Background & Aims
Knowledge about the development, processing and perception of pain, why it becomes chronic and how to use this knowledge has been shown to help patients cope better with their pain. Pain Neuroscience Education (PNE) explains the neuroscientific background of pain and is recommended in guidelines for the treatment of chronic pain. The efficacy of PNE for migraine has not been previously studied. Migraine is often associated with neck pain and neck dysfunction. Physiotherapy (PT) can address these components. The aim of this study was therefore to adapt PNE to the specificities of migraine and to investigate the additional effect of PNE on headache frequency, migraine frequency and headache-related disability when offered as an adjunct to physiotherapy.
Methods
In this two-arm randomized, non-blinded study, migraine patients received six sessions PT+PNE or six sessions PT alone. Participants were included if they had been diagnosed with migraine (>4 days per month) with or without neck pain according to the current diagnostic criteria of the International Classification of Headache Disorders. A three-month waiting period was preceded. Primary endpoints were frequency of headaches, frequency of migraine (headache with migraine character) and associated disability. Secondary outcome measures included frequency of acute medication use (number/month), frequency of neck pain (days/month), average intensity of headache and neck pain (NPRS), neck pain-associated disability (NDI), cutaneous allodynia (ASC-12), perception of health/depression symptoms (PHQ-9), impairment due to headache (MIDAS), migraine-specific quality of life (MSQoL) and acquired knowledge of the neurophysiology of pain (NPQ-D). Data were analyzed with a linear mixed model (LMM).
Results
82 participants were randomized. The effect of time overall was significant in headache frequency both for the PT group (p=0.04) and for the PT+PNE group (p=0.00). The differences between the groups at the individual time points and also overall were significant (p=0.007*). The PT group improved by 22% on average, the group PT+PNE by 30%.
The overall time effect in migraine days is not significant for the PT group (p=0.08), but for the PT+PNE group (p=0.00*). The differences between the groups at the individual time points and the group differences overall are significant (p=0.00). The PT group improved by 15% in the migraine days, the PT+PNE group improved by 44% (from 6,2 to 3,6 days per month).
The migraine-related impairment decreases significantly in both groups, with no difference between the groups (p=0.57). Most secondary outcomes show a significant effect of time, with no interaction between time and group. During the study no side effects or adverse events were observed.
Conclusions
Migraine patients who received either physiotherapy or physiotherapy+pain neuroscience education showed improvements in the primary and secondary endpoints after the intervention. Physiotherapy combined with pain neuroscience education was significantly more effective than physiotherapy alone to reduce migraine frequency and should be considered for the treatment of migraine.
Pain neuroscience education should be integrated into physiotherapy treatment. The effect of PNE in this study is comparable with the results of other studies on chronic pain syndromes in which PNE is used. Neck pain and headaches can be positively influenced by PNE. The reason for the decrease in the number of headache and migraine days as well as the number of neck pain days, in significant contrast to the group with physiotherapy alone, could be that the patients apply the knowledge about pain to their pain concepts in general.
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Presenting Author
Ruth Meise
Poster Authors
Ruth Meise
OTHR
University of Lübeck
Lead Author
Gabriela Carvalho
Prof. Dr.
Furtwangen University, Faculty of Health, Safety, Society
Lead Author
Christian Thiel
PhD
Hochschule für Gesundheit [University of Applied Sciences] Bochum
Lead Author
Kerstin Luedtke
University of Luebeck
Lead Author
Topics
- Specific Pain Conditions/Pain in Specific Populations: Migraine