has not been objectified yet.
Purpose: To verify if MPT can provoke the familiar headache and upon maintaining the pressure can result in a decrease hereof. Additionally to objectify the required dosage.
Methods: Fifteen patients with chronic migraine received MPT on the atlanto-occipital and C2-C3 segment, the rectus capitis posterior minor and obliquus capitis muscles. The amount of pressure applied by the therapist during MPT was constantly measured using Force Sensing Resistor-sensors registered by CAPTIV software. In 8 patients the MPT were maintained (max 120 seconds) and repeated (three trials). Before and after the MPT, Pressure Pain Thresholds (PPT) on the trapezius, thenar and anterior tibial muscles were measured to investigate sensitisation as an underlying mechanism.
Results: Familiar headache was provoked in all patients during MPT. The peak intensity of the provoked headache ranged from 1 to 9 points on a scale of 10 points (Median score: 4/10 points).
The applied pressure during the MPT was relatively low (1557g/cm2 to 1814 g/cm2) and remained stable throughout the application (less than 20% change).
Maintaining the MPT resulted in a significant decrease of the headache in all patients (p 0.05). This decrease occurred faster in the three consecutive trials (p .024). No significant changes in PPT were recorded after the application of MPT.
Conclusion(s): This pilot study demonstrates the therapeutic potential of MPT for patients with migraine. Future clinical trials with larger patient samples and multiple MPT applications are needed to confirm these results and to analyse the underlying working mechanism.
Implications: Since many patients with migraine look for non-pharmacological treatment options, this is of high clinical value. If confirmed in future studies MPT can be a valuable treatment option for patients with migraine.
Keywords: Migraine, Manual Therapy, Treatment
Funding acknowledgements: We gratefully acknowledge Miss Schaerlaken Evi for her help with our data analysis.
Musculoskeletal physical therapy can be considered as a prophylactic treatment since evidence is emerging that it may reduce the frequency and intensity of migraine. Manual Pressure Techniques (MPT) are relatively new techniques where a continuous pressure is applied to provoke the familiar headache and is consequently maintained until the provoked headache disappears. The dosage of MPT (amount of pressure, number of repetitions and duration) to obtain this provocation and reduction has not been objectified yet.
Purpose: To verify if MPT can provoke the familiar headache and upon maintaining the pressure can result in a decrease hereof. Additionally to objectify the required dosage.
Methods: Fifteen patients with chronic migraine received MPT on the atlanto-occipital and C2-C3 segment, the rectus capitis posterior minor and obliquus capitis muscles. The amount of pressure applied by the therapist during MPT was constantly measured using Force Sensing Resistor-sensors registered by CAPTIV software. In 8 patients the MPT were maintained (max 120 seconds) and repeated (three trials). Before and after the MPT, Pressure Pain Thresholds (PPT) on the trapezius, thenar and anterior tibial muscles were measured to investigate sensitisation as an underlying mechanism.
Results: Familiar headache was provoked in all patients during MPT. The peak intensity of the provoked headache ranged from 1 to 9 points on a scale of 10 points (Median score: 4/10 points).
The applied pressure during the MPT was relatively low (1557g/cm2 to 1814 g/cm2) and remained stable throughout the application (less than 20% change).
Maintaining the MPT resulted in a significant decrease of the headache in all patients (p 0.05). This decrease occurred faster in the three consecutive trials (p .024). No significant changes in PPT were recorded after the application of MPT.
Conclusion(s): This pilot study demonstrates the therapeutic potential of MPT for patients with migraine. Future clinical trials with larger patient samples and multiple MPT applications are needed to confirm these results and to analyse the underlying working mechanism.
Implications: Since many patients with migraine look for non-pharmacological treatment options, this is of high clinical value. If confirmed in future studies MPT can be a valuable treatment option for patients with migraine.
Keywords: Migraine, Manual Therapy, Treatment
Funding acknowledgements: We gratefully acknowledge Miss Schaerlaken Evi for her help with our data analysis.
Topic: Musculoskeletal: spine; Neurology
Ethics approval required: Yes
Institution: University Hopsital Antwerp and University of Antwerp
Ethics committee: Ethisch Comité UZA - UA
Ethics number: B300201734328
All authors, affiliations and abstracts have been published as submitted.
