Physiotherapy
Physiotherapy is one of a number of complementary therapies that have been shown to provide relief to people who live with migraine.
The underlying principle of physiotherapy is to restore movement and function to someone affected by injury or illness. Physiotherapists are trained to address issues with bones, joints, soft tissues, the brain or nervous system, the heart and circulation, and even the lungs and breathing.
Working with a physiotherapist can involve receiving detailed advice and education, a tailored exercise program and/or manual therapy such as massage and heat application.
Watch Rachel Forlonge from Neurolink Physiotherapy talk to Migraine Australia’s RK Crosby about migraine treatment options here:
Physiotherapy benefits for headaches
Patients thought to benefit most from physical therapy are those who experience headaches with musculoskeletal problems.
Physical therapy techniques used during a headache have been shown to temporarily reduce the pain of the attack. Patients are sometimes taught how to apply ice or practice relaxation techniques, and/or therapists may administer massage or perform manual cervical traction.
Physical therapy will try to restore mobility in these joints and correct muscle imbalances, poor postures, and physical activities that may be contributing to the headaches.
Physiotherapy benefits for migraine
Like headaches, migraine attacks may begin with a feeling of tension and discomfort in the neck. Although, unlike headache, this tension is considered secondary to the migraine (that is, a symptom of migraine not the cause of the attack). Stretching exercises can still be useful in helping to reduce the discomfort.
Because migraine is a centrally-mediated pain disorder (a disorder in the central nervous system involving the nerves and blood vessels) it causes both pain and the neurologic symptoms associated with migraine. Whereas medications affect the central nervous system in an attempt to address this dysfunction, physical therapy works on the muscles and joints in the peripheral system. This means, how an individual migraine warrior responds to physical therapy depends on the extent to which the muscles and joints are involved in his or her head pain.
Most researchers agree that physiotherapy is useful to treat musculoskeletal impairments and dysfunctions; meaning physiotherapy can help with weakness, numbness, balance and vestibular symptoms. Physiotherapy is most beneficial for those with hemiplegic, brainstem and/or vestibular migraine.
Research has also shown that physiotherapy can statistically reduce the intensity, frequency and duration of certain types of migraine. However, while the precise explanation for this is unknown, it is believed that physiotherapy works by increasing the cervical pressure pain threshold, providing patients with a ‘sense of improvement’.
Safety and recommended treatment
Due to the complexity of migraine, any intervention needs to be tailored to each patient as opposed to executing a standardised treatment protocol.
For this reason, it is important that individuals undergo a comprehensive physical examination and detailed interview to ensure the therapist has a good understanding of the patient’s unique condition.
Physiotherapy will mainly focus on musculoskeletal dysfunctions and vestibular symptoms/postural control impairment. Interventions will usually include a combination of manual therapy, exercise, and education.
The Watson Approach is often referenced by physiotherapists and is an approach that focuses attention on the upper cervical spine, attempting to determine any vertebrae that may be linked to headache-like pain. While it is non-invasive and non-manipulative, any benefit will depend on the type of migraine and symptoms experienced in each individual case.
You should always seek out a registered physiotherapist. The Australian Physiotherapy Association tool https://choose.physio/find-a-physio can help find a physiotherapist near you. There is also the option to find a physiotherapist who specialises in neurology and/or pain management (among many other specialties).
You can also ask your local Migraine Warrior Support Network for a recommendation.