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Migraine Headache

Original Editors - Katie Elder from Bellarmine University's Pathophysiology of Complex Patient Problems project.

Top Contributors - Katie Elder, Admin, Shaymaa Merazy, Ewa Jaraczewska, Jess Bell, Kim Jackson, Vidya Acharya, Elaine Lonnemann, Manisha Shrestha, Jo Etherton, Jonathan Wong, WikiSysop, Uchechukwu Chukwuemeka, Evan Thomas, Kucheli Michelle Banu, 127.0.0.1, Scott Buxton, Kirenga Bamurange Liliane and Carina Therese Magtibay

Introduction

Migraine is a neurological disorder that can be highly debilitating. It is a leading cause of disability globally, particularly in people under 50. It affects quality of life, work productivity, and social interactions, and has wider societal costs.[1] Timely and accurate diagnosis is essential for successful outcomes. Effective management is typically multimodal and individualised. This page introduces migraine, including its diagnostic criteria, the difference between episodic and chronic migraine, the phases of a migraine, other types of headaches, and assessment and treatment strategies.

Diagnostic Criteria

Migraine is diagnosed by a medical professional using the International Classification of Headache Disorders (ICHD-3) criteria. There are two major types of migraine: migraine without aura and migraine with aura.

A diagnosis of migraine without aura requires:[2][3]

  1. At least five attacks fulfilling criteria 2-5
  2. Headache attacks lasting 4-72 hours [when untreated]
  3. Headache that has at least two of the following characteristics:
    • unilateral location
    • throbbing/pulsating quality
    • moderate or severe pain intensity
    • aggravation by or causing avoidance of routine physical activity
  4. During the headache, at least one of the following:
    • nausea and/or vomiting
    • photophobia and phonophobia (sensitivity to light and sound)
  5. Not attributed to another disorder

Migraine with aura is characterised by recurrent attacks of unilateral visual, sensory, or other central nervous system symptoms. Symptoms last for minutes and are fully reversible. They usually develop gradually, and are typically followed by a headache and other migraine symptoms. Aura can, however, occur without a subsequent headache (called typical aura without headache).[3] The full ICHD-3 criteria for migraine with aura and its subtypes are available here.

Episodic and Chronic Migraine

Migraine is grouped into two main types (episodic and chronic) based on headache frequency.[4] In episodic migraine, a person experiences fewer than 15 headache days per month. In chronic migraine, the person experiences headache on 15 or more days per month for at least three months, and at least eight of these headache days meet the diagnostic criteria for migraine. Chronic migraine typically has a greater impact on daily functioning and requires distinct management approaches.[2]

Prevalence

Migraine is one of the leading causes of disability worldwide and one of the most common primary headache disorders.[3] Migraine affects 14-15% of the global population,[5][6] and is around three times more common in women than men.[7][8] Migraine prevalence peaks in people between the ages of 35 and 45. Prevalence generally declines after age 50, particularly in women after menopause.[9][10]

Migraine is also common in young people, with a global prevalence of around 11%.[11] Before puberty, migraine prevalence is similar in boys and girls. From around age 9, it becomes more prevalent in girls. Onset often coincides with menarche. Early menarche is considered a risk factor for migraine development.[9]

Migraine can significantly disrupt daily life. It can cause missed work or school and affect mental health, relationships, and quality of life. Migraine often co-occurs with other chronic conditions like depression, anxiety, vascular disease, and other pain syndromes, which adds to its burden.[9][2]

Migraine Phases

Migraine has four distinct phases: prodrome (preictal), aura, pain (ictal), and postdrome (postictal). The interictal phase refers to the interval between attacks.[12]

Prodrome (Preictal) Phase

The prodrome phase is the period before a headache begins. Prodromal symptoms include changes in appetite, frequent yawning, mood shifts, increased urination, neck stiffness, heightened sensitivity to light and sound, tinnitus, digestive issues, and communication difficulties.[13]

Aura Phase

Not all people with migraine experience the aura phase. Symptoms develop gradually and are fully reversible. They include visual disturbances, sensory changes, and difficulties with speech and language.[14]

Pain (Ictal) Phase

Symptoms during the pain phase include headache, nausea, and vomiting, along with increased sensitivity to light, noise, and odours. These symptoms are worsened by physical activity.[2][3]

Postdrome (Postictal) Phase

The postdrome, sometimes called the "migraine hangover", follows the pain phase and is commonly characterised by fatigue, low mood, muscle weakness, and difficulty concentrating. Some individuals may experience euphoria instead.[15]

Migraine vs Other Types of Headaches

Accurately identifying the specific type of headache, including atypical migraines, is crucial for effective treatment. Patients often mislabel their headaches, sometimes incorrectly assuming a severe headache is a migraine, or dismissing a migraine diagnosis due to a lack of classic symptoms.[8] Table 1 compares the main features of different headache types.

