Effect of Mechanism-Based Cervical Sensorimotor Rehabilitation on Cervical Muscle Activation, Joint Position Error, and Migraine Burden in Patients With Chronic Migraine: A Randomized Controlled Trial
To investigate the effectiveness of mechanism-based cervical sensorimotor rehabilitation on cervical muscle activation, cervical proprioception, and migraine burden.
Chronic migraine is a disabling neurological disorder characterised by headache occurring on at least 15 days per month for more than three months, with migraine features on at least eight days per month according to the International Classification of Headache Disorders (ICHD-3). In addition to headache symptoms, individuals with chronic migraine frequently exhibit cervical musculoskeletal impairments, including reduced cervical range of motion, impaired cervical proprioception, altered neuromuscular control, and increased activity of superficial cervical muscles. These impairments are thought to be associated with altered sensorimotor integration and dysfunction of the trigeminocervical complex, potentially contributing to headache persistence and disability. Although several studies have reported beneficial effects of cervical rehabilitation in patients with migraine, the underlying neuromuscular mechanisms remain insufficiently understood. In particular, few randomized controlled trials have simultaneously investigated changes in cervical muscle activation, cervical joint position error, and migraine-related outcomes following a structured cervical sensorimotor rehabilitation programme. Understanding these mechanisms may improve clinical decision-making and facilitate the development of targeted rehabilitation strategies. This study is a prospective, assessor-blinded, parallel-group randomized controlled trial designed to investigate the effectiveness of a mechanism-based cervical sensorimotor rehabilitation programme in patients with chronic migraine. A total of 80 participants diagnosed with chronic migraine according to the International Classification of Headache Disorders, Third Edition (ICHD-3) will be recruited from the outpatient clinics of the Faculty of Physical Therapy, Beni-Suef University. Participants will be randomly allocated in a 1:1 ratio to either an experimental group or a control group using a computer-generated randomization sequence with concealed allocation.
Inclusion Criteria: * Male or female adults aged 18-55 years. Diagnosed with chronic migraine according to the International Classification of Headache Disorders, Third Edition (ICHD-3), defined as headache occurring on ≥15 days per month for more than 3 months, with migraine features present on at least 8 days per month. History of migraine for at least 12 months prior to enrolment. Experiencing chronic migraine during the previous three months, confirmed through clinical history and/or headache diary. Presence of cervical sensorimotor impairment, demonstrated by at least one of the following: Increased cervical joint position error. Reduced cervical range of motion. Impaired cervical motor control. Neck pain or cervical dysfunction associated with migraine.
Exclusion Criteria: * • Diagnosis of headache disorders other than chronic migraine (e.g., cervicogenic headache, cluster headache, or medication-overuse headache). Previous cervical spine surgery, fracture, or significant cervical trauma. Cervical radiculopathy, myelopathy, or severe cervical spine pathology. Neurological disorders other than migraine (e.g., stroke, multiple sclerosis, Parkinson's disease). Vestibular disorders affecting balance or proprioception. Inflammatory or systemic musculoskeletal diseases (e.g., rheumatoid arthritis, ankylosing spondylitis). Pregnancy or breastfeeding. Physiotherapy, chiropractic treatment, acupuncture, or cervical rehabilitation within the previous 3 months. Botulinum toxin injections or cervical pain interventions within the previous 3-4 months. Changes in migraine preventive medication within the previous 4 weeks. Skin conditions preventing surface EMG electrode placement. Inability to comply with the study protocol or provide informed consent.
[{"measure":"cervical joint position error","timeFrame":"after the 8-week intervention, and at the 3-month follow-up"}]