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Osteopathic treatment of migraine without aura: outcome research.

3rd International Conference of Osteopatic Medicine - Pescara 2013
by

Vito Adragna

on 20 April 2016

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Transcript of Osteopathic treatment of migraine without aura: outcome research.

European population: 7% males e 18% females

More than one person out of 10, 1/3 from childhood

Decrease quality of life and health status

International Headache Society (IHS) Classification (2004)

Migraine
Tension-type headache
Cluster headache
Other headache

Diagnosis:

at least 5 attacks with the following characteristics of pain and related disorders:


At least 2 of the 4 characteristics of pain:
unilateral location
pulsating quality
moderate or severe intensity
aggravation by or causing avoidance of routine physical activity
At least 1 of the associated symptoms:
nausea and/or vomiting
photophobia and phonophobia
Headache attacks lasting 4-72 hours (untreated or unsuccessfully treated)
Frequency of taking drugs
Intensity of migraine attacks
Frequency of migraine attacks
Methods
Enrollment
inclusion
° Age between 30 and 70 years
° Minimum 2 migraine attacks per month
° Only NSAI drugs therapy as needed
exclusion
° Tumors/neoplasms

° Degenerative neurological diseases
° Pregnancy and breastfeeding
° Neurological diagnosis:
migraine without aura IHS 1.1 - ICD G43.0
MIDAS
questionnaire

t0, before 1° OMT
t1, follow up
- visceral tecnique
- cranio-sacral tecnique
- miofascial release
- HLVA
Frequency of somatic dysfunction (t0)
Conclusions
Limits
Control group
No reliability test
Thanks !
Bibliografia

1. Maurizio Gionco, “Manuale delle Cefalee 2011”, ed. Lingomed
2. Aleksander Chaibi, Peter J. Tuchin , Michael Bjørn Russell, “Manual therapies for migraine: a systematic review”, J Headache Pain, 2011, review,12: 127-133
3. Loretta L. Muller, “Diagnosing and Managing Migraine Headache”,JAOA , November 2007, 6(Suppl), 107(11): ES10-ES16
4. Astin JA, Ernst E, “The Effectiveness of Spinal Manipulation for the Treatment of Headache Disorders A Systematic Review of Randomized Clinical Trials”, Cephalalgia, 2002, 22: 617-623
5. David M.Biondi, “Physical Treatments for Headache: A Structured Review”, Headache, 2005, 45: 738-746
6. Anderson R.E., Seniscal C. “A comparison of selected osteopathic treatment and relaxation for tension-type headache”, Headache, Sep 2006, 46(8): 1273-80
7. Karen Voigt e al., “ Efficacy of OMT of female patients with migraine: results of a RCT”, The Journal of Alternative and Complementary Medicine, 2011, 17(3): 225-230
8. Younes Jahangiri Noudeh, Nasibeh Vatankhah, Hamid R. Baradaran, “Reduction of Current Migraine Headache Pain Following Neck Massage and Spinal Manipulation”, International Journal of Terapeutic Massage and Bodywork, March 2012, 5(1): 5-13
9. R.Michael Gallegher, “Headache Pain”, JAOA, September 2005, 4 (Suppl) ,105(9): S7-S11
10. Cesar Fernandez-de-las-Penas e al., “Methodological Quality of andomized Controlled Trials of Spinal Manipulation and Mobilization in Tension-Type Headache, Migraine, and Cervicogenic Headache”, J Orthop Sports Phys Ther, March 2006 , 36(3): 160-169
11. Erik Schabert , William Thomas Crow, “Impact of Osteopathic Manipulative Treatment on Cost of Care for Patients With Migraine Headache: A Retrospective Review of Patient Records”, JAOA, August 2009,109(8): 403-407
12. Michael L. Kuchera “Applying Osteopathic Principles to Formulate Treatment for Patients With Chronic Pain”, JAOA, November 2007, 6 (Suppl), 107(11): pp ES28-ES38
13. George R. Nissan, Merle L. Diamond, “Advances in Migraine Treatment”, JAOA, Aprile 2005, 2(Suppl) , 105(4): S9-S15
14. Ashley C Keays e al., "Is osteopathic manipulation effective for headaches?", J Fam Pract 2008 mar, 57(3): 190-191
15. V. Adragna, BM Camerani, R. Desideri, F. Abburà, E. Simonetto, "Osteopathic manipulative treatment and chronic tension-type headache: outcome research" J Headache Pain (2012), 13 (Suppl):S51-52
16. Stovnerl- et al, "The global burden of headache: a documentation of headache prevalence and disability worldwide" Cephalalgia. 2007 Mar;27(3):193-210
17. Lance JW, Anthony M., Some clinical aspects of migraine. Arch Neurol 1966;15:356-361
18. Olesen J, Lipton RB., Migraine classification and diagnosis. International Headache Society criteria.. Neurology 1994; 44( Suppl 4):6-10
19. Rasmussen BK, Jensen R, Olesen J,A population-based analysis of the diagnostic criteria of the International Headache Society. Cephalalgia 1991;11:129-34

Drug therapy period, as needed
G. Giannotti D.O., R. Galati D.O., R. Desideri D.O.,
V. Adragna D.O., L. Triggiani M.D.