Table 1. Comparing different types of headaches
Headache type Usual site of pain Usual description of pain Possible associated symptoms Duration Improved by Made worse by Diagnostic criteria summary
Migraine without aura[16][17][18] Unilateral (60%), frontotemporal (adults), or bilateral (children) Pulsating quality; moderate or severe intensity Nausea, vomiting, photophobia, phonophobia, cranial autonomic symptoms, and cutaneous allodynia 4-72 hours Triptans, gepants, nonsteroidal anti-inflammatory drugs (NSAIDs), Botox, anti-calcitonin gene-related peptide inhibitors (CGRP), cold, sleep, absence of light and sound Routine physical activity, stress, sleep deprivation, fasting, hormonal fluctuations, alcohol, odours, and other triggers 5 attacks; 4-72 hour duration; with 2 of the following symptoms: unilateral, pulsating, moderate/severe intensity, aggravated by activity.

And 1 of the following symptoms: nausea/vomiting, photophobia and phonophobia

Tension-type headache (TTH)[16][17][18] Bilateral (forehead, temples, or back of head) Pressing or tightening (non-pulsating) quality; mild or moderate intensity Pericranial tenderness; mild nausea, typically no photophobia or phonophobia 30 minutes to many days Analgesics, massage, heat or cold Stress, sleep disturbances, and poor self-rated health 10 episodes; bilateral; pressing/tightening; mild/moderate; not aggravated by activity; no nausea/vomiting; maximum 1 of photophobia/phonophobia
Cluster headache[16][18] Strictly unilateral; orbital, supraorbital, or temporal Severe or very severe intensity; piercing or excruciating pain Ipsilateral conjunctival injection, lacrimation, nasal congestion, runny nose, eyelid oedema, and restlessness 15-180 minutes High-flow oxygen (100%) and triptans (subcutaneous/intranasal) Alcohol, histamine, and nitroglycerin 5 attacks; severe unilateral orbital/temporal pain; 15-180 minutes; ipsilateral autonomic sign or restlessness; frequency 1 every other day to 8 per day
Trigeminal neuralgia[16][18][19] Unilateral facial pain; distribution of trigeminal nerve divisions Severe intensity; electric shock-like, shooting, stabbing, or sharp quality; abrupt onset/termination Facial muscle contraction and mild autonomic symptoms (ex.: lacrimation, eye redness) A fraction of a second to 2 minutes Anticonvulsant medications  and microvascular decompression Innocuous stimuli (light touch, talking, chewing, cold, brushing teeth) Recurrent paroxysms of unilateral facial pain; 1 second to 2 minutes; severe intensity; electric shock-like/shooting; precipitated by innocuous stimuli
Occipital neuralgia[20][16] Unilateral or bilateral; posterior scalp (occipital nerve distribution); may radiate to fronto-orbital area Severe intensity; shooting, stabbing, or sharp/piercing quality Allodynia (scalp/hair), nerve tenderness, and trigger points Seconds to a few minutes NSAIDs, muscle relaxants, Botox, local anaesthetic block Neck flexion/extension, head rotation, wearing hats, and lying supine on pillows Unilateral or bilateral paroxysmal severe pain in occipital distribution; 2 of: shooting/stabbing, severe, or paroxysmal; associated with dysaesthesia/allodynia; eased by local block
Medication-overuse headache (MOH)[21][16] Pre-existing headache pattern (usually migraine or TTH) Chronic daily headache; significant worsening of pre-existing headache. Often described as dull Dependent on the underlying primary headache Persistent (at least 15 days/month for > 3 months) Withdrawal of overused medication Regular overuse of acute medication (triptans/opioids  10 days/month;

NSAIDs/Tylenol (acetaminophen) 15 days/month)

Headache  15 days/month in patient with pre-existing headache; regular medication overuse for > 3 months

Physiotherapy Assessment of Migraine

Migraine is diagnosed by a medical practitioner. The physiotherapist's role in assessment is to understand the patient's migraine experience, identify contributing factors, and screen for red flags or features that warrant onward referral.

