Headache

Physiotherapy for Migraines | Assesment & Treatment

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Physiotherapy for Migraine

Physiotherapy for Migraines | Assesment & Treatment

 

Definition

The word “migraine is derived from the the Greek word “hemikrania,” which was eventually translated into Latin as “hemigranea,” which was eventually translated to “migraine” in French. They are characterized by a throbbing pain on one side of the head, a migraine is a moderate to severe headache.
Migraine attacks are intricate brain processes that frequently last from several hours to several days. Without an aura, migraines are most frequently encountered (75 percent of cases).
Additionally, a lot of people experience symptoms like feeling or being unwell, as well as increased sensitivity to light or sound.
Around 1 in 5 women and 1 in 15 men suffer from migraines, making it a widespread medical disease. Early adulthood is typically when they start.

Epidemiology

Stovner et al. (2007) found a lifetime prevalence of 14% for migraine. Migraines are about 3 times more prevalent in women compared to men. First episodes often start during puberty and prevalence increases untilt he ages of 35 to 39 before it decreaseses, especially after menopause (Lipton et al. 2007).  In addition, it is ranked second in terms of the number of years people spend living with a handicap, after back pain.

When looking at the current prevalence of different forms of headaches, TTH is the most prevalent form in the adult population worldwide with a mean prevalence of 42%, followed by migraine with 11% (Stovner et al. (2007). The following graph shows the current prevalence of different forms of headaches in different age categories (Stovner et al. (2007):

 

The following figure shows the prevalence of headache on different continents around the world:

 

Signs & Symptoms

The ICD-H III defines following criteria to diagnose a migraine headache without aura:

Recurrent headache disorder manifesting in attacks lasting 4-72 hours. Typical characteristics of the headache are unilateral location, pulsating quality, moderate or severe intensity, aggravation by routine physical activity and association with nausea and/or photophobia and phonophobia.

Diagnostic criteria:

A. At least five attacks1 fulfilling criteria B-D

B. Headache attacks lasting 4-72 hr (untreated or unsuccessfully treated)2;3

C. Headache has at least two of the following four characteristics:

1. unilateral location:

  1. pulsating quality
  2. moderate or severe pain intensity
  3. aggravation by or causing avoidance of routine physical activity (eg, walking or climbing stairs)

2. During headache at least one of the following:

    1. nausea and/or vomiting
    2. photophobia and phonophobia

 

Migraines with aura are defined as follows:

Recurrent attacks, lasting minutes, of unilateral fully-reversible visual, sensory or other central nervous system symptoms that usually develop gradually and are usually followed by headache and associated migraine symptoms.

Diagnostic criteria:

A. At least two attacks fulfilling criteria B and CB. One or more of the following fully reversible aura symptoms:

  1. visual
  2. sensory
  3. speech and/or language
  4. motor
  5. brainstem
  6. retinal

C. At least three of the following six characteristics:

  1. at least one aura symptom spreads gradually over ≥5 minutes
  2. two or more aura symptoms occur in succession
  3. each individual aura symptom lasts 5-60 minutes1
  4. at least one aura symptom is unilateral2
  5. at least one aura symptom is positive3
  6. the aura is accompanied, or followed within 60 minutes, by headache

D. Not better accounted for by another ICHD-3 diagnosis.

Assessment

Treatment

In the review and meta-analysis by Luedtke et al. (2016) it was found that sub-analyses of the different physiotherapy interventions showed that aerobic exercise and a combination of physical and psychological interventions were effective for the reduction of migraine attack duration; however, no trials were available that used either manual therapy, trigger point therapy, or strength training. In their systematic review and meta-analysis, Lemmens et al. (2019) confirms that aerobic exercise seems to be able to reduce migraine frequency with a  mean reduction of 0.6 ± 0.3 migraine days/month. Krøll et al. (2018) investigated the effects of aerobic exercise in migraineurs with concomitant TTH and neck pain and found that exercise reduced migraine frequency, pain intensity, and duration pre and post-intervention. However, compared to the control group, the results did not reach significance.

 

References

Krøll, L. S., Hammarlund, C. S., Linde, M., Gard, G., & Jensen, R. H. (2018). The effects of aerobic exercise for persons with migraine and co-existing tension-type headache and neck pain. A randomized, controlled, clinical trial. Cephalalgia38(12), 1805-1816.

Lemmens, J., De Pauw, J., Van Soom, T., Michiels, S., Versijpt, J., Van Breda, E., … & De Hertogh, W. (2019). The effect of aerobic exercise on the number of migraine days, duration and pain intensity in migraine: a systematic literature review and meta-analysis. The journal of headache and pain20(1), 1-9.

Lipton, R. B., Bigal, M. E., Diamond, M., Freitag, F., Reed, M. L., & Stewart, W. F. (2007). Migraine prevalence, disease burden, and the need for preventive therapy. Neurology68(5), 343-349.

Luedtke, K., Allers, A., Schulte, L. H., & May, A. (2016). Efficacy of interventions used by physiotherapists for patients with headache and migraine—systematic review and meta-analysis. Cephalalgia36(5), 474-492.

Olesen, J. (2018). International classification of headache disorders. The Lancet Neurology17(5), 396-397.

Stovner, L. J., Hagen, K., Jensen, R., Katsarava, Z., Lipton, R. B., Scher, A. I., … & Zwart, J. A. (2007). The global burden of headache: a documentation of headache prevalence and disability worldwide. Cephalalgia27(3), 193-210.

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