ORIGINAL ARTICLE   Free access

European Journal of Physical and Rehabilitation Medicine 2018 February;54(1):1-12

DOI: 10.23736/S1973-9087.17.04568-3

Copyright © 2017 EDIZIONI MINERVA MEDICA

language: English

Does myofascial and trigger point treatment reduce pain and analgesic intake in patients undergoing onabotulinumtoxinA injection due to chronic intractable migraine?

Marialuisa GANDOLFI ^{1, 2} ✉, Christian GEROIN ^{1, 2}, Nicola VALÈ ^{1, 2}, Fabio MARCHIORETTO ³, Andrea TURRINA ⁴, Eleonora DIMITROVA ^{1, 2}, Stefano TAMBURIN ¹, Anna SERINA ¹, Paola CASTELLAZZI ⁵, Andrea MESCHIERI ⁵, François RICARD ⁶, Leopold SALTUARI ^{7, 8}, Alessandro PICELLI ^{1, 2}, Nicola SMANIA ^{1, 2}

¹ Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy; ² UOC Neurorehabilitation, AOUI Verona, Verona, Italy; ³ Unit of Neurology, Sacro Cuore Don Calabria Hospital, Verona, Italy; ⁴ International Madrid School of Osteopathy, Italian Section, Verona, Italy; ⁵ School of Specialization in Physical Medicine and Rehabilitation, University of Verona, Verona, Italy; ⁶ Madrid School of Osteopathy, Madrid, Spain; ⁷ Research Department for Neurorehabilitation South Tyrol, Bolzano, Italy; ⁸ Department of Neurology, Hochzirl Hospital, Zirl, Austria

BACKGROUND: Chronic migraine is a disabling disorder associated with myofascial and trigger point disorders in the neck. Pharmacological management is the first line of treatment; however, rehabilitation procedures aimed at lessening symptoms of myofascial and trigger point disorders may add value in the management of headache symptoms.
AIM: The aim of this study was to evaluate the feasibility of myofascial and trigger point treatment in chronic migraine patients receiving prophylactic treatment with onabotulinumtoxinA. To evaluate the treatment effects on headache frequency and intensity, analgesic consumption, cervical range of motion, trigger point pressure pain threshold, quality of life, and disability.
DESIGN: Pilot, single-blind randomized controlled trial with two parallel groups.
SETTING: Neurorehabilitation Unit.
POPULATION: Twenty-two outpatients with chronic migraine.
METHODS: Patients were randomly assigned to receive either cervicothoracic manipulative treatment (N.=12) or transcutaneous electrical nerve stimulation (TENS) in the upper trapezius (N.=10). Treatment consisted of 4 sessions (30 min/session, 1 session/week for 4 weeks). A rater blinded to treatment allocation evaluated outcomes before treatment, during treatment, and 1 month after the end of treatment. Consistent with the pilot nature of the study, feasibility was considered the primary outcome and efficacy the secondary outcome.
RESULTS: All patients completed the study. No adverse events were reported. No significant between-group differences in pain intensity were observed during the study period. At post-treatment evaluation, the total consumption of analgesics (P=0.02) and non-steroidal anti-inflammatory (P=0.02) drugs was significantly lower in the manipulative treatment group than in the TENS group. These effects paralleled significant improvements in trigger point sensitivity and cervical active range of motion.
CONCLUSIONS: Manipulative techniques aimed at reducing peripheral nociceptive triggers might add value in the management of chronic migraine symptoms and lower acute medication use.
CLINICAL REHABILITATION IMPACT: An interdisciplinary approach comprising pharmacological and non-pharmacological strategies can reduce analgesic consumption and myofascial dysfunction symptoms in chronic migraine patients.

KEY WORDS: Myofascial pain syndromes - Musculoskeletal manipulations, Botulinum toxins, type A - Anti-inflammatory agents, non-steroidal - Tryptamines