Individualised physiotherapy management of persons with migraine and neck pain: a feasibility study.
Up to 80 per cent of individuals with migraine also suffer neck pain.
Many seek local neck treatment as a cure or temporary relief but to date evidence of benefit is limited. Previous trials have treated individuals with migraine associated neck pain as homogenous. This is not the case.
Our research identified cervical musculoskeletal dysfunction in about 40 per cent and pain hypersensitivity in about 50 percent of participants with migraine. This indicates the presence of four subgroups in this population: i) with cervical musculoskeletal dysfunction and pain hypersensitivity, ii) only cervical musculoskeletal dysfunction, iii) only pain hypersensitivity, iv) neither.
We hypothesise that physiotherapy intervention should therefore be individualised according to these subgroups but such individualisation of management is novel in this population. Therefore the primary aim of this study is to establish the feasibility of conducting an efficacy trial on individualised physiotherapy management of patients with migraine and neck pain, including patient perspectives on preferred primary outcomes and meaningful effect sizes. The secondary aims are to describe this novel individualised treatment program and explore the effects and possible underlying mechanisms.
Participants will be asked to complete some questionnaires about their wellbeing, headache characteristics, neck pain characteristics, or other symptoms they experience as well as the impact of migraine on their daily life. They will also be asked to complete a short questionnaire of their pain symptoms when they are experiencing migraine. They will then attend the university clinic to undergo some clinical testing of their neck, and sensory systems.
The clinical testing will include an examination of the joints and muscles in their neck, eye movements, visual tests, sensation tests and balance. All testing will be completed in a single session of about one and a half hours, with adequate time allowed for them to have breaks between testing. Participants will then be asked to be interviewed (about twenty minutes) on their expectations of physiotherapy treatments. They will also be asked to complete a very short daily online survey (about two minutes) on their symptoms over the period of the study.
After completion of the daily online survey for at least one month, participants will then be asked to attend 6-8 sessions of 45-min physiotherapy sessions at the university clinic over 6 weeks while continuing to complete the daily online survey. At the end of 6 weeks, participants will be asked to complete online questionnaires and attend the university clinic to undergo some clinical testing of their neck and sensory systems again. Participants will also be asked to participate in an interview on their experience in the study.
Eligibility
Inclusion criteria
- Adults 18-60 years old
- Classified with Migraine (ICHD-3 criteria) as main headache if more than 1 type of headache
- At least 2 migraine attacks per month over the past 3 months
- Neck pain present (in any phase of the migraine cycle)
- No change to preventative management over the past month and no plans to change in the next 3 months
- Willing to undergo baseline and post-intervention assessments, have treatment as allocated, and attend follow-ups and complete headache diaries and questionnaires
Exclusion Criteria
- Current or recent (within last 3 months) physiotherapy/osteopathic/chiropractic management
- Conditions with general hypersensitisation such as Fibromyalgia, Chronic Fatigue Syndrome, Long Covid Syndrome
Participant benefits
6-8 free physiotherapy sessions over 6 weeks as part of the study.
Register your interest
To register your interest or find out more information, visit the link below.
This study has been approved by The University of Queensland Human Research Ethics Committee [Approval No.
2021/HE002638].