Individualised physiotherapy management of persons with migraine and neck pain: a feasibility study.

All participants will be assessed for any cervical musculoskeletal disorder and heightened pain sensitivity (generalized or in the neck) at the start of the trial to guide physiotherapy treatment. All participants will be provided with individualised physiotherapy treatments over six weeks, in 6 to 8 physiotherapy sessions of 45 minutes duration each, by a musculoskeletal physiotherapist experienced in treating patients with headaches and heightened pain sensitivity. Treatments will be personalised according to the individual’s condition (with or without cervical musculoskeletal disorder and/or pain hypersensitivity). The time spent performing manual therapy, exercise, or pain science education will be adapted for each patient at each session, according to the physiotherapist’s evaluation, patient’s preference, and headache phase. All participants will be offered pain science education and aerobic exercise prescription (e.g., walking, cycling or running program). Additional treatments will be provided to some subgroups: a) Participants with cervical musculoskeletal dysfunction will be offered specific neck treatments including manual therapy (e.g., joint mobilisations), motor control and strength exercises for cervical and axioscapular muscles and proprioceptive exercises as indicated aimed at addressing pain and the identified cervical impairments. b) If pain hypersensitivity is also detected, the type of treatment, dosage and frequency, will be tailored on each occasion by the treating physiotherapist with input from the participant. For example, if the individual is treated during an ictal phase, manual therapy techniques may be applied more gently, in an altered direction that feels most comfortable for the participant (i.e. aiming at decreasing headache). c) If only pain hypersensitivity and no cervical musculoskeletal dysfunction is detected in the participant, physiotherapy treatment will focus mainly on pain science education and aerobic exercise prescription, with manual therapy intervention aimed at improving the tolerance of the pain system. d) If neither cervical musculoskeletal dysfunction nor pain hypersensitivity is detected in the participant, physiotherapy treatment will only consist of pain science education and aerobic exercise prescription. Pain science education will be delivered face-to-face with the physiotherapist with the help of visual aids in interactive discussions with each participant to allow questions. It will be tailored to the individual participant’s needs and beliefs about pain to include explanations about pain, factors influencing pain perception such as the cognitive aspects, and how to use the information to better manage migraine. At each treatment session, the physiotherapist will assess for changes in clinical condition and progress or modify interventions as indicated. Individualised self-management plans will also be provided at the end of the intervention period. Attendance rate and participant self-reports of compliance to home exercises will be used to assess adherence to intervention.

All participants will be assessed for any cervical musculoskeletal disorder and heightened pain sensitivity (generalized or in the neck) at the start of the trial to guide physiotherapy treatment. Participants will be provided with individualised physiotherapy treatments sessions over six weeks, in 6 to 8 physiotherapy sessions of 45 minutes duration each, by a musculoskeletal physiotherapist experienced in treating patients with headaches and heightened pain sensitivity. Treatments will be personalised according to the individual’s condition (with or without cervical musculoskeletal disorder and/or pain hypersensitivity). The time spent performing manual therapy, exercise, or pain science education will be adapted for each patient at each session, according to the physiotherapist’s evaluation, patient’s preference, and headache phase. All participants will be offered pain science education and aerobic exercise prescription (e.g., walking, cycling or running program). Additional treatments will be provided to some subgroups: a) Participants with cervical musculoskeletal dysfunction will be offered specific neck treatments including manual therapy (e.g., joint mobilisations), motor control and strength exercises for cervical and axioscapular muscles and proprioceptive exercises as indicated aimed at addressing pain and the identified cervical impairments. b) If pain hypersensitivity is also detected, the type of treatment, dosage and frequency, will be tailored on each occasion by the treating physiotherapist with input from the participant. For example, if the individual is treated during an ictal phase, manual therapy techniques may be applied more gently, in an altered direction that feels most comfortable for the participant (i.e. aiming at decreasing headache). c) If only pain hypersensitivity and no cervical musculoskeletal dysfunction is detected in the participant, physiotherapy treatment will focus mainly on pain science education and aerobic exercise prescription, with manual therapy intervention aimed at improving the tolerance of the pain system. d) If neither cervical musculoskeletal dysfunction nor pain hypersensitivity is detected in the participant, physiotherapy treatment will only consist of pain science education and aerobic exercise prescription. Pain science education will be delivered face-to-face with the physiotherapist with the help of visual aids in interactive discussions with each participant to allow questions. It will be tailored to the individual participant’s needs and beliefs about pain to include explanations about pain, factors influencing pain perception such as the cognitive aspects, and how to use the information to better manage migraine. At each treatment session, the physiotherapist will assess for changes in clinical condition and progress or modify interventions as indicated. Individualised self-management plans will also be provided at the end of the intervention period. Attendance rate and participant self-reports of compliance to home exercises will be used to assess adherence to intervention.