The following general principles support migraine assessment and treatment. Where possible, avoid bright/neon lights and noisy environments, strong odours, such as perfume or cleaning products, and conduct one-on-one interviews to limit the number of people the patient must interact with.[2]

Subjective Assessment

During the subjective examination, ask the patient about migraine features and symptoms, including pain intensity and the frequency of the episodes. Additional areas to cover include medication use, sensitisation symptoms, such as allodynia, and general physical and mental health issues. Temporomandibular joint (TMJ) issues can also have an impact on migraine, so ask about teeth grinding and if the patient has a bruxism diagnosis.[2]

For more information on TMJ-related headaches, see: Headaches and Cervical Spine Conditions Related to Temporomandibular Disorders.

Red Flags

Patients presenting with any of the following should be seen by a doctor immediately:[2]

  • Sudden, severe headache
  • New neurological deficits
  • A change in the usual headache pattern
  • A headache accompanied by fever, trauma, or signs of a systemic illness

If you would like to read more on headache red flags, see: Red Flags Associated with Headaches.

Objective Assessment

The objective examination may include pain sensitivity tests to evaluate the role of central sensitisation, and postural analysis, with attention to head position. Forward head position is commonly observed in people with migraine and may indicate the presence of muscle imbalance, though this association is not universal. Cervical range of motion, neck muscle strength, and overall endurance should also be assessed. Given the bidirectional relationship between temporomandibular disorders (TMD), neck pain and headache,[22] screening for TMD and trigger points is also recommended.[2]

Migraine Questionnaires

Several validated questionnaires can support assessment and monitor progress.

ID Migraine™ is a very quick, validated three-item screening tool covering disability, nausea, and photophobia. It is suitable for use in primary care or during an initial assessment.[2]

Migraine Disability Assessment (MIDAS) is a simple, widely used questionnaire for stratifying migraine severity and tracking change. It assesses migraine-related disability over the past three months across work, home, and social activities, using five scored questions and two additional clinical questions.[2]

Headache Impact Test (HIT-6) is a very quick six-item questionnaire used in both clinical practice and research. It measures the impact of headaches on daily functioning, cognition, and psychological distress.[2]

Migraine-Specific Quality of Life Questionnaire (MSQ) is a 14-item tool with strong psychometric properties. It measures the impact of migraine on daily functioning and quality of life in more detail.[2]

Headache Disability Inventory (HDI) is a 25-item questionnaire that measures the emotional and functional impact of headaches. It is useful for capturing broader disability and emotional burden.[2]

Migraine Interictal Burden Scale (MIBS-4) is a four-item tool that measures the burden of migraine between attacks, including its impact on work, family, planning, and emotional function. It captures interictal burden, which is often missed by tools focused only on attacks.[2]

Treatment for Migraine

Treatment for migraine is broadly divided into pharmacological and non-pharmacological approaches.

Pharmacological Treatment

Pharmacological treatment includes preventative medications, used to reduce the likelihood of attacks, and acute medications, taken when a migraine starts.[2]

Preventative Medication

Several options are available for migraine prevention. These include injectable medications specifically designed for migraine, alongside older, established treatments, such as beta-blockers, anti-epileptics, and antidepressants.[23] Botox injections are also an option for some patients.[24]

Acute Medication

Acute migraine treatment must be personalised, as no single solution works for all patients. Early intervention during the headache phase is important, as it improves treatment response and reduces attack severity. Treatment options fall into two main categories: over-the-counter (OTC) analgesics and anti-inflammatory medications, and migraine-specific medications. The most common migraine-specific medications are triptans, and more recently, a new category called gepants. Medications are available in various formulations, such as oral tablets, injectables, sublingual tablets, and nasal sprays, to accommodate different needs.[23]

