A suggested cause of migraine headaches (as well as tension-type headaches) appears to be cervical musculoskeletal abnormalities. This study tested the effectiveness of physical therapy (PT) treatment, and relaxation and thermal biofeedback (RTB). First, the researchers evaluated both PT and RTB, individually, to assess their success in alleviating chronic migraine headaches. Then, they offered patients in each group, whose chronic condition was not reduced by 50%, the other form of treatment. Follow-up appraisals were conducted at three, six, and twelve months.

The physical therapy regimen focused on:

  • Posture correction for alignment of head and spine
  • Cervical range of motion for neck and shoulders
  • Isometric strengthening of the neck
  • Flare management techniques
  • Active self mobilization of the spine
  • Whole body stretching 

The program was designed to target muscular abnormalities, and the subjects were instructed to utilize the regimen twice daily for approximately thirty minutes.

The relaxation and thermal biofeedback treatment centered on muscle relaxation, breathing exercises, and thermal feedback. Again, the participants were requested to practice at home, and were provided audiotapes for relaxation and a portable biofeedback mechanism.

Since women are three times more likely to suffer from migraines than men, they made up the entire study group. Thirty women were in the PT group, and 39 in the RTB. Only 13% in the physical therapy group had a successful outcome, whereas chronic headache alleviation was reported in 51% of the RTB patients. In the follow-up, both groups retained the gains they had achieved during therapy.

When the patients who did not find relief in the first test attempted the alternate treatment, PT achieved a 47% success and RTB 50%. Therefore, RTB was exceedingly successful as a primary and secondary treatment. And although physical therapy failed as a sole treatment method, the authors suggest it was following thermal biofeedback.

The authors speculate on the findings of this study. Physical therapy was designed to improve the posture, flexibility, and range of motion, whereas RTB directly focused on reducing muscle tension. Also RTB affects perceptions of pain control by subjects:

"A number of studies have demonstrated that an important predictor of successful treatment outcome from pain rehabilitation is the development of sense of self-efficacy or self-control. This sense of control may also be a key ingredient in the self-management of migraine. For some patients, this perceived control plus muscle relaxation is sufficient to produce significant improvement, explaining the success of RTB alone. PT treatment, without the additional development of self-control skills proved ineffective in the present study."

Finally, the authors suggest the possibility of different migraine headache sufferer subgroups, based on muscular factors. An association between muscular abnormalities and treatment programs could not be accomplished in this study, but such research would be needed and useful.

Marcus DA, Scharff L, Mercer S, Turk DC. Nonpharmacological treatment for migraine: incremental utility of physical therapy with relaxation and thermal biofeedback. Cephalalgia 1998; 18:266-72.