PO-54 | Patient perspectives on physiotherapy interventions for migraine: a pre- and post-intervention qualitative study

Zhiqi Liang,¹ Caitlin Scott,¹ Felix Cabrera Manrique,¹ Sumin Kim,¹ Chun Shun Lee,¹ Bixiang Cheng,¹ Chun Yiu Kwok,¹ Matteo Castaldo² | ¹University of Queensland; ²Parma University, Italy

Background: Physiotherapy interventions are widely used by migraine patients, however the evidence supporting these types of interventions are still contrasting. The aim of this study was to explore expectations and experiences of patients regarding physiotherapy management for migraine.

Methods: This was a qualitative study. Individuals with at least a 1-year history and monthly attacks of migraine were included. Eleven out of 13 participants in a feasibility study on physiotherapy management for migraine were interviewed by an independent researcher over phone or videoconferencing using a semi-structured format before and after undergoing two months of physiotherapy treatments that included education, manual therapy and exercise. Over eight hours of interviews were audio-recorded and transcribed. Reflexive thematic analysis identified codes and key themes after five research team meetings.

Results: All but one participant reported overall positive experience. Three themes were interpreted. Theme 1 was a gap in migraine management filled by physiotherapy. Participants expressed need for self-management strategies and information from a clinician who had time to understand, validate their experience and have ongoing discussion. They wanted assessment and treatment for neck pain and were interested in exploring non-pharmacological treatment options, including specific exercise and manual therapy. Theme 2 was that many outcomes mattered to patients. Participants had low expectations prior to physiotherapy, mainly seeking self-management strategies. After experiencing physiotherapy, all indicated that short term pain relief was important. Reduced duration, intensity and frequency of neck pain and headache were valued outcomes leading to perceived improved quality of life and function. Aggravation of symptoms was tolerated if there were immediate gains or clear understanding of why it was necessary. Some participants’ main goal was reduced medication use. Long term outcomes were not yet measured but participants expressed feeling positive and empowered. Theme 3 was about accessibility. Participants liked that physiotherapy sessions were longer and more frequent than visits to medical doctors. However, the cost and time spent could be deterrents unless outweighed by improved outcomes. Exercise prescription and advice needed to be practical and take into account individuals’ busy routines.

Conclusion: Patients want physiotherapy incorporated with usual care to improve symptoms and empower self-management.