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Effect of manual therapy associated with neck muscle exercise program and pain education in patients with migraine: a 3-armed randomized clinical trial

Grant number: 20/10091-7
Support type:Scholarships in Brazil - Doctorate (Direct)
Effective date (Start): January 01, 2021
Effective date (End): October 31, 2023
Field of knowledge:Health Sciences - Physiotherapy and Occupational Therapy
Principal researcher:Débora Bevilaqua Grossi
Grantee:Gabriella de Almeida Tolentino
Home Institution: Faculdade de Medicina de Ribeirão Preto (FMRP). Universidade de São Paulo (USP). Ribeirão Preto , SP, Brazil

Abstract

Migraine is a highly prevalent and disabling disease, whose standard treatment is pharmacological. Considering the high prevalence of musculoskeletal dysfunctions associated with Migraine, physiotherapeutic interventions have been proposed for Migraine attacks management. There is moderate to low evidence level of different techniques or approaches often tested in isolation. Thus, a multimodal approach that combines manual techniques focused on the Migraineurs musculoskeletal impairments, added to pain education, can be beneficial to the patients and whose effectiveness is unknown. This study aims to investigate the effect of a multimodal protocol versus manual therapy versus therapeutic education on the impact related to headache in individuals with Migraine. Seventy-five participants with Migraine, of both sexes, aged between 18 and 55 years, will be included. Participants will be randomized into three groups: therapeutic education group (n=25), manual therapy group (n=25), and multimodal group (n=25). The therapeutic education group will receive one session of orientation on pain self-management, active stretching, and walking daily. The manual therapy group will receive a treatment consisting of cervical stretching and manual therapy techniques to disable trigger points. The multimodal group will receive a treatment consisting of relaxation techniques, stretching and myofascial release focused on craniocervical muscles, neck muscle exercise program, and pain education. The protocols will last for 12 weeks, and the participants will be evaluated at four, eight, and twelve weeks, and post-treatment at 1-mo, 2-mo, and 4-mo follow-up. The primary outcome will be headache-related disability. Secondary outcomes will be measured using the pain diary, questionnaires that assess psychosocial factors and sensitivity, as well as disability, and clinical tests that assess mobility, strength, and cervical muscles performance. The results of this study may provide clinical evidence of new treatment options for pain attacks management, as well as for musculoskeletal disorders related to Migraine. (AU)