Biobehavioral Physical Therapy Strategies Based on Therapeutic Exercise Applied to Chronic Migraine Patients
Condition: Chronic Migraine; Chronic Headache
MeSH terms: Migraine Disorders; Headache Disorders; Headache
Study type: Interventional

Summary: 
      The purpose of this study is to know wich combination of treatments are the most effective in
      patients with chronic migraine. The study design is a simple blind randomized controlled
      trial (outcomes assessor). The study population: Men and women aged from 18 to 70 years old
      with chronic migraine for at least 12 weeks. Interventions: A combination of techniques
      during 6 weeks (6 sessions; 1 per week)
    

Detailed description: 
      Migraine is a neurological disease characterized by attacks of pulsating headache on one side
      of the head, presenting autonomic nervous system disfunction. Migraine is associated to
      significant personal and social burden. Physical activity could worsen patient´s symptoms.
      Migraine is associated with nausea, vomiting, photophobia and phonophobia Chronic migraine
      patients according to the third IHS ( International Headache Society) classification suffer
      headache at least 15 days per month no less than 3 months.

      According to Pozo-Rosich et al., migraine incidence worldwide is 2% of the general
      population. In the US the 18% of migraine patients are females corresponding the 6% to males.

      As comorbid diseases usually associated to migraine are found disability, depression, anxiety
      and biobehavioral disorders. Migraine is a chronic disease which cause biopsychosocial damage
      and decrease quality of life in its patients. Risk factors to endure Migraine are sex
      (females), obesity and overuse of headache medicaments.

      Migraine origin and its physiopathology in unknown although there are several studies that
      support a central sensitization mechanism at the level of trigeminocervical complex to
      explain migraine. Trigeminocervical complex is made by the convergence between superior
      neurons of the trigeminal nucleus caudalis and the dorsal cervical horns of the first and
      second cervical levels.

      Some authors suggest that it is a biobehavioral disorder that results from a cortical
      hypersensitivity and an associated social learning process. Behavioral habits and medication
      intake due to migraine attacks are important factors to keep in mind. Stanos et al. concluded
      that the best treatment for chronic migraine was a multidisciplinary treatment including
      biobehavioral and pharmacological approaches. Biobehavioral treatments (BBTs) for chronic
      pain patients includes therapeutic patient education (TPE) and selfcare, cognitive behavioral
      interventions, and biobehavioral training (biofeedback, relaxation training, and stress
      management).

      TPE provides contact between the care providers and patients. TPE has been extensively
      studied in the management of anxiety, stress, and pain for chronic lower back pain. It is
      thought that in chronic diseases, TPE should be adapted to the needs of patients and
      caregivers. BBTs were identified as "grade A" evidence in the American Consortium of Evidence
      Based Headache Guidelines. It has been proposed that BBT based on educational approaches be
      used to manage migraines.
    

Intervention name(s): Therapeutic patient education; Therapeutic exercise; No intervention; Manual Therapy
Intervention type(s): Behavioral; Other; Other; Other
Intervention description(s): Therapeutic patient education based on pain physiology from a biobehavioral perspective adding a training in coping strategies.; Therapeutic exercise consist on stretch of cervical-scapular muscles ( Trapezius and angular of the scapula), Cranium-cervical flexor stabilization exercise, auto cervical tractions, shoulders rotation, low intensity exercise ( walking), craniocervical extension, cervical flexion and extension.; No intervention consist on measure the whole variables in chronic migraine patients to compare it with experimental interventions; Manual therapy consist on ; oscillatory traction , maintained craniocervical traction, upper cervical flexion mobilization, side glide roll, anterior-posterior upper cervical mobilization with wedge, lateral glide at the C1-C2 and C2-C3 levels, retraction technique, trigeminocervical neural mobilization , and upper cervical traction, followed by posterior-anterior glide at C4.
Other intervention name(s): TPE; TE; NI; MT
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment
Keywords: patient education; therapeutic exercise; manual therapy