PT Crab 🦀 Issue 143 - My graine

First off, migraine are migraine, not migraines. It’s like being offside. There’s no offsides, just offside.

But I digress, a bit. And if you were wondering, we are talking about migraine. Ya see, it’s a disease, and there’s a lot of PT to it, as you’ll learn soon.

Also, it’s 27 days until autumn! Which is something.

Also also, help grow the Crab, invite your friends! Please. And be sure to check out the archive on the site.

With that, let’s dive in!

P.S. This weeks’ PT Crab is brought to you by Trailblazing Love. More on that later.

A PT’s Perspective of Migraine

The Gist - This is an overview piece from Current Pain and Headache Reports where two PTs write about their perspectives of treating migraine. This is a bit of an overview piece aimed at helping physicians understand what exactly PTs can do with migraine, but it’s still useful if you don’t treat migraine very often as a piece just to discuss what you can do and what doesn’t help too much.

First off, red flags. Recognizing primary vs secondary headache is important. Primary is a headache resulting from multiple entities that cause episodic and chronic head pain in the absence of an underlying pathologic process, disease, or traumatic injury.” This includes migraine and tension-type headache. Secondary headache is one “in which the headache is a symptom of another disorder recognized as a potential underlying cause.” The SNNOOP10 is a tool to assess whether a headache is primary or secondary and is just 10 yes or no questions. You can check it out here.

One you know whether the headache is primary or secondary, it’s time to talk about the exam. For an MSK exam, most people with migraine also have concomitant neck pain, ROM limitations, and weakness, as you may expect. We’ll dig deeper into this in another piece farther down. These writers recommend the NDI and HDI for general headache outcome measures and the MIDAS (Migraine Disability Assessment Scale). They also recommend vestibular screening to make sure nothing is going on there. For treatment, read on.

Tell Me More - Let’s talk treatment. These folks recommend a three-fold approach to treatment: MSK, vestibular, and behavioral. For MSK, that’s based on the neck defects that you find in your exam. There’s mixed evidence that neck strengthening is helpful for migraine, but it is helpful for weak necks so if someone has a weak neck, treat it. Vestibularly, similar things apply. Go with what you’ve seen is problematic.

Behaviorally, that’s a bit more interesting. They recommend using progressive muscle relaxation, guided imagery, mindfulness-based therapy, and biofeedback. Pain neuroscience education is also recommended. The one of those that you may not have heard of before is progressive muscle relaxation, AKA PMR. It’s a behavioral therapy that involves tensing and relaxing different muscle groups throughout the neck in order to understand and reduce muscle tension. There’s a bit of evidence that it can reduce the frequency and magnitude of migraine attacks.

The case ends with quite a good case study and breakdown of individual treatment case, so if you want more specifics than I’ve offered here, give that a good look. And if you don’t, then, well, don’t.

With that, here’s the paper.

Paper? Here, it’s here. That’s what I just said.

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And that’s our week, hope you have a nice weekend!

Bye!