Medication-overuse headache (MOH), sometimes called rebound headache, can develop in patients who use acute migraine medications more than 10 days per month. Frequent use of these medications can paradoxically increase headache frequency. This can be a difficult balance for people living with migraine, as they are advised to take acute medication at the first signs of an attack, while also needing to avoid overuse. Tracking headaches and medication use is therefore important. [2]

Non-Pharmacological Treatment

Non-pharmacological treatment, including physiotherapy, plays a meaningful role in migraine management. Treatment is adapted depending on whether the patient is in a migraine episode or not. During an episode, the goal is to decrease symptoms. Between episodes, there is more scope to work on education, exercise, and prevention.[2]

Education

Patient education is an important part of treatment. It can include pain neuroscience education, explanations of what migraine is and the phases of a migraine episode, so the patient can recognise their prodrome signs. Other useful topics include medication-overuse headache and central sensitisation, and strategies for pain reduction and ongoing support.[25]

Therapeutic Modalities

Research and clinical practice support the use of the following therapeutic modalities.

Kinesio Taping for upper trapezius inhibition

Kinesio taping can be used to inhibit the upper trapezius and the deep cervical extensor muscles. Tape is applied with little to no tension, from the insertion to the origin of the muscles, while the muscles are in a stretched position. For example, during upper trapezius taping, the patient gently tilts their head, bringing the ear toward the shoulder opposite to the side being taped. Some patients also report benefit from applying Kinesio tape with 50 to 75% stretch directly on the forehead, over the area of pain.[2] A randomised controlled trial by Biber and Polat found that combining Kinesio taping, physiotherapy, and pharmacological treatment significantly improved clinical outcomes for patients with migraine and neck pain, including reductions in headache and neck pain intensity, increased pressure pain threshold, and improved quality of life scores compared with control groups.[26]

Dry needling

Dry needling of the cervical dorsal muscles has also been shown to be effective. A systematic review by Maroto-García et al. found that dry needling and manipulation techniques produced positive effects on a range of outcomes in patients with headache, including reduced pain and sensitivity, as well as improved functionality and overall general health.[27]

Transcutaneous electrical nerve stimulation (TENS) has also been investigated for migraine. Hokenek et al. reported that TENS appeared to be a fast-acting, effective therapy for acute migraine in the emergency department.[28]

Acupuncture has been associated with a moderate decrease in headache frequency compared with no acupuncture.[29]

Manual Therapy

Manual therapy can be helpful for some patients, particularly those with cervical dysfunction, muscle tension, TMJ involvement, or scapular issues.[2] The evidence on manual therapy is mixed. Manual therapy incorporating postural and cranio-cervical exercises was not more effective than usual care in decreasing the number of migraine days or most secondary outcomes. However, it was associated with high patient preference and treatment satisfaction.[30] [31] [32] Cervical manipulation has been associated with short-term improvement in migraine, but caution is warranted given the rare but serious risk of vertebral artery dissection, stroke, or transient ischaemic attack.[33][34][32]

Exercise

Regular exercise and physical activity can produce meaningful improvements for people with migraine. However, exercise should be approached carefully, especially as physical activity commonly worsens symptoms in migraine. Gradual integration is, therefore, important.

Patients should be advised to include a proper warm-up and cool-down, and pay attention to their hydration. Exercise programmes should start with gentle exercises and be performed consistently. Graded exposure is an effective way to introduce exercise, and patients should be supported with education on pacing and activity regulation.[2]

Different types of exercise can benefit patients with migraine. The key is finding out what works best for each person. Moderate-intensity aerobic exercise, such as brisk walking or cycling, is often a good starting point and there is strong evidence supporting its role in migraine prevention; it has been found that regular aerobic exercise can be as effective as some preventative medications for certain patients.[35] Higher-intensity aerobic exercise can also be beneficial for some people when introduced gradually.[2] Muscle-strengthening exercises and vigorous activities can also significantly decrease the frequency of headaches and migraines,[36][37] and gentle stretching of the cervical muscles and myofascial release are effective in improving symptoms.[2][38]

Yoga-based breathing and relaxation programmes combine movement, breathing, and relaxation. These programmes can help regulate the nervous system and reduce stress. Sujan et al. found that headache frequency, pain intensity, and headache-related disability (HIT-6 scores) all improved substantially following a yoga and relaxation programme.[39] There were also improvements in quality of life, physiological metrics (resting heart rate and blood pressure), and headache symptoms.[39]

Lifestyle Modification

Lifestyle advice was identified as one of the top management strategies for tension-type headache and migraine in a Delphi study of physiotherapists.[40] Education on general health, exercise, sleep, diet, and relaxation techniques can benefit patients with migraine. Useful topics include caffeine reduction, weight management, and mindfulness, though more detailed dietary advice should come from a dietitian.

