Musculoskeletal dysfunctions and physiotherapy treatment strategies in patients with migraine

Background: Neck pain is prevalent in patients with migraine but its role for the physiotherapy management is unclear. Method: In this narrative review, results of studies, contributing to the overall understanding of musculoskeletal dysfunctions in patients with migraine are summarized, as are approaches to subgroup migraine and attempts to improve migraine non-pharmacologically. Results: Our line of research shows that musculoskeletal dysfunctions are prevalent in patients with migraine. Pain provocation during manual palpation of the upper cervical spine might be relevant when referred pain to the head is elicited. This subgroup of patients might benefit from physiotherapy treatment to the neck. Preliminary data from treatment studies shows that a small reduction of headache and migraine days can be achieved when treating the neck. The reduction in migraine days might be enhanced when treating migraine as a chronic pain disease and adding pain neuroscience education to the neck treatment. Conclusions: Physiotherapy assessment and treatment plays a role in the management of migraine. The effectiveness of different physiotherapy approaches and pain neuroscience education needs to be evaluated further in randomized controlled trials.