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Efficacy of Osteopathic Manipulation Therapy in the Treatment of Post-concussive Versus Primary Migraines
Song, J. [1]
Hall, T. [4]
Waddington, M. [2]

Journal: Journal of Osteopathic Medicine Date: 2023/12, 123(12):Pages: A42-A44. doi: Subito , type of study: observational study

Full text    (https://www.degruyter.com/document/doi/10.1515/jom-2023-2000/html)

Keywords:

concussion [29]
migraine [57]
observational study [126]
OMT [2951]
osteopathic manipulative treatment [2973]

Abstract:

Statement of Significance: Migraines are a common disease that affects approximately 15% of Americans. It is manifested as moderate to severe paroxysmal, throbbing, and unilateral headaches, persisting between 4 hours to 3 days, and may occur concomitant with photophobia, phonophobia, osmophobia, allodynia, nausea, vomiting, and pain with motion [2]. There have been recent insights into migraine’s pathophysiology, yet adequate recognition and intervention remain unmet needs. To evaluate the efficacy and safety of using osteopathic manipulation therapy (OMT) for treatment of post-concussive migraines compared to primary migraines, also examining the disparate biomechanical changes to the anatomy and physiology that take place in the two etiologies of migraine so to better encourage restoration of the body’s normal structure-function relationship. Research Methods: This is a prospective observational study conducted at the Neuromuscular Medicine Clinic. No randomization has been used. Inclusion criteria consists of patients aged 18 years or older, exhibition of migraines after mild traumatic brain injury (TBI) with lingering symptoms beyond 2 weeks post incident, and patients with primary migraine headaches (not caused by another underlying medical condition; clinical diagnosis not requiring workup or imaging). Excluded from the study are patients who are younger than 18 years of age at time of consent, secondary causes (non-concussive) of migraines, currently on preventative or abortive migraine therapies, receiving nerve blocks/trigger point injections, undergoing physical/occupational therapy, or seeking chiropractic care. Patients with contraindications to OMT treatment, which include presence of active abscesses, localized infections, bacteremia, bone fractures, certain stages of carcinomas, thrombotic events, recent surgical wounds, and lymphoma, are also excluded. Study participants have been divided into two groups—post- concussive and primary migraine patients. OMT treatment will be applied to both groups to target somatic dysfunctions of the cranial, suboccipital, upper extremity, costal, thoracic, and abdominal regions. Quantitative pain measures will be extracted using the Visual Analogue Scale, Verbal Rating Scale, and Numerical Rating Scale. The aim is to recruit about 200 patients in total for the study and perform statistical analyses using Spearmon correlation and ANOVA variance analysis (via the IBM SPSS Statistics Software) to delineate the efficacy of OMT in the alleviation of post-concussive versus primary migraine symptoms. The biomechanical model of osteopathic medicine is employed in the study, as helping the body restore the correct alignment of its structures using external force encourages the flow of essential nutrients to promote innate body healing mechanisms and optimal functionality. Data Analysis: Six study participants have been recruited to date, with three in the post-concussive migraine group and three in the primary migraine group. Both groups of patients experienced symptoms of moderate to severe unilateral head pain, associated with photophobia, phonophobia, nausea, and gradual, brief auras less than an hour in duration, mostly visual, which precede the migraine attacks. The post-concussive migraine patients also presented with daytime drowsiness, lack of focus/concentration, balance issues, dizziness, and insomnia [4], which were not present in patients with primary migraines. Comprehensive neurological examinations conducted in the office were unremarkable for both groups of patients. Patients were treated with OMT in office at four-week intervals and have attended on average two sessions so far with marked improvement/resolution of migraine symptoms (pain rating dropped from 9-10/10 to under 3/10, frequency of migraine attacks decreased from daily/continuous to monthly or less). During the visits, thoracic dysfunctions were released with balanced ligamentous tension, high velocity low amplitude thrust, and myofascial release techniques. Direct trapezial inhibition, scapular release, and suboccipital muscle stretch were administered bilaterally. Cranial strain pattern correction, cervical spinal/soft tissue release, autonomic nervous system normalization, lymphatic drainage stimulation, and supraclavicular restrictions were employed. Both direct and indirect techniques were utilized. The treatment course lasted approximately twenty minutes per visit and resolution of dysfunctions were rechecked post treatment. In the post-concussive migraine group, the additional symptoms also showed remarkable alleviation with OMT treatment, albeit to a lesser extent. Patients will continue to be followed in office for a minimum of four months with visits spaced at four-week intervals until complete symptomatic resolution. Conclusion: Approximately 39 million people (about twice the population of New York) in the United States, and 1 billion globally, are afflicted with migraine headaches, making it one of the most common neurological diseases in the world. Migraines cost the US about $36 billion (about $110 per person in the US) annually in healthcare expenditure and lost productivity [5]. It is therefore of paramount importance to find novel and cost-effective ways to revolutionize management of the disorder. From our study perspective, OMT has been effective in stimulating the vagus nerve, which is part of the parasympathetic nervous system, and aids in normalization of blood flow to the brain and modulation of painful stimuli. It also promotes lymphatic drainage from the brain, allowing better removal of waste products and metabolites. OMT has been hypothesized to rebalance the vegetative nervous system (VNS) nuclei and diminish pro-inflammatory substances, both responsible for migraine-associated pain [1]. OMT also disrupts the cycle of muscle-spasm/spinal misalignment induced pain [3]. Patients in both groups exhibited significant migraine improvement/resolution post two OMT sessions, without simultaneously undertaking other treatment interventions, shedding light on the promise that OMT is an effective adjunctive or primary tool to provide lasting relief for patients suffering from migraines. Limitations to our study include confounding factors that affect pain perception/tolerance, such as the patients’ differing sporadic use of over-the-counter anti-inflammatories/painkillers, age and stress levels, genetic predispositions, nutritional/exercise status, alcohol/tobacco use, and support systems. Future research should probe into the role of underlying psychiatric conditions, such as cortical spreading of depression or anxiety, in inducing aura and prolonging migraine healing, as well as the interplay of an interprofessional team in migraine management.

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