Does myofascial and trigger point treatment reduce pain and analgesic intake in patients undergoing onabotulinumtoxinA injection due to chronic intractable migraine?

Eur J Phys Rehabil Med. 2018 Feb;54(1):1-12. doi: 10.23736/S1973-9087.17.04568-3. Epub 2017 Jul 27.


Background: Chronic 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.

Aim: The 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.

Design: Pilot, single-blind randomized controlled trial with two parallel groups.

Setting: Neurorehabilitation Unit.

Population: Twenty-two outpatients with chronic migraine.

Methods: Patients 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.

Results: All 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.

Conclusions: Manipulative techniques aimed at reducing peripheral nociceptive triggers might add value in the management of chronic migraine symptoms and lower acute medication use.

Clinical rehabilitation impact: An interdisciplinary approach comprising pharmacological and non-pharmacological strategies can reduce analgesic consumption and myofascial dysfunction symptoms in chronic migraine patients.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Acetylcholine Release Inhibitors / therapeutic use*
  • Adolescent
  • Adult
  • Aged
  • Analgesics / therapeutic use
  • Botulinum Toxins, Type A / therapeutic use*
  • Chronic Disease
  • Feasibility Studies
  • Female
  • Humans
  • Injections
  • Male
  • Middle Aged
  • Migraine Disorders / therapy*
  • Musculoskeletal Manipulations*
  • Myofascial Pain Syndromes / therapy*
  • Pain Measurement
  • Pilot Projects
  • Range of Motion, Articular
  • Single-Blind Method
  • Transcutaneous Electric Nerve Stimulation
  • Treatment Outcome
  • Trigger Points*
  • Young Adult


  • Acetylcholine Release Inhibitors
  • Analgesics
  • Botulinum Toxins, Type A