Physical Therapy: Headaches
Marcus DA, Mercer S, Scharff L, Turk DC, Nonpharmacological Treatment for
Migraine: Incremental Utility of Physical Therapy with Relaxation and Thermal
Biofeedback Cephalgia. 1998 ;18: 266-72
The identification of musculoskeletal abnormalities in headache patients has
led to the incorporation of physical therapy (PT) into treatment programs for
chronic headache. The current studies: (i) investigated the efficacy of PT as
a treatment for migraine, and (ii) investigated the utility of PT as an
adjunct treatment in patients who fail to improve with relaxation
training/thermal biofeedback (RTB). PT alone is not effective in reducing
headache, with only 14% of subjects reporting significant headache reduction
(mean reduction of 15.6% in comparison with 41.3% in RTB). However, PT may
have been a useful adjunct, with 47% of a group of 11 subjects who had failed
to improve with RTB reporting improvement with the addition of PT. It is
recommended that RTB remain the nonmedical treatment of choice for migraine,
and that PT may be a useful adjunct for patients who fail to improve after
such treatment.
Robbins L, Cryotherapy for headache Headache.. 1989 Oct;29: 598-600
45 patients with migraine or migraine plus chronic daily headache the
effectiveness of a coldwrap for headache relief. 35.5% judged it not
effective, 29% judged it mildly effective, 26.5% found it moderately
effective, and 9% judged it completely effective. Previous studies on ice
treatment for headache are reviewed.
Brunson J, Jay G, Jeffers Branson S, The effectiveness of physical therapy in
the treatment of chronic daily headaches Headache. 1989 ; 29 : 156-62
We investigated the adjunctive use of physical therapy, with the more
standard modalities of medication and/or biofeedback-enhanced neuromuscular
reeducation, in patients with chronic daily headaches, who had palpable
muscle spasm in the neck and shoulder regions. Patients in group one received
medication detoxification (when necessary), amitriptyline and (in some
cases), biofeedback. Patients in group two received detoxification (when
necessary), amitriptyline (in some cases) and physical therapy, including
TENS (transcutaneous electrical nerve stimulation). Patients in group three
received detoxification (when necessary), amitriptyline (in some cases), and
TENS without other modalities of physical therapy. Patients in group two and
three, as judged by changes in Headache Index, showed a significantly faster
and greater decline in headaches than patients in group one, and maintained
this excellent relief through the 6 month follow-up period. From a
biochemical perspective, this improvement may be related to the demonstrable
increase in serotonin levels that attends TENS. From a behavioural
perspective, improvement may be related to the change in "locus of control"
from the headache to the patient that attends the more "active" modalities of
TENS and physical therapy, as opposed to the more "passive" modality of
medication alone.
Lance J, The controlled application of cold and heat by a new device
(Migra-lief apparatus) in the treatment of headache Headache.. 1988 28
:458-61
An apparatus which incorporates a cooling compartment encircling the
extending down the neck, and a separate warming compartment applied to the
vertex, was employed in 28 patients with recurrent headaches (20 with
migraine, 7 with tension headaches, and 1 with cluster headaches) who had
inadequate relief from prophylactic and acute medications. This Migra-lief
apparatus reduced severity of headache in 15 of the migraine patients, 6 of
the tension headache patients, and in the one cluster headache patient.
Chiropractic and Headache Related Literature