Migraine
Conditions
Keywords
Migraine, Fatigue, Pain, Physical Function, Individualized Physical Therapy
Brief summary
Migraine is a prevalent neurological disorder associated with pain, fatigue, and reduced physical function. The aim of this randomized controlled trial is to examine the effects of a personalized and structured physiotherapy program-including cervical spine stabilization exercises, vestibular rehabilitation, and pain neuroscience education-on pain intensity, fatigue, and functional outcomes in individuals with migraine. Participants will be randomly allocated to an intervention group receiving personalized physiotherapy or a control group receiving standard physiotherapy care. Outcomes will be assessed at baseline, post-intervention, and follow-up.
Detailed description
Migraine is a disabling primary headache disorder characterized by recurrent attacks and frequently accompanied by cervical musculoskeletal dysfunction, vestibular symptoms, and altered pain processing mechanisms. Current evidence suggests that physiotherapy interventions targeting manual therapy, cervical stabilization, vestibular function, and pain neuroscience education may positively influence migration-related outcomes; However, studies combining these components in a personalized treatment model are limited. This randomized controlled trial aims to investigate the effectiveness of a personalized structured physiotherapy program designed specifically for individuals with migraine. The interventions will include manual therapy, cervical spine stabilization exercises, vestibular rehabilitation strategies, and pain neuroscience education delivered by a physiotherapist. The control group will receive only pain neuroscience education. Primary outcomes will include pain intensity and frequency. Secondary outcomes will include fatigue, disability level, cervical function, physical performance, and patient-reported functional limitations. Assessments will be conducted at baseline, immediately post-intervention, and during a follow-up period. The findings are expected to contribute to evidence-based physiotherapy approaches for migraine management.
Interventions
OTHERPersonalized Structured Physiotherapy Intervention
The manual therapy will include component, applied according to individual patient needs to reduce pain, improve mobility, and modulate neuromuscular control. The cervical spine stabilization exercises will target deep neck flexors and cervical postural muscles to improve neuromuscular control, endurance, and motor coordination. The vestibular rehabilitation component will include gaze stabilization, habituation, and balance exercises tailored to migraine-related vestibular symptoms. The PNE program will consist of structured individual education sessions focusing on pain neurobiology, central sensitization, and self-management strategies. Participants will attend supervised physiotherapy sessions twice weekly for 8 weeks, complemented by a personalized home exercise program. All components will be delivered by a licensed physiotherapist.
OTHERStandard Treatment
Participants continue routine care including medications prescribed by their physician. Only two 40-minute Pain Neuroscience Education sessions over 8 weeks. No physiotherapy or exercise intervention provided.
Sponsors
Hacettepe University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
SINGLE (Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
18 Years to 55 Years
Healthy volunteers
No
Inclusion criteria
* Aged between 18 and 55 years * Diagnosed with migraine according to the International Classification of Headache Disorders - 3rd edition (ICHD-3) criteria * Experiencing 2-8 migraine attacks per month in the last 3 months * Able to participate in an 8-week physiotherapy intervention program * Able to understand instructions and provide written informed consent * Stable medication use for migraine for at least 1 month prior to participation (no changes planned during study period)
Exclusion criteria
* • Presence of other primary headache disorders (cluster headache, tension-type headache as primary diagnosis, etc.) * Neurological diseases (epilepsy, stroke, multiple sclerosis) * Vestibular disorders unrelated to migraine * Cervical radiculopathy, myelopathy, or severe cervical spine pathology * History of neck surgery or significant cervical trauma * Severe musculoskeletal conditions affecting posture or cervical function * Pregnancy or breastfeeding * Participation in another clinical trial within the last 3 months * Inability to attend intervention sessions or complete outcome assessments
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Pain Intensity (VAS) | Baseline, Week 8 | Pain intensity will be assessed using the Visual Analog Scale (VAS), ranging from 0 (no pain) to 10 (worst imaginable pain). Measurements will be taken at baseline, and at the completion of the 8-week intervention. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Fatigue (Modified Fatigue Impact Scale - MFIS) | Baseline and Week 8 | Fatigue levels will be measured using the Modified Fatigue Impact Scale (MFIS), which evaluates physical, cognitive, and psychosocial aspects of fatigue. |
| Migraine Disability (MIDAS Total Score) | Baseline and Week 8 | Migraine-related disability will be assessed with the MIDAS total score, which quantifies the impact of migraine on daily activities over the past 3 months. |
| Quality of Life (Headache Impact Test - HIT-6) | Baseline and Week 8 | Quality of life will be evaluated using the HIT-6 questionnaire, which measures headache-related impact on daily functioning. |
| Trigger Point Tenderness / Pressure Pain Threshold | Baseline and Week 8 | Assessment with Manuel compression. |
| Craniovertebral Angle (Forward Head Posture) | Baseline and Week 8 | Forward head posture will be assessed by measuring the craniovertebral angle using a goniometer, with smaller angles indicating more pronounced forward head posture. |
| Pain Frequency (MIDAS A Question) | Baseline and Week 8 | Pain frequency will be assessed using Question A of the Migraine Disability Assessment Questionnaire (MIDAS), which evaluates the number of headache days over the previous 3 months. |
| Deep Cervical Flexor Muscle Performance | Baseline and Week 8 | Deep cervical flexor endurance and activation will be assessed using the Stabilizer Pressure Biofeedback Unit during cranio-cervical flexion tasks. |
| Neck Pain Intensity (VAS) | Baseline, Week 8 | Neck pain intensity will be measured using a 0-10 Visual Analog Scale (VAS) to assess changes over time. |
| Dizziness Handicap (DHI) | Baseline and Week 8 | Vestibular disability will be assessed with the Dizziness Handicap Inventory (DHI), evaluating functional, emotional, and physical impacts of dizziness. |
| Balance (Mini-BESTest) | Baseline and Week 8 | Balance performance will be evaluated using the Mini-Balance Evaluation Systems Test (Mini-BESTest), which assesses dynamic balance and postural control. |
| Cervical Range of Motion | Baseline and Week 8 | Cervical mobility (flexion, extension, lateral flexion, rotation) will be measured with a goniometer to assess changes in cervical spine range of motion. |
Countries
Turkey (Türkiye)
Contacts
Primary Contactİkra Hatice DİNÇ, MSC
Backup ContactYeliz SALCI, Associate Professor
Outcome results
None listed