Additional Effects of a Physical Therapy Protocol on Headache Frequency, Pressure Pain Threshold, and Improvement Perception in Patients With Migraine and Associated Neck Pain: A Randomized Controlled Trial

Arch Phys Med Rehabil. 2016 Jun;97(6):866-74. doi: 10.1016/j.apmr.2015.12.006. Epub 2015 Dec 21.


Objective: To evaluate the additional effect provided by physical therapy in migraine treatment.

Design: Randomized controlled trial.

Setting: Tertiary university-based hospital.

Participants: Among the 300 patients approached, 50 women (age range, 18-55y) diagnosed with migraine were randomized into 2 groups: a control group (n=25) and a physiotherapy plus medication group (n=25) (N=50).

Interventions: Both groups received medication for migraine treatment. Additionally, physiotherapy plus medication patients received 8 sessions of physical therapy over 4 weeks, comprised mainly of manual therapy and stretching maneuvers lasting 50 minutes.

Main outcome measures: A blinded examiner assessed the clinical outcomes of headache frequency, intensity, and self-perception of global change and physical outcomes of pressure pain threshold and cervical range of motion. Data were recorded at baseline, posttreatment, and 1-month follow-up.

Results: Twenty-three patients experienced side effects from the medication. Both groups reported a significantly reduced frequency of headaches; however, no differences were observed between groups (physiotherapy plus medication patients showed an additional 18% improvement at posttreatment and 12% improvement at follow-up compared with control patients, P>.05). The reduction observed in the physiotherapy plus medication patients was clinically relevant at posttreatment, whereas clinical relevance for control patients was demonstrated only at follow-up. For pain intensity, physiotherapy plus medication patients showed statistical evidence and clinical relevance with reduction posttreatment (P<.05). In addition, they showed better self-perception of global change than control patients (P<.05). The cervical muscle pressure pain threshold increased significantly in the physiotherapy plus medication patients and decreased in the control patients, but statistical differences between groups were observed only in the temporal area (P<.05). No differences were observed between groups regarding cervical range of motion.

Conclusions: We cannot assume that physical therapy promotes additional improvement in migraine treatment; however, it can increase the cervical pressure pain threshold, anticipate clinically relevant changes, and enhance patient satisfaction.

Keywords: Controlled clinical trial; Headache; Rehabilitation.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Analgesics / therapeutic use*
  • Breathing Exercises / methods
  • Cervical Vertebrae / physiopathology*
  • Female
  • Humans
  • Middle Aged
  • Migraine Disorders / complications
  • Migraine Disorders / therapy*
  • Musculoskeletal Manipulations / methods*
  • Neck Pain / etiology
  • Neck Pain / therapy*
  • Pain Threshold
  • Physical Therapy Modalities
  • Range of Motion, Articular
  • Single-Blind Method
  • Trigger Points / physiopathology
  • Young Adult


  • Analgesics

Associated data

  • ReBec/RBR-6kvx74