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Observational Study
. 2022 Mar;43(3):2021-2029.
doi: 10.1007/s10072-021-05491-w. Epub 2021 Aug 5.

Instrumental assessment of physiotherapy and onabolulinumtoxin-A on cervical and headache parameters in chronic migraine

Manuela Deodato  1   2   3 , Antonio Granato  4   5 , Caterina Borgino  4 , Alessandra Galmonte  4 , Paolo Manganotti  4   5
Affiliations
Observational Study

Instrumental assessment of physiotherapy and onabolulinumtoxin-A on cervical and headache parameters in chronic migraine

Manuela Deodato et al. Neurol Sci. 2022 Mar.

Abstract

Introduction: The purpose of the present study is to compare the effect of the physiotherapy to onabolulinumtoxin-A, and their combination, in relation to cervical and headache parameters in patients with chronic migraine.

Methods: This is an observational cohort study conducted by a headache center and a physiotherapy degree course on 30 patients with chronic migraine. The patients were distributed in three groups of treatments for three months: onabolulinumtoxin-A only, physiotherapy only, and onabolulinumtoxin-A plus physiotherapy. The patients were evaluated, before and after each treatment, using the following: the postural assessment software SAPO for the forward head posture; the CROM goniometer for the cervical range of motion; the Migraine Disability Assessment Score for headache parameters.

Results: After 3 months of each treatment, the scores obtained for the headache-related disability and the frequency of migraine decreased significantly for all groups, but the pain intensity scores changed significantly only in the onabolulinumtoxin-A (p = 0.01) and in the onabolulinumtoxin-A plus physiotherapy groups (p = 0.007). On the other hand, the forward head posture was reduced significantly in the physiotherapy (p = 0.002) and in the onabolulinumtoxin-A plus physiotherapy groups (p = 0.003). The cervical range of motion increased significantly in certain directions in the physiotherapy group and in the onabolulinumtoxin-A plus physiotherapy groups.

Conclusions: The physiotherapy improved the cervical parameters. The onabolulinumtoxin-A decreased pain intensity. As a consequence, it can be said that the combined treatment was more useful than a mono-therapy alone. From our results, it can be concluded that onabolulinumtoxin-A plus physiotherapy could be a good option in the management of chronic migraine.

Keywords: Cervical range of motion; Chronic migraine; Forward head posture; Onabolulinumtoxin-A; Physiotherapy.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Forward head posture (FHP). FHP in onabotulinumtoxin-A only (BoNT-A), onabotulinumtoxin-A plus physiotherapy (BoNT-A+PT), and physiotherapy only (PT) at the first evaluation (T1) and at the end of each treatments (T2); Wilcoxon non-parametric test *p < 0.05; **p < 0.01
Fig. 2
Fig. 2
Cervical range of motion (CROM): flexion in onabotulinumtoxin-A only (BoNT-A), onabotulinumtoxin-A plus physiotherapy (BoNT-A+PT), and physiotherapy only (PT) at the first evaluation (T1) and at the end of each treatments (T2); Wilcoxon non-parametric test *p < 0.05; **p < 0.01
Fig. 3
Fig. 3
Cervical range of motion (CROM): extension in onabotulinumtoxin-A only (BoNT-A), onabotulinumtoxin-A plus physiotherapy (BoNT-A+PT), and physiotherapy only (PT) at the first evaluation (T1) and at the end of each treatments (T2); Wilcoxon non-parametric test *p < 0.05; **p < 0.01
Fig. 4
Fig. 4
Migraine Disability Assessment Score (MIDAS): MIDAS-B intensity of headache attack (on a scale of 1–10) in the previous 3 months, in onabotulinumtoxin-A only (BoNT-A), onabotulinumtoxin-A plus physiotherapy (BoNT-A+PT), and physiotherapy only (PT) at the first evaluation (T1) and at the end of each treatments (T2); Wilcoxon non-parametric test *p < 0.05; **p < 0.01
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