Jung Andres, Eschke Robert-Christopher, Gabler Tom, Pawlowsky Vera, Luedtke Kerstin
Institut für Gesundheitswissenschaften, Universität zu Lübeck, Ratzeburger Allee 160, 23562, Lübeck, Deutschland.
Schmerz. 2022 Aug;36(4):272-283. doi: 10.1007/s00482-021-00611-z. Epub 2021 Dec 22.
According to the current guidelines preventive treatment of migraine should consist of a combination of pharmacological and nonpharmacological forms of treatment. Physiotherapeutic modalities could be an option for nonpharmacological migraine management.
The aim was to assess the efficacy of physiotherapeutic interventions on pain intensity, duration and frequency as well as the quality of life of patients with migraine.
A systematic literature search was carried out in four databases: the Physiotherapy Evidence Database (PEDro), Web of Science, Medline via PubMed and the Cochrane Library. Randomized controlled trials (RCTs) that were published up to the end of July 2021 and examined the effectiveness of physiotherapeutic treatment in migraine patients were eligible for inclusion. Studies that did not examine an adult population, interventions not carried out by a physiotherapist or not reporting an appropriate outcome were excluded. The assessment of the risk of bias was carried out with the revised version of the Cochrane risk of bias tool 2.0. A descriptive and quantitative synthesis using mean difference with a random effects model and 95% confidence intervals were used.
The present review included 13 RCTs reporting on a total of 595 patients. The risk of bias was high for four studies, low for two studies and the remaining seven studies had some concerns. The interventions examined were multimodal physiotherapy programs, various mobilization techniques, trigger point therapy, manual lymphatic drainage, massage and various stretching techniques. All interventions examined had a significantly positive effect on the selected parameters compared to the baseline values. Especially combinations of various physiotherapeutic modalities showed clinically relevant results.
The evidence suggests that multimodal physiotherapy treatment is a good supplement to medication and should therefore be considered as a nonpharmacological treatment for patients with migraine; however, further RCTs with a low risk of bias are necessary in order to confirm the effectiveness with high quality evidence.
根据当前指南，偏头痛的预防性治疗应包括药物治疗和非药物治疗相结合的方式。物理治疗方法可能是偏头痛非药物管理的一种选择。
评估物理治疗干预对偏头痛患者疼痛强度、持续时间和频率以及生活质量的疗效。
在四个数据库中进行了系统的文献检索：物理治疗证据数据库（PEDro）、科学网、通过PubMed检索的Medline以及Cochrane图书馆。纳入截至2021年7月底发表的、研究物理治疗对偏头痛患者有效性的随机对照试验（RCT）。未研究成年人群、非物理治疗师实施的干预或未报告适当结果的研究被排除。使用Cochrane偏倚风险工具2.0的修订版进行偏倚风险评估。采用随机效应模型和95%置信区间的均差进行描述性和定量综合分析。
本综述纳入了13项RCT，共涉及595例患者。四项研究的偏倚风险高，两项研究的偏倚风险低，其余七项研究存在一些问题。所研究的干预措施包括多模式物理治疗方案、各种松动技术、触发点疗法、手动淋巴引流、按摩和各种拉伸技术。与基线值相比，所有研究的干预措施对所选参数均有显著的积极影响。特别是各种物理治疗方式的组合显示出临床相关结果。
证据表明，多模式物理治疗是药物治疗的良好补充，因此应被视为偏头痛患者的非药物治疗方法；然而，需要进一步开展偏倚风险低的RCT，以高质量证据证实其有效性。
