Physical therapy and migraine: musculoskeletal and balance dysfunctions and their relevance for clinical practice

• Published in: Revista brasileira de fisioterapia (São Carlos (São Paulo, Brazil)) Brazil)), 2020-07, Vol.24 (4), p.306-317
• Main Authors: Carvalho, Gabriela Ferreira, Schwarz, Annika, Szikszay, Tibor Maximilian, Adamczyk, Waclaw Marceli, Bevilaqua-Grossi, Débora, Luedtke, Kerstin
• Format: Article
• Language: English
• Subjects: Masterclass; Migraine with aura; Musculoskeletal dysfunction; Neck pain; Physical and rehabilitation medicine; Postural balance; Vestibular migraine
• ISSN: 1413-3555; 1809-9246
• DOI: 10.1016/j.bjpt.2019.11.001

•Migraine is associated with high levels of disability and comorbidities.•Disability levels can be influenced by the presence of aura and migraine chronicity.•Manual and exercise therapy aim to reduce musculoskeletal pain and sensitization.•Balance and vestibular rehabilitation is suggested to enhance function and reduce dizziness.•Patients may benefit from physical examination and tailored treatment paths including education. Migraine is a primary headache with high levels of associated disability that can be related to a variety of symptoms and comorbidities. The role of physical therapy in the management of migraine is largely unknown. Therefore, the aim of this review is to highlight and critically discuss the current literature and evidence for physical therapy interventions in individuals with migraines. A narrative review of the literature was performed. Physical therapists assessing and treating patients with migraine should focus on two primary aspects: (1) musculoskeletal dysfunctions, and (2) vestibular symptoms/postural control impairment. Signs and symptoms of musculoskeletal and/or vestibular dysfunctions are prevalent among individuals with migraines and different disability levels can be observed depending on the presence of aura or increment of the migraine attacks. A proper physical examination and interview of the patients will lead to a tailored treatment plan. The primary aim regarding musculoskeletal dysfunctions is to reduce pain and sensitization, and physical therapy interventions may include a combination of manual therapy, exercise therapy, and education. The aim regarding postural control impairment is to optimize function and reduce vestibular symptoms, and interventions should include balance exercises and vestibular rehabilitation. However, consistent evidence of benefits is still lacking due to the lack of and therefore need for tailored and pragmatic clinical trials with high methodological quality.