PRP158: Standardized myofascial release therapy for the treatment of chronic migraine
Robert Lennon, MD, FAAFP, JD, JD; Aleksandra Zgierska, MD, PhD
Context: Migraine is the leading cause of disability worldwide. Chronic migraine (CM) is the most debilitating type of migraine, costing the US about $15.5 billion dollars per year. CM has only two well studied pharmacologic treatment options, with limitations due to cost and side effects. Osteopathic manipulative therapy (OMT) has been shown to reduce CM symptoms. However, all OMT studies on CM to date rely on the practitioner to select from among several OMT techniques. The absence of a standard treatment procedure limits the extent to which their results can be replicated. With a standard treatment procedure the apparent benefit of OMT for CM may be widely adopted across primary care providers with minimal cost and virtually no side effects. Objective: To determine the efficacy of a standardized OMT treatment procedure in the treatment of CM. Study Design: Quasi-experimental trial. Setting or Dataset: Outpatient primary care treatment facility. Population studied: 20 adults with CM, untreated by current prophylactic therapies for CM. Adults with fibromyalgia, severe mental disease or conditions for which OMT is contraindicated will be excluded. Intervention/Instrument (for interventional studies): The OMT procedure used is a series of gentle myofascial release techniques. These take about 5 minutes to complete, and are repeated every two weeks for a total of 5 treatments. Unique to this procedure is that there is all CM patients will get the same treatment – there is no tailoring based on osteopathic evaluation. Outcome Measures: Primary: reduction in frequency and/or severity of migraines, measured by common migraine measurement instruments – headache diary, HIT-6, MSQ and MIDAS. Secondary: decrease in medication use (including opioids) as measured by electronic health record extraction. Results: We anticipate significant reductions in the frequency and severity of migraines in patients who complete at least 3 of 5 treatments. We expect medication use to decrease.