PT  - JOURNAL ARTICLE
AU  - Burke, Kyle
AU  - Blaker, Joshua
AU  - Zgierska, Aleksandra
AU  - Lennon, Robert
TI  - A standardized osteopathic manipulative technique for the treatment of chronic migraine headaches
AID  - 10.1370/afm.22.s1.5587
DP  - 2023 Nov 01
TA  - The Annals of Family Medicine
PG  - 5587
VI  - 21
IP  - Supplement 3
4099  - http://www.annfammed.org/content/21/Supplement_3/5587.short
4100  - http://www.annfammed.org/content/21/Supplement_3/5587.full
SO  - Ann Fam Med2023 Nov 01; 21
AB  - Context: In the US, 40 million people suffer from migraines; 8% have debilitating chronic migraines (CM). Standard care such as topiramate, onabotulinumtoxin A, and calcitonin gene-related peptide monoclonal antibodies are not universally effective and cause adverse effects (AE). Non-pharmacologic treatments such as osteopathic manipulative treatment (OMT) are reported effective and may minimize AEs but current studies are limited by non-uniformity of treatment protocols.Objective: To evaluate the feasibility of a standardized OMT procedure for CM and gather preliminary data on its effectiveness in a primary care setting.Study Design & Analysis: Prospective, single-arm feasibility study. Changes were evaluated using MANOVA to 95% confidence with f distribution for effect size.Setting: Outpatient clinical research center.Population Studied: Adults aged 18 to 60 seen within the last three years for chronic migraine (ICD 10 code G43.709) with no recent or ongoing treatment with topiramate or onabotulinumtoxin A.Intervention/Instrument: Participants received up to 5 biweekly treatments (minimum 3) of five 1-minute standardized myofascial release movements and completed 1- and 3-month post-treatment assessments.Outcome Measures: Primary: study completion rate and treatment satisfaction. Secondary: changes between baseline and 1-month, and baseline and 3-month scores on: Headache Impact Test (HIT-6) and the Migraine Specific Quality of Life Questionnaire (MSQ); changes between baseline and 3-month score on the Migraine Disability Assessment Test (MIDAS).Results: All 11 participants (mean age 47 years; 10 female, 1 male) completed the baseline, 1-, and 3-month assessments and ≥3 treatments. Treatment satisfaction was high (4.7/5). Improvements between baseline and 1-month were: HIT-6: 3.4->3.1 (p<.05, ηp2=0.16 (large effect)); MSQ: 2.9->2.2 (p=.087, ηp2=0.12 (medium effect)). Improvements between baseline and 3-month were: HIT-6: 3.4->2.9 (p=.074, ηp2=0.13 (medium effect)); MSQ: 2.9->2.0 (p=0.39, ηp2=0.09 (medium effect)); MIDAS: 9.1->5.6 (p<.05, ηp2=0.19 (large effect)).Conclusions: A standardized OMT protocol is feasible for chronic migraine treatment, with significant large effect size improvements on HIT-6 and MIDAS scores, and non-significant but medium effect size improvement on the MSQ. Improvements on the HIT-6 and MSQ wane over time. Further studies are warranted to confirm generalizability and characterize the extinction coefficient of efficacy.