The Effect Of Selective Neck Muscle Release Techniques On Clinical Indicators of Patients with Migraine Headache: A Randomized Controlled Trial

Objective: Subjects with migraine headache often have stiff posture, especially in the head and neck. Also, these patients often have reduced cervical range of motion, faulty posture, forward head posture, increased sensitivity on the cervical muscles, and myofascial pain syndrome. Myofascial Trigger Points (MTrPs) are considered as the contributing factors to migraine headache. They produce painful trigger points in the cervical muscles. There are different techniques for eliminating MTrPs such as soft tissue (neck muscles) release technique, Ultrasound, and deep heat therapy, laser therapy, and dry needling. The current study aimed to investigate the effects of selective neck muscle release techniques on clinical indicators (frequency/intensity/duration of headache, medication, functional disability, and pressure pain threshold) in patients with migraine headache.  Materials & Methods: The current study is a randomized controlled trial was conducted in the physical therapy research center of Shiraz University of Medical Sciences in Iran from August 2017 to February 2018. The statistical population consisted of all patients with migraine headache. Of these, 40 patients (aged 25-55 years) with trigger points in neck muscles including sternocleidomastoid, upper trapezius, and suboccipital were selected and then randomly assigned into two groups of release (mean age, 40.4±11.2 years) and control (mean age, 37.45±8.9 years). The subjects in the release group received 6 sessions for 2 weeks (combined MTrP therapy and stretching movements), while control group received placebo superficial massage. Headache frequency/intensity/duration, medication, functional disability, and pressure pain threshold (PPT) were assessed before, immediately after intervention, and at 1-month follow-up period. For data analysis, the two-way mixed design of ANOVA was used in SPSS v.23 software to evaluate the main effects of the two factors of group and time on the dependent variables. If the group effect was significant, independent t-test was performed to evaluate the differences in study variables between the two groups after the treatment and at the follow-up period, and if the time effect was significant, the paired t-test was carried out to assess the differences between the two groups before and after treatment and at the follow-up period. The significance was considered at P<0.05. Results: All the variables had normal distribution (P˃0.05); therefore, parametric tests were used for analyzing data. Based on the results, there were no significant differences between the two groups in all quantitative and qualitative variables before treatment(P˃0.05). The release group showed improvement in the headache frequency, intensity, and duration, medication use, the functional ability, and the PPT level in comparison with the control group (p<0.001). According to the paired t-test results, the release group showed a significant reduction in headache parameters, medication use and functional disability and increased PPT after the intervention and at the follow-up period (P<0.001). Conclusion: The release techniques for selective neck muscles including MTrP therapy and stretching movements were helpful in improving some clinical indicators such as headache parameters, medication use, functional ability, and PPT in a short time. Therefore, these techniques can be recommended for treating migraine headache patients with MTrPs in sternocleidomastoid, upper trapezius, and suboccipital muscles.