Efficacy of invasive techniques in physical therapy for migraine treatment and prevention: a systematic review of randomized controlled trials
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Lonzar, Giorgia
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Abuín Porras, Vanesa
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Blanco Muñiz, José Ángel del
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González de la Flor, Ángel
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García Pérez de Sevilla, Guillermo
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Domínguez Balmaseda, Diego
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1
Universidad Europea de Madrid
info
ISSN: 0104-4230
Datum der Publikation: 2023
Ausgabe: 69
Nummer: 2
Seiten: 346-351
Art: Artikel
Andere Publikationen in: Revista da Associação Médica Brasileira
Zusammenfassung
Approximately 14% of the world population suffers frommigraine, a highly debilitating idiopathic primary headache1.The classification and diagnosis of migraines are carriedout according to the International Classification of HeadacheDisorders (ICHD-3), based primarily on monthly migrainefrequency and the manifestation of aura. More than 15 attacksper month is considered chronic and ≤15 episodic2.The etiology of this autonomic dysfunction is unclear, but aplausible hypothesis suggests peripheral and/or central sensitization.Generally, a migraine attack develops in three or four successive stagesin which the onset of pain is determined by the trigeminal-vascularsystem. Parasympathetic activity increases in the intracranial arteries and fires the first-order neurons of this structure, sending nociceptive information from the durometer to the trigeminal ganglion.The information is then forwarded to the brainstem, in the spinaltrigeminal nucleus (STN), via second-order trigeminal vascularneurons. The trigeminovascular neurons of the third-order STNare located in the thalamus, and from there, the nociceptive information is finally sent to the somatic-sensory cortex3.Migraine medication is known to induce moderate-to-severeadverse effects, and the prophylactic treatments’ effectivenessis only 50–60%, further decreasing in the chronic modality4,5.Nonpharmacological treatments for migraine prophylaxis includephysical activity, relaxation, and physiotherapy. Physiotherapy,in particular, includes treatments such as neuromodulation,acupuncture, and myofascial release techniques.Neuromodulation refers to any intervention (drug or physical agent) that can induce a stimulating or inhibiting effect ona neurological function6.Another treatment with neuromodulatory effects is acupuncture—a Traditional Chinese medicine therapy that obtainstherapeutical benefits by stimulating specific points in the body (acupoints)5. Acupoints usually correspond with nerve fibers and terminals, which, when stimulated, modulate the information they emit7.Myofascial treatment is another physiotherapy approach usedfor migraine prevention. This therapy, through techniques suchas dry needling (DN), treats pain induced by myofascial triggerpoints (TrPs), and hyperirritable loci caused by dysfunctionalmotor endplates. When palpated or when the muscle harboringthem gets activated or stretched, TrPs induce referred and/or localpain8. TrPs in the craniocervical area constantly emit nociceptiveinputs to the STN, facilitating its sensitization and, therefore,predisposing both the onset and chronification of migraine1.Despite being a recent systematic review on the subject,the articles included are not recent, which justifies an updateon the subject.
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