Interprofessional Teams

Migraine often co-occurs with anxiety, depression, and other chronic pain conditions. This can intensify disability and worsen the psychosocial impact of migraine. Collaboration with other healthcare professionals is important for patients with concurrent issues.[41] Physiotherapy works best as part of a multidisciplinary approach with a strong focus on self-management.[2]

Resources



References

  1. ↑ Peres MFP, Sacco S, Pozo-Rosich P, Tassorelli C, Ahmed F, Burstein R, et al. Migraine is the most disabling neurological disease among children and adolescents, and second after stroke among adults: A call to action. Cephalalgia. 2024 Aug;44(8):3331024241267309.
  2. ↑ 2.00 2.01 2.02 2.03 2.04 2.05 2.06 2.07 2.08 2.09 2.10 2.11 2.12 2.13 2.14 2.15 2.16 2.17 2.18 2.19 2.20 2.21 2.22 Ferland L. Migraine Overview Course. Physiopedia Plus, 2026.
  3. ↑ 3.0 3.1 3.2 3.3 The International Classification of Headache Disorders. 3rd Edition. IHS Classification ICHD-3. Available from: https://ichd-3.org/ [accessed 19 May 2026].
  4. ↑ Lipton RB, Chu MK. Conceptualizing the relationship between chronic migraine and episodic migraine. Expert Rev Neurother. 2009 Oct;9(10):1451-4.
  5. ↑ Dong L, Dong W, Jin Y, Jiang Y, Li Z, Yu D. The global burden of migraine: a 30-year trend review and future projections by age, sex, country, and region. Pain Ther. 2025 Feb;14(1):297-315.
  6. ↑ Husøy AK, Yu S, Liu R, Herekar AA, Ahmed B, Herekar AD, et al. The global prevalence of headache disorders of public-health importance: a meta-analysis of population-based individual participant data from 41,614 adults from 17 countries. J Headache Pain. 2025 Oct 7;26(1):204.
  7. ↑ Cohen F, Brooks CV, Sun D, Buse DC, Reed ML, Fanning KM, Lipton RB. Prevalence and burden of migraine in the United States: a systematic review. Headache: The Journal of Head and Face Pain. 2024 May;64(5):516-32.
  8. ↑ 8.0 8.1 Rossi MF, Tumminello A, Marconi M, Gualano MR, Santoro PE, Malorni W, Moscato U. Sex and gender differences in migraines: a narrative review. Neurol Sci. 2022 Sep;43(9):5729-5734.
  9. ↑ 9.0 9.1 9.2 Waliszewska-Prosół M, Grandi G, Ornello R, Raffaelli B, Straburzyński M, Tana C, Martelletti P. Menopause, Perimenopause, and Migraine: Understanding the Intersections and Implications for Treatment. Neurol Ther. 2025 Jun;14(3):665-680.
  10. ↑ Bugge NS, Vetvik KG, Alstadhaug KB, Braaten T. Migraine through puberty and menopausal transition-data from the population-based Norwegian Women and Health study (NOWAC). J Headache Pain. 2025 Jun 20;26(1):145.
  11. ↑ Wang Q, Luo R, Wen Q. Rising trends in the burden of migraine among children and adolescents: a comprehensive analysis from 1990 to 2021 with future predictions. Front Public Health. 2025 Oct 23;13:1634098.
  12. ↑ Vincent M, Viktrup L, Nicholson RA, Ossipov MH, Vargas BB. The not so hidden impact of interictal burden in migraine: A narrative review. Front Neurol. 2022 Nov 3;13:1032103.
  13. ↑ Sebastianelli G, Atalar AÇ, Cetta I, Farham F, Fitzek M, Karatas-Kursun H, Kholodova M, Kukumägi KH, Montisano DA, Onan D, Pantovic A. Insights from triggers and prodromal symptoms on how migraine attacks start: the threshold hypothesis. Cephalalgia. 2024 Oct;44(10):03331024241287224.
