Manual therapy as a prophylactic treatment for migraine: design of a randomized controlled trial

We present the design for and discuss the feasibility of a pragmatic, randomized controlled trial on the effectiveness of a multimodal manual therapy (MT) treatment compared to usual care by the general practitioner (GP) for the prophylactic treatment of migraine.MethodsEligible participants will be recruited in primary care using the International Classification of Headache Disorders III criteria for migraine of the International Headache Society. Participants will be randomized to either multimodal MT treatment or usual care provided by the GP. GPs will be asked to treat the usual care group according to the Dutch GP guideline for headache. The multimodal MT intervention will include manual pressure techniques, neck muscle-strength exercises and mobilization of the cervical and thoracic spine.The trial will consist of a 12-week treatment period and follow-up measurements at 12, 26 and 52  weeks. The primary outcome measure is the number of migraine days per 4 weeks, assessed with a headache diary. Secondary outcome measures are the number of migraine attacks, medication use, disability due to headache, headache intensity, number of participants reporting a 50% migraine reduction, measurement of cervical pressure pain thresholds, presence of allodynia, endurance of cervical flexor muscles, days of absence of work and global perceived effect.DiscussionThe results of the trial will show whether a multimodal MT intervention is an effective non-pharmacological treatment o...
Source: Trials - Category: Research Source Type: clinical trials

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AbstractPurpose of ReviewSymptomatic lumbar spinal stenosis (LSS) is a condition affecting a growing number of individuals resulting in significant disability and pain. Traditionally, treatment options have consisted of conservative measures such as physical therapy, medication management, epidural injections and percutaneous adhesiolysis, or surgery. There exists a treatment gap for patients failing conservative measures who are not candidates for surgery. Minimally invasive lumbar decompression (MILD ®) and interspinous process device (IPD) with Superion® represent minimally invasive novel treatment options that ...
Source: Current Pain and Headache Reports - Category: Neurology Source Type: research
DiscussionControlled trials are needed to determine the best rehabilitation approach for mTBI with persistent symptoms such as neck pain, headache and dizziness. This RCT will be crucial to guide future clinical management recommendations.Trial registrationClinicalTrials.gov Identifier -NCT03677661, Registered on September, 15th 2018.
Source: BMC Sports Science, Medicine and Rehabilitation - Category: Sports Medicine Source Type: research
Abstract SYNOPSIS: Whiplash and concussion may have similar presenting symptoms, biomechanical mechanisms, and neurophysiological sequelae, but neither enjoys a gold standard diagnostic test. Guidelines for whiplash and concussion are developed and implemented separately. This disparate process may contribute to misdiagnosis, delay appropriate primary care management, and impair patient outcomes. In our clinical commentary, we present 3 cases where signs and symptoms consistent with whiplash were identified in primary care. Symptoms in all cases included neck pain, headache, dizziness, and concentration deficits, ...
Source: Physical Therapy - Category: Physiotherapy Authors: Tags: J Orthop Sports Phys Ther Source Type: research
DiscussionAll analyses in this study will be based on the previous published papers. Therefore, ethical approval and patient consent are not required. The findings of this study will provide important information on the value of dry needling for the management of tension-type headache, cervicogenic headache, and migraine.Trial registrationPROSPERO registration number:CRD42019124125.
Source: Chiropractic and Manual Therapies - Category: Complementary Medicine Source Type: research
Conclusion: These findings support the hypothesis that in FM a deteriorated function of cortical inhibition, indexed by a higher SICI parameter, a lower function of the DPMS, together with a higher level of BDNF indicate that FM has different pathological substrates from depression. They suggest that an up-regulation phenomenon of intracortical inhibitory networks associated with a disruption of the DPMS function occurs in FM. Introduction Major depressive disorder (MDD) and fibromyalgia (FM) present overlapped symptoms. Although the connection between these two disorders has not been elucidated yet, the disruption...
Source: Frontiers in Human Neuroscience - Category: Neuroscience Source Type: research
Conclusion Trochlear pain (trochleodynia) is becoming recognized as a set of disorders that can present in isolation or concomitantly with co-existing migraines, tension-type headaches, or other headache disorders, possibly explaining subpar symptom control in a small but significant number of individuals globally. Trochleodynia features unilateral periocular pain that may involve the ipsilateral hemicranium. Pain exacerbation occurs with trochlear palpation and supraduction of the affected eye especially in the adducted position. Trochleodynia may respond to oral NSAIDs if symptoms are mild and of recent onset. While ora...
Source: Frontiers in Neurology - Category: Neurology Source Type: research
Conclusions: Pre-injury psychiatric and pre-injury headache/migraine symptoms are risk factors for worse functional and post-concussive outcomes at 3- and 6-months post-mTBI. mTBI patients presenting to acute care should be evaluated for psychiatric and headache/migraine history, with lower thresholds for providing TBI education/resources, surveillance, and follow-up/referrals. Clinical Trial Registration: www.ClinicalTrials.gov, identifier NCT01565551. Introduction Traumatic brain injury (TBI) remains a significant cause of morbidity and mortality worldwide. In 2013 ~2.8 million TBI cases were recorded annually i...
Source: Frontiers in Neurology - Category: Neurology Source Type: research
This study aims at investigating the still poorly clear pathogenesis of migraine and the potential role of anti-CGRP mAbs in the scenario of prophylaxis of migraine. Introduction: Migraine Clinic Migraine consists in unilateral headache accompanied by a cluster of other sensory, autonomic and cognitive symptoms and it has been identified by the global burden of disease (GBD) study 2016 as the sixth most prevalent disorder and one of the main causes of disability all over the world, often occuring in working age and in young adult and middle-aged women (Collaborators, 2018). Hence, migraine represents a very serious...
Source: Frontiers in Pharmacology - Category: Drugs & Pharmacology Source Type: research
If you are one of the more than 100 million Americans suffering with chronic pain, you know how desperate you can get searching for relief. For constant or chronic pain, sometimes knowing that you can only get temporary relief from medications sits at the back of your brain and sets up pain anticipation. Shouldn’t there be a better way, an approach or approaches that don’t rely on pharmaceutical drugs to combat pain? According to new research, there are some new pain relief methods that look very promising to do just that. Treatment from Strangers Mat Provide Unexpected Pain Relief It may seem counter-intuitiv...
Source: World of Psychology - Category: Psychiatry & Psychology Authors: Tags: Chronic Pain Health-related Mental Health and Wellness Mindfulness Psychology Research Treatment Source Type: blogs
Over the past few years I’ve been pondering the presumed gap between people living with pain and the people who “treat” or work with them.  Most of my readers will know that I live with widespread pain (aka fibromyalgia) or pain that is present in many parts of my body, and the associated other symptoms like DOMS that last for weeks not a day or two, and increased sensitivity to heat, cold, pressure, chilli, sound and so on. I first “came out” with my pain about 15 years ago: that is, I first disclosed to people I worked with that I had this weird ongoing pain – and finally joined...
Source: HealthSkills Weblog - Category: Anesthesiology Authors: Tags: Chronic pain Professional topics Research Therapeutic approaches inclusion inequality Source Type: blogs
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