In this masterclass by Professor Kerstin Luedtke, an in-depth examination of the physiotherapy management of migraine is provided. The presentation begins by explaining the classification of headaches according to the International Headache Society, highlighting the distinction between primary headaches, such as migraines, and secondary headaches. Luedtke discusses the cyclic nature of migraines, emphasizing the various phases, including prodromal, ictal, and postdromal, and detailing the symptoms associated with each. She underscores the role of the hypothalamus as a potential “migraine generator” and explores the pathophysiology of migraines, touching on how different brain structures interact. The presentation also explores the involvement of the neck in migraine symptoms, citing studies that show musculoskeletal changes in migraine patients, and discusses the trigeminocervical complex hypothesis as a possible explanation for neck pain associated with migraines.

Luedtke also reviews treatment approaches for migraines, including physiotherapy, manual therapy, aerobic exercise, and pain neuroscience education, and highlights their benefits in reducing migraine frequency and disability. She stresses that while physiotherapy can alleviate some symptoms and improve quality of life, it is not a cure for migraines, which are rooted in central nervous system changes. The presentation suggests incorporating lifestyle changes such as maintaining regular sleep patterns, aerobic exercise, and stress management into migraine management. Finally, Luedtke discusses the challenges of reliably identifying migraine triggers, emphasizing that reported triggers may sometimes be a part of the migraine process itself rather than consistent causes. The session concludes with a reminder to set realistic treatment goals and to view migraine as a chronic pain condition with associated comorbidities.

Dr. Kerstin Luedtke is a physiotherapist, manual therapist and professor at the university of Lübeck, Germany. She has published over 100 papers on a variety of topics and has done extensive research on migraines.