In this week back, I’m going to talk headaches, because things have been a headache. But other than what we covered last week, things are going pretty well. I did just find out that I misspelled my own email address on the resumes I’ve been sending to employers, but since 95% of applications are via online portals, it’s been nbd so far. Just a facepalm moment, that’s all. Thanks for all your support last week, everyone was wonderful in response to my email. If you emailed and haven’t heard from me in person yet, I’m getting to you, promise, the response was overwhelming. Y’all are the best.
With that, let’s dive in!
A Headache Umbrella
The Gist - This umbrella review looked into the effects of exercise and manual therapy on primary headache. A group of many Spanish folks published it in Physical Therapy last winter. They looked into 31 systematic reviews, 7 about exercise and 23 about manual therapy (idk where that extra one went either) to find that exercise might be effective and so might manual therapy, but there are complications.
For exercise, most of the work assessed aerobic training in people with migraine to demonstrate that it “can reduce pain intensity, headache duration, and frequency of headache episodes… with limited to moderate-quality evidence.” Tension-type headaches responded well to craniocervical and upper limb strength training too. Because the evidence was moderate even with heterogeneous programs, “the type of exercise does not seem to be the most important parameter in the management of primary headaches as it does with other chronic pain conditions.”
Briefly, for manual therapy (MT), “results show much heterogeneity among results and that MT efficacy is not clear.” Some showed effects, but they didn’t persist at followup. Additionally, “One of the more studied modalities is spinal manipulation, but the results are not clear in connection with migraine or TTH, nor does it appear to be superior to other forms of MT.” There was some evidence that manual therapy improves pain intensity in people with tension type headaches, more on that (and more) below.
Tell Me More - If people have tension-type headaches only, manual therapy “appears to be able to improve pain intensity… so health professionals who opt for MT in primary headache management should include soft-tissue techniques, specifically trigger- point therapies, or a combination of joint-based and soft tissue-based techniques.” We all know that research around manual therapy is complicated and shouldn’t be used on its own and the article does a good job of commenting on this as well.
To zip back to exercise, briefly, the speculated method of action is discussed in the paper as well.
It is necessary to consider that exercise-induced hypoalgesia results from the combination of cognitive, emotional, and biological mechanisms. Exercise exposes the patient to a mechanical and psychological threat and allows the body and the nervous system to adapt. Exercise in individuals with chronic pain, if perceived as uncontrollable and painful, may trigger nociceptive facilitation and act as a nocebo; but if the individual chooses the exercise and feels good when doing it, this decreases perceived stress and pain. Better self-control of the event, such as beliefs about low fear-avoidance and low pain self-efficacy, is associated with better outcomes after an exercise intervention. These variables could result in greater adherence or a stronger involvement in exercise interventions, which could potentially result in better clinical outcomes
Paper? Gotcha. It’s open access too.
If you want to know about how manual therapy affects quality of life in those living with headaches or migraine, or how MT combined with cervical stabilization exercises help with TMJ pain and headache, well you’re gonna have to join the pack and become a King Crab supporter. You can do that here for instant access.
And that’s our week! That sure felt good and didn’t take all that long. It did take a bit of extra time to parse the papers. They’re dense, did you know that? I certainly do now. You have to get used to reading them, I suppose. But anyway, we’ll be back next week, same bad time and channel.
Here’s this week’s bibliography
- Varangot-Reille, C., Suso-Martí, L., Dubuis, V., Cuenca-Martínez, F., Blanco-Díaz, M., Salar-Andreu, C., Casaña, J., & Calatayud, J. (2022). Exercise and Manual Therapy for the Treatment of Primary Headache: An Umbrella and Mapping Review. Physical Therapy, 102(3), pzab308. https://doi.org/10.1093/ptj/pzab308