Tertiary Care With or Without Manual Therapy for Chronic Migraine

A Pragmatic Randomised Controlled Trial on the Effectiveness of Manual Therapy as an Adjunct to Tertiary Management in Chronic Migraine

The aim of this study is to determine if adding manual therapy to care as usual reduces the discomfort from chronic migraine compared to care as usual alone

Inclusion Criteria:

Female adults 18 years of age or older with a good command of English (to enable informed consent) Existing patients with chronic migraine as diagnosed by a clinical interview with a neurologist in line with the International Classification of Headache Diagnosis criteria (ICHD) Undergoing care as usual from the neurologist

Exclusion Criteria:

Currently having or had manual therapy for neck, shoulder in the last six weeks.

Having a condition contraindicated for manual therapy including but not limited to inflammatory disorders, severe osteoporosis and tumours.

Identification of any medical 'red flags' by the neurologist including

• Evidence of any central nervous system involvement for example:
• Facial palsy (presence of ptosis/Horner's syndrome)
• Visual disturbance (presence of blurred vision, diplopia, hemianopia)
• Speech disturbance (presence of dysarthria, dysphonia, dysphasia such as expressive or receptive)
• Balance disturbance (presence of dizziness, imbalance, unsteadiness, falls)
• Paraesthesia (presence, location such as upper limb/lower limb, face)
• Weakness (presence, location such as upper limb/lower limb)
• Known major psychiatric or psychological conditions not under control