Neck-specific strengthening exercise compared with placebo sham ultrasound in patients with migraine: a randomized controlled trial.

BMC neurology. 2022;22(1):126
Full text from:

Plain language summary

Patients with migraine may experience neck pain, worsened performance of cervical muscles, reduced cervical spine range of motion, and increased muscle sensitivity in the craniocervical region. Physiotherapy is an important nonpharmacological treatment option for reducing the duration and frequency of migraine attacks and may include manual therapy, soft-tissue techniques, and strength and endurance training. The aim of this study was to verify the effectiveness of craniocervical muscle-strengthening exercise (CMSE) in reducing the frequency and intensity of headache in migraine patients. This study is a two-armed, parallel-group randomized controlled trial. Men and women aged between 18 and 55 years, diagnosed only with migraine and at least three days of pain per month were included. Participants were randomly assigned to one of the two groups; intervention (n=21) or placebo (n=21) group. Results show that CMSE neither reduced the frequency and intensity of headache nor improved the performance and sensitivity of the cervical muscles, cervical range of motion, and migraine and neck pain-related disabilities. However, a significant improvement for pressure pain threshold was noticed in the sensitivity of the frontal muscle in favour of the intervention group. Authors conclude that performing CMSE is not enough to reduce the frequency and intensity of headache or improve the performance of the cervical muscles and reduce migraine and neck pain related disabilities.

Abstract

BACKGROUND Migraine patients have musculoskeletal disorders and pain in the cervical. And, despite the pathophysiology demonstrating the relationship between migraine and the cervical spine, the effectiveness of craniocervical exercises in these patients has not been verified. So, the aimed of this study was verify the effectiveness of craniocervical muscle-strengthening exercise (CMSE) in reducing the frequency and intensity of headache in migraine patients.  METHODS A two-armed, parallel-group randomized controlled trial with a 3-month follow-up was performed. For eight weeks, the volunteers in the intervention group (n = 21) performed a protocol of CMSE, while those in the sham ultrasound group (n = 21) received the application of disconnected therapeutic ultrasound in the upper trapezius and guideline for home-stretching. The primary outcomes were the frequency and intensity of the headache. The secondary outcomes were questionnaires about migraine and neck disability, and satisfaction with the treatment, cervical range of motion, the pressure pain threshold, craniocervical flexion test (CCFT), cervical muscle strength and endurance test, and the cervical muscle activity during the physical tests. RESULTS No differences were observed for the changes observed in primary outcomes after eight weeks and at the 3-months follow up (p > 0.05). For the secondary outcomes, craniocervical exercises improved the sensitivity of the frontal muscle (p = 0.040) and promoted a reduced amplitude of muscle activity of the anterior scalene and upper trapezius in the last stages of CCFT (p ≤ 0.010). There was also reduced muscle activity of the anterior scalene and splenius capitis in the endurance test (p ≤ 0.045), as evaluated by surface electromyography. CONCLUSION CMSE were insufficient in reducing the frequency and intensity of headache, improving the performance of the cervical muscles, or reducing migraine and neck pain-related disabilities. This was found despite a decreased electromyographic activity of the cervical muscles during the last stages of CCFT and increased median frequency during the endurance test. TRIAL REGISTRATION Accession code RBR-8gfv5j , registered 28/11/2016 in the Registro Brasileiro de Ensaios Clínicos (ReBEC).

Lifestyle medicine

Fundamental Clinical Imbalances : Neurological
Patient Centred Factors : Mediators/Migraine
Environmental Inputs : Physical exercise
Personal Lifestyle Factors : Exercise and movement
Functional Laboratory Testing : Imaging

Methodological quality

Jadad score : 3
Allocation concealment : Yes

Metadata

Nutrition Evidence keywords : Exercise ; Migraine ; Body mass index ; BMI