PO-60 | Effectiveness of aerobic exercise, Mulligan technique, and myofascial release in migraine management: preliminary data from a randomized controlled trial

Marco Bravi,^1,2 Fabio Santacaterina,^1,2 Federica Bressi,^1,2 Francesca Nasto,^1,2 Claudia Altamura,^1,2 Fabrizio Vernieri^1,2 | ¹Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Rome, Italy; ²Università Campus Bio-Medico di Roma, Rome, Italy

Background: Migraine affects approximately 14% of the global population, worsens patients’ quality of life and causes a substantial economic burden on individuals, employers, and society. Pharmacological treatments remain first-line options; however, there is emerging evidence regarding benefit of physiotherapy approaches like aerobic exercise and manual therapy. This study aims to evaluate the effectiveness of different physiotherapy interventions in improving clinical outcomes in patients with migraine.

Methods: In this prospective, monocentric, randomized controlled trial, 40 patients with migraine were recruited at the Headache and Neurosonology Unit of Fondazione Policlinico Universitario Campus BioMedico. Participants were randomized into four groups: pharmacological control (CTRL), Mulligan mobilization (MM), aerobic exercise (AE), or myofascial release (MR). Each group received 12 sessions (40 min, 3 times/week/4 weeks). Assessments were performed at baseline (T0), post-intervention (T1), 3 months later (T2). Outcomes included: acute medication intake in the last month, attacks frequency, duration, pain intensity), MIDAS, Neck Disability Index, VAS, cervical range of motion (ROM) and strength.

Results: Compared to baseline, a significant reduction in acute medication intake was observed at T1 in the MR versus the CTRL (p = 0.017; MR = –4; CTRL = 0) group, and at T2 for the AE versus CTRL (p = 0.007; AE = –5.6; CTRL = –0.1) group. Migraine frequency significantly decreased in the MM group compared to CTRL both at T1 (p = 0.003; MU = –5.6; CTRL = –0.1) and T2 (p = 0.004; MU = –6.0; CTRL = –0.3). Cervical flexion ROM showed a significant improvement at T1 in the MM (p = 0.006; MM = +9°) and AE (p < 0.001; AE = +15.7°) compared to a reduction in the CTRL group (–10°). All other outcomes did not show significant differences, although favorable trends were observed in physiotherapy groups compared to CTRL. 

Conclusion: The preliminary results of this study support the effectiveness of physiotherapy in the management of migraine, as they were associated with significant improvements in headache frequency, acute medication intake, and cervical mobility compared to pharmacological treatment alone. Furthermore, favorable trends across pain, disability, and strength suggest a potential added value of physiotherapy. These findings highlight the importance of integrating physiotherapy into the management of migraine patients. Further studies with larger samples and long-term follow-up are needed to confirm our findings.