Tolentino Gabriella de Almeida, Florencio Lidiane Lima, Pradela Juliana, Pinheiro-Araújo Carina Ferreira, Martins Jaqueline, de Cassia Cabral Norato Adrila, Sambini Felipe Daniel, Malosti Teodoro Rodrigues José Lucas, Fernández-de-Las-Peñas César, Dach Fabiola, Bevilaqua-Grossi Débora
Department of Health Sciences, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil; Department of Neurology, University of Utah, Salt Lake City, UT, USA.
Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos, Alcorcón, Spain.
Musculoskelet Sci Pract. 2025 Aug;78:103360. doi: 10.1016/j.msksp.2025.103360. Epub 2025 May 28.
Physical therapy is a non-pharmacological approach for migraine management. However, the effectiveness of a multimodal approach combining manual therapies, cervical exercises, and therapeutic education, compared to these interventions individually, remains unclear.
to investigate the effects of a multimodal approach versus manual therapies or pain neuroscience education alone in migraine patients.
A three-arm, parallel, single-blind, randomized clinical trial was conducted over 12 weeks, with assessments at baseline, 4, 8, and 12 weeks, and follow-up assessments at 1, 2, and 4 months. Seventy-five participants were randomly allocated to the Therapeutic Education Pain Neuroscience Group (TEG), Manual Therapies Group (MTG), or Multimodal Group (MUG). The primary outcome was the Headache Impact Test (HIT-6). Secondary outcomes included headache frequency, intensity, and duration; neck disability index (NDI); Allodynia Symptom Checklist (ASC-12); maladaptive beliefs; pain catastrophizing; quality of life; dizziness; and cervical assessments. Mixed models were analyzed in SPSS, considering group, time, and group-by-time interactions.
All groups demonstrated significant HIT-6 improvement (p < 0.001). MTG showed greater improvement at week 4, while TEG surpassed MTG by week 12. At follow-up, MUG demonstrated superior reduction in headache impact. Significant group-by-time interactions favored multimodal treatment for headache frequency, intensity, neck pain, ASC-12, NDI, quality of life, and Flexion Rotation Test (p < 0.01). Also, MUG showed clinically relevant changes in NDI, Pain Catastrophizing Scale, quality of life, ASC-12, and Tampa Scale for Kinesiophobia.
Although all treatments were effective, MUG was superior in sustaining reductions in headache impact at follow-up, and improving psychosocial, headache and neck-related outcomes.
物理治疗是偏头痛管理的一种非药物方法。然而，与这些干预措施单独使用相比，结合手法治疗、颈椎锻炼和治疗性教育的多模式方法的有效性仍不明确。
研究多模式方法与单独的手法治疗或疼痛神经科学教育相比，对偏头痛患者的影响。
进行了一项为期12周的三臂、平行、单盲随机临床试验，在基线、第4、8和12周进行评估，并在第1、2和4个月进行随访评估。75名参与者被随机分配到治疗性教育疼痛神经科学组（TEG）、手法治疗组（MTG）或多模式组（MUG）。主要结局是头痛影响测试（HIT-6）。次要结局包括头痛频率、强度和持续时间；颈部残疾指数（NDI）；异常性疼痛症状清单（ASC-12）；适应不良信念；疼痛灾难化；生活质量；头晕；以及颈椎评估。在SPSS中分析混合模型，考虑组、时间和组×时间交互作用。
所有组的HIT-6均有显著改善（p < 0.001）。MTG在第4周显示出更大的改善，而TEG在第12周超过了MTG。在随访中，MUG在头痛影响方面的降低更为显著。显著的组×时间交互作用表明，多模式治疗在头痛频率、强度、颈部疼痛、ASC-12、NDI、生活质量和屈伸旋转试验方面更具优势（p < 0.01）。此外，MUG在NDI、疼痛灾难化量表、生活质量、ASC-12和坦帕运动恐惧量表方面显示出临床相关变化。
尽管所有治疗方法都有效，但MUG在随访中维持头痛影响降低以及改善心理社会、头痛和颈部相关结局方面更具优势。
