• Marialuisa Gandolfi, Christian Geroin, Nicola Valè, Fabio Marchioretto, Andrea Turrina, Eleonora Dimitrova, Stefano Tamburin, Anna Serina, Paola Castellazzi, Andrea Meschieri, François Ricard, Leopold Saltuari, Alessandro Picelli, and Nicola Smania.
• Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy - marialuisa.gandolfi@univr.it.
• Eur J Phys Rehabil Med. 2018 Feb 1; 54 (1): 1-12.

BackgroundChronic migraine is a disabling disorder associated with myofascial and trigger point disorders in the neck. Pharmacological management is the first line of treatment; however, rehabilitation procedures aimed at lessening symptoms of myofascial and trigger point disorders may add value in the management of headache symptoms.AimThe aim of this study was to evaluate the feasibility of myofascial and trigger point treatment in chronic migraine patients receiving prophylactic treatment with onabotulinumtoxinA. To evaluate the treatment effects on headache frequency and intensity, analgesic consumption, cervical range of motion, trigger point pressure pain threshold, quality of life, and disability.DesignPilot, single-blind randomized controlled trial with two parallel groups.SettingNeurorehabilitation Unit.PopulationTwenty-two outpatients with chronic migraine.MethodsPatients were randomly assigned to receive either cervicothoracic manipulative treatment (N.=12) or transcutaneous electrical nerve stimulation (TENS) in the upper trapezius (N.=10). Treatment consisted of 4 sessions (30 min/session, 1 session/week for 4 weeks). A rater blinded to treatment allocation evaluated outcomes before treatment, during treatment, and 1 month after the end of treatment. Consistent with the pilot nature of the study, feasibility was considered the primary outcome and efficacy the secondary outcome.ResultsAll patients completed the study. No adverse events were reported. No significant between-group differences in pain intensity were observed during the study period. At post-treatment evaluation, the total consumption of analgesics (P=0.02) and non-steroidal anti-inflammatory (P=0.02) drugs was significantly lower in the manipulative treatment group than in the TENS group. These effects paralleled significant improvements in trigger point sensitivity and cervical active range of motion.ConclusionsManipulative techniques aimed at reducing peripheral nociceptive triggers might add value in the management of chronic migraine symptoms and lower acute medication use.Clinical Rehabilitation ImpactAn interdisciplinary approach comprising pharmacological and non-pharmacological strategies can reduce analgesic consumption and myofascial dysfunction symptoms in chronic migraine patients.

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