  14. ↑ Viana M, Tronvik EA, Do TP, Zecca C, Hougaard A. Clinical features of visual migraine aura: a systematic review. J Headache Pain. 2019 May 30;20(1):64.
  15. ↑ Karsan N, Peréz-Rodríguez A, Nagaraj K, Bose PR, Goadsby PJ. The migraine postdrome: spontaneous and triggered phenotypes. Cephalalgia. 2021 May;41(6):721-30.
  16. ↑ 16.0 16.1 16.2 16.3 16.4 16.5 Headache Classification Committee of the International Headache Society (IHS) The International Classification of Headache Disorders, 3rd edition. Cephalalgia. 2018 Jan;38(1):1-211.
  17. ↑ 17.0 17.1 Onan D, Younis S, Wellsgatnik WD, Farham F, Andruškevičius S, Abashidze A, Jusupova A, Romanenko Y, Grosu O, Moldokulova MZ, Mursalova U, Saidkhodjaeva S, Martelletti P, Ashina S. Debate: differences and similarities between tension-type headache and migraine. J Headache Pain. 2023 Jul 21;24(1):92.
  18. ↑ 18.0 18.1 18.2 18.3 San-Juan D, Velez-Jimenez K, Hoffmann J, Martínez-Mayorga AP, Melo-Carrillo A, Rodríguez-Leyva I, García S, Collado-Ortiz MÁ, Chiquete E, Gudiño-Castelazo M, Juárez-Jimenez H, Martínez-Gurrola M, Marfil A, Nader-Kawachi JA, Uribe-Jaimes PD, Darío-Vargas R, Villareal-Careaga J. Cluster headache: an update on clinical features, epidemiology, pathophysiology, diagnosis, and treatment. Front Pain Res (Lausanne). 2024 Mar 8;5:1373528.
  19. ↑ Liu Y, Tanaka E. Pathogenesis, Diagnosis, and Management of Trigeminal Neuralgia: A Narrative Review. J Clin Med. 2025 Jan 15;14(2):528.
  20. ↑ Swanson D, Guedry R, Boudreaux M, Muhlenhaupt E, Kaye AD, Viswanath O, Urits I. An Update on the Diagnosis, Treatment, and Management of Occipital Neuralgia. J Craniofac Surg. 2022 May 1;33(3):779-783.
  21. ↑ Gosalia H, Moreno-Ajona D, Goadsby PJ. Medication-overuse headache: a narrative review. J Headache Pain. 2024 May 31;25(1):89.
  22. ↑ Du SS, Hu YY, Niu YM. Associations between temporomandibular disorders/bruxism and head and neck pains: a bidirectional Mendelian randomization study. J Oral Facial Pain Headache. 2025 Dec;39(4):122-137.
  23. ↑ 23.0 23.1 Puledda F, Silva EM, Suwanlaong K, Goadsby PJ. Migraine: from pathophysiology to treatment. J Neurol. 2023 Jul;270(7):3654-3666.
  24. ↑ Shaterian N, Shaterian N, Ghanaatpisheh A, Abbasi F, Daniali S, Jahromi MJ, Sanie MS, Abdoli A. Botox (OnabotulinumtoxinA) for Treatment of Migraine Symptoms: A Systematic Review. Pain Res Manag. 2022 Mar 31;2022:3284446.
  25. ↑ Meise R, Carvalho GF, Thiel C, Luedtke K. Additional effects of pain neuroscience education combined with physiotherapy on the headache frequency of adult patients with migraine: A randomized controlled trial. Cephalalgia. 2023 Feb;43(2):3331024221144781.
  26. ↑ Biber EK, Polat B. Effects of kinesiotaping combined with physical therapy in patients with migraine-associated neck pain: a randomized controlled study. BMC Musculoskelet Disord. 2025 Oct 23;26(1):990.
  27. ↑ Maroto-García R, Sánchez-Fernández S, Monclús-Díez G, Sánchez-Jorge S, López-Redondo M, Kołacz M, Kosson D, Valera-Calero JA. Effects of Spinal Manipulation and Dry Needling on Headache and Migraine: A Systematic Review of Randomized Controlled Trials. Journal of Clinical Medicine. 2026 Mar 9;15(5):2084.
  28. ↑ Hokenek NM, Erdogan MO, Hokenek UD, Algin A, Tekyol D, Seyhan AU. Treatment of migraine attacks by transcutaneous electrical nerve stimulation in emergency department: A randomize controlled trial. Am J Emerg Med. 2021 Jan;39:80-85.
