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A Multimodal Conservative Approach to Treating Migraine: A Physical Therapist’s Perspective

  • Non-pharmacologic Aspects of Pain, Migraine, and Headache (D Buse, Section Editor)
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Abstract

Purpose of Review

Migraine is common and interventions to treat or manage it vary. Physical therapists possess a varied skill set that can assess and treat limitations related to migraine and its symptoms. Conservative and non-pharmacological examination and treatment techniques for migraine and headache management are reviewed in terms of efficacy and relevance in order to describe the physical therapist’s abilities and clinical reasoning process when confronting a patient with migraine symptoms.

Recent Findings

A thorough examination is necessary to detect red flags and will reveal a person with migraine’s biopsychosocial limitations to manage their symptoms. Strength, endurance, cervical mobility, and visual deficits are common in those reporting headaches and examination techniques, along with patient-reported outcome measures, can elicit objective data for re-assessment during an episode of care. Exercise interventions, manual therapy, biofeedback techniques, and vestibular therapy have become viable and efficacious non-pharmacological interventions in recent years to assist the patient with managing and mitigating their migraine symptoms, along with mindfulness-based exercises. A case study, with individualized treatment approaches based on examination findings, current evidence, and accrued expertise, demonstrates the clinical applicability of a physical therapist’s multimodal approach to treating migraine.

Summary

Psychologically- informed physical therapy with mindfulness-based approaches and biofeedback can help a patient gain more control over their symptoms and their body’s response to head pain, while exercise and vestibular therapy can assist the system with recovery and adaptation from deficits related to migraine symptoms. A thorough examination, with an individually- tailored rehabilitation plan incorporating movement and mindfulness-based therapies, is recommended.

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Authors and Affiliations

  1. Clinical Lead, Hospital for Special Surgery, 535 E. 70th Street, NY, 10021, New York City, USA

    Scott Siverling & Peter Schultz

  2. Physical Therapist/Owner, Dynamic Sports PT, 6 E 39th St Ste 504, NY, 10016, New York City, USA

    Peter Schultz

  3. Adjunct Faculty, Tufts University School of Medicine Doctor of Physical Therapy Program, 136 Harrison Avenue, Boston, MA, 02111, USA

    Scott Siverling

  4. Adjunct Instructor, Rutgers School of Health Professions Doctor of Physical Therapy Program, 65 Bergen St Ste 120, Newark, NJ, 07107, USA

    Scott Siverling

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Correspondence to Scott Siverling.

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Siverling, S., Schultz, P. A Multimodal Conservative Approach to Treating Migraine: A Physical Therapist’s Perspective. Curr Pain Headache Rep 27, 329–337 (2023). https://doi.org/10.1007/s11916-023-01140-3

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