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Migraine is a prevalent neurological disorder associated with pain, fatigue, and reduced physical function. The aim of this randomized controlled trial is to examine the effects of a personalized and structured physiotherapy program-including cervical spine stabilization exercises, vestibular rehabilitation, and pain neuroscience education-on pain intensity, fatigue, and functional outcomes in individuals with migraine. Participants will be randomly allocated to an intervention group receiving personalized physiotherapy or a control group receiving standard physiotherapy care. Outcomes will be assessed at baseline, post-intervention, and follow-up.
Migraine is a disabling primary headache disorder characterized by recurrent attacks and frequently accompanied by cervical musculoskeletal dysfunction, vestibular symptoms, and altered pain processing mechanisms. Current evidence suggests that physiotherapy interventions targeting manual therapy, cervical stabilization, vestibular function, and pain neuroscience education may positively influence migration-related outcomes; However, studies combining these components in a personalized treatment model are limited.
This randomized controlled trial aims to investigate the effectiveness of a personalized structured physiotherapy program designed specifically for individuals with migraine. The interventions will include manual therapy, cervical spine stabilization exercises, vestibular rehabilitation strategies, and pain neuroscience education delivered by a physiotherapist. The control group will receive only pain neuroscience education.
Primary outcomes will include pain intensity and frequency. Secondary outcomes will include fatigue, disability level, cervical function, physical performance, and patient-reported functional limitations. Assessments will be conducted at baseline, immediately post-intervention, and during a follow-up period. The findings are expected to contribute to evidence-based physiotherapy approaches for migraine management.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Personalized Structured Physiotherapy Intervention | Experimental | Participants will receive a personalized, structured physiotherapy program including manual therapy, cervical spine stabilization exercises, vestibular rehabilitation exercises, and pain neuroscience education. The intervention will be delivered by a licensed physiotherapist twice weekly for 8 weeks. The manual therapy will include component, applied according to individual patient needs to reduce pain, improve mobility, and modulate neuromuscular control. The cervical spine stabilization exercises will target deep neck flexors and cervical postural muscles to improve neuromuscular control, endurance, and motor coordination. The vestibular rehabilitation component will include gaze stabilization, habituation, and balance exercises tailored to migraine-related vestibular symptoms. The PNE program will consist of structured individual education sessions focusing on pain neurobiology, central sensitization, and self-management strategies. Participants will attend supervised physio |
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| Standard Treatment | Active Comparator | Participants will continue their routine migraine care, including any pharmacological treatment. During the 8-week study period, they will receive only two 40-minute Pain Neuroscience Education sessions. No additional physiotherapy or exercise interventions. |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Personalized Structured Physiotherapy Intervention | Other | The manual therapy will include component, applied according to individual patient needs to reduce pain, improve mobility, and modulate neuromuscular control. The cervical spine stabilization exercises will target deep neck flexors and cervical postural muscles to improve neuromuscular control, endurance, and motor coordination. The vestibular rehabilitation component will include gaze stabilization, habituation, and balance exercises tailored to migraine-related vestibular symptoms. The PNE program will consist of structured individual education sessions focusing on pain neurobiology, central sensitization, and self-management strategies. Participants will attend supervised physiotherapy sessions twice weekly for 8 weeks, complemented by a personalized home exercise program. All components will be delivered by a licensed physiotherapist. |
| Measure | Description | Time Frame |
|---|---|---|
| Pain Intensity (VAS) | Pain intensity will be assessed using the Visual Analog Scale (VAS), ranging from 0 (no pain) to 10 (worst imaginable pain). Measurements will be taken at baseline, and at the completion of the 8-week intervention. | Baseline, Week 8 |
| Measure | Description | Time Frame |
|---|---|---|
| Pain Frequency (MIDAS A Question) | Pain frequency will be assessed using Question A of the Migraine Disability Assessment Questionnaire (MIDAS), which evaluates the number of headache days over the previous 3 months. | Baseline and Week 8 |
| Fatigue (Modified Fatigue Impact Scale - MFIS) |
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Inclusion Criteria:
Aged between 18 and 55 years
Exclusion Criteria:
• Presence of other primary headache disorders (cluster headache, tension-type headache as primary diagnosis, etc.)
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| İkra Hatice DİNÇ, MSC | Contact | +905374115611 | ikrahatice1997@gmail.com | |
| Yeliz SALCI, Associate Professor | Contact | +905303272310 | fztyeliz@hotmail.com |
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Erzincan Binali Yıldırım Univercity, Medicine Faculty | Erzincan | 24000 | Turkey (Türkiye) |
Individual participant data (IPD) will not be shared. The dataset contains sensitive clinical information, and sharing is not planned. Only aggregated results will be available upon publication.
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| ID | Term |
|---|---|
| D008881 | Migraine Disorders |
| D005221 | Fatigue |
| D010146 | Pain |
| ID | Term |
|---|---|
| D051270 | Headache Disorders, Primary |
| D020773 | Headache Disorders |
| D001927 | Brain Diseases |
| D002493 | Central Nervous System Diseases |
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| Standard Treatment | Other | Participants continue routine care including medications prescribed by their physician. Only two 40-minute Pain Neuroscience Education sessions over 8 weeks. No physiotherapy or exercise intervention provided. |
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Fatigue levels will be measured using the Modified Fatigue Impact Scale (MFIS), which evaluates physical, cognitive, and psychosocial aspects of fatigue. |
| Baseline and Week 8 |
| Migraine Disability (MIDAS Total Score) | Migraine-related disability will be assessed with the MIDAS total score, which quantifies the impact of migraine on daily activities over the past 3 months. | Baseline and Week 8 |
| Quality of Life (Headache Impact Test - HIT-6) | Quality of life will be evaluated using the HIT-6 questionnaire, which measures headache-related impact on daily functioning. | Baseline and Week 8 |
| Craniovertebral Angle (Forward Head Posture) | Forward head posture will be assessed by measuring the craniovertebral angle using a goniometer, with smaller angles indicating more pronounced forward head posture. | Baseline and Week 8 |
| Cervical Range of Motion | Cervical mobility (flexion, extension, lateral flexion, rotation) will be measured with a goniometer to assess changes in cervical spine range of motion. | Baseline and Week 8 |
| Deep Cervical Flexor Muscle Performance | Deep cervical flexor endurance and activation will be assessed using the Stabilizer Pressure Biofeedback Unit during cranio-cervical flexion tasks. | Baseline and Week 8 |
| Trigger Point Tenderness / Pressure Pain Threshold | Assessment with Manuel compression. | Baseline and Week 8 |
| Neck Pain Intensity (VAS) | Neck pain intensity will be measured using a 0-10 Visual Analog Scale (VAS) to assess changes over time. | Baseline, Week 8 |
| Dizziness Handicap (DHI) | Vestibular disability will be assessed with the Dizziness Handicap Inventory (DHI), evaluating functional, emotional, and physical impacts of dizziness. | Baseline and Week 8 |
| Balance (Mini-BESTest) | Balance performance will be evaluated using the Mini-Balance Evaluation Systems Test (Mini-BESTest), which assesses dynamic balance and postural control. | Baseline and Week 8 |
| D009422 | Nervous System Diseases |
| D012816 | Signs and Symptoms |
| D013568 | Pathological Conditions, Signs and Symptoms |
| D009461 | Neurologic Manifestations |