  29. ↑ Linde K, Allais G, Brinkhaus B, Fei Y, Mehring M, Vertosick EA, Vickers A, White AR. Acupuncture for the prevention of episodic migraine. Cochrane Database Syst Rev. 2016 Jun 28;2016(6):CD001218.
  30. ↑ Amons AL, Castien RF, De Hertogh W, van der Wouden JC, Twisk JW, Dekker J, van der Horst HE. Effectiveness of manual therapy as a prophylactic treatment for migraine: a randomized controlled trial. Arch Physiother. 2026 Feb 13;16:11-22.
  31. ↑ Chaibi A, Tuchin PJ, Russell MB. Manual therapies for migraine: a systematic review. The journal of headache and pain. 2011 Apr 1;12(2):127-33.
  32. ↑ 32.0 32.1 Biondi DM. Physical treatments for headache: a structured review. Headache: The Journal of Head and Face Pain. 2005 Jun;45(6):738-46.
  33. ↑ Rist PM, Hernandez A, Bernstein C, Kowalski M, Osypiuk K, Vining R, Long CR, Goertz C, Song R, Wayne PM. The Impact of Spinal Manipulation on Migraine Pain and Disability: A Systematic Review and Meta-Analysis. Headache. 2019 Apr;59(4):532-542.
  34. ↑ Voigt K, Liebnitzky J, Burmeister U, Sihvonen-Riemenschneider H, Beck M, Voigt R, Bergmann A. Efficacy of osteopathic manipulative treatment of female patients with migraine: results of a randomized controlled trial. The Journal of alternative and complementary medicine. 2011 Mar 1;17(3):225-30.
  35. ↑ Irby MB, Bond DS, Lipton RB, Nicklas B, Houle TT, Penzien DB. Aerobic Exercise for Reducing Migraine Burden: Mechanisms, Markers, and Models of Change Processes. Headache. 2016 Feb;56(2):357-69.
  36. ↑ Florencio LL, de Oliveira AS, Carvalho GF, Tolentino Gde A, Dach F, Bigal ME, Fernández-de-las-Peñas C, Bevilaqua Grossi D. Cervical Muscle Strength and Muscle Coactivation During Isometric Contractions in Patients With Migraine: A Cross-Sectional Study. Headache. 2015 Nov-Dec;55(10):1312-22.
  37. ↑ Wang Y, Zhu X, Liang Y. Which Exercise Patterns Are Most Effective for Reducing Severe Headache/Migraine in Adults? Evidence From a Nationally Representative U.S. Sample. Am J Lifestyle Med. 2025 May 9:15598276251341206.
  38. ↑ Rezaeian T, Ahmadi M, Mosallanezhad Z, Nourbakhsh MR. The impact of myofascial release and stretching techniques on the clinical outcomes of migraine headache: A randomized controlled trial. J Res Med Sci. 2021 Jul 31;26:45.
  39. ↑ 39.0 39.1 Sujan MU, Inbaraj G, Rao MR, Vadiraja HS, Jahnavi VM, Mulakur S, Kisan R, Adoor M, Raghuram MS, Nandakumar B, Nalini A. Yoga-based breathing and relaxation as adjunctive therapy for chronic migraine: A randomized controlled trial on clinical outcomes and autonomic regulation. Complementary Therapies in Medicine. 2025 Oct 30:103291.
  40. ↑ De Pauw R, Dewitte V, De Hertogh W, Cnockaert E, Chys M, Cagnie B. Consensus among musculoskeletal experts for the management of patients with headache by physiotherapists? A delphi study. Musculoskeletal Science and Practice. 2021 Apr 1;52:102325.
  41. ↑ Souren R, Winteler BR, Bischoff N, Fluri O, Grolimund J, Scutelnic A, Streitberger K, Beckwée D, Schankin CJ. Effectiveness of a Multidisciplinary Headache Management Program: An Open-Label Pilot Study. Clinical and Translational Neuroscience. 2025 Jun 18;9(2):27.
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