+
Migraine without aura
Osteopathic treatment of migraine without aura: outcome research
Outcome research
{
outcome evaluation
OMT
outcome evaluation
Detection times of outcome
t0, before 1° OMT
t1, follow up

Osteopathic Manipulative Treatment
Treatment:
Individual treatment
Times of OMT
5 OMT in 8 weeks
Headache diary
Outcome
Primary
outcome
Intensity of migraine attacks
Secondary
outcome
Frequency of migraine attacks
Frequency of taking drugs
Tools
Primary outcome
Secondary outcome
MIDAS questionnaire
Headache diary
Phases of the study
Duration of the study
6 months
P1
Enrollment
Delivery of the Headache diary
P2
P3
P4
Secondary Outcome
baseline
Osteopathic analisys
MIDAS: t0
Primary Outcome
Detection

of the Headache diary: t0
Secondary Outcome
Osteopatic Manipulative Treatment
follow-up
MIDAS: t1
Primary Outcome
Detection

of the Headache diary: t1
Secondary Outcome
Drug therapy period, as needed
Osteopathic Manipulative Treatment
Results
=
19 females
3 males
22 subjects
Secondary Outcome
Headache diary
Wilcoxon Test
Frequency of migraine attacks
Frequency of taking drugs
t0
difference
p-value
t1
20.73
0.018
-5.36
15.36
avarage rate of migraine attaks (days)
t0
difference
p-value
t1
14.82
0.001
-6.14
8.68
avarage rate of taking drugs (days)
Primary Outcome
MIDAS
Intensity of migraine attacks
t0
difference
p-value
t1
6.05
0.0005
-1.41
4.64
MIDAS: average of the scores of point "D"
Musculoskeletal system
62.4 %
Visceral system
23.8 %
Cranio-sacral system
13.8 %
SBS 5,7%
Sigma 5,7%,
Somatic dysfunction more frequently
D1-K1 5%
Analysis of somatic dysfunctions in the follow-up (t1)
three months later P1
for 8 weeks after t0
one months after last OMT
three months after t0
Primary Headaches - Secondary Headaches - Cranial Neuralgias
Migraine
without aura

Stovner L. et al, Cephalalgia 2007
M. Gionco, 2011
Not attributed to another disorder
Target
Verify the efficacy of OMT in patients with migraine without aura in NSAI drugs therapy as needed
Headache Surgery
San Giovanni Battista Hospital
Rome

Roma
Stewart WF et al, Pain 2000
Efficacy of OMT
Intensity of migraine attacks
Visceral system
Migraine attack
Diffusion of the osteopathic practice in the
hospital setting
with physicians collaboration who embrace
osteopathic medicine

We hope that our study can serve as a suggestion for future studies is more thorough, both for increasingly frequent collaborations with hospitals open to new health's frontiers.
Frequency of migraine attacks
Frequency of taking drugs
Musculoskeletal system
Cranio-sacral system
C0-C1
disfunction

vertebral artery
compression
alteration of the local tissue density
C1-C2
disfunction

tone of the lateral rectus muscles
posterior meningeal artery
thoracic inlet disfunction
stellate ganglion
cranial vasomotricity
D1-D4
disfunction

sympathetic vasomotor
centers
alteration of sympathetic vasomotor control
visceral
disfunction
assimilation of substances
elimination of catabolites
local vascular and neurological function
modification of
blood flow
cranial vascularization
p-value 0.018
p-value 0.0005
p-value 0.001
IHS 1.1 - ICD10 G43.0
from february 2012 to july 2012
SBS
disfunction
CSF
cranial vascularization
cellular exchange

Allostasys
Adragna V. et al, J Headache Pain 2012
Chaibi A. et al, J Headache Pain 2011
mean age: 45.95 years
Lance JW et al, Arch Neurol 1966
Olesen J et al, Neurology 1994
Rasmussen BK et al, Cephalalgia 1991
IHS Discussion Group, 2004
G. Sances, UO Cefalee, IRCCS Fondazione Istituto Neurologico C. Mondino, Pavia
Two osteopaths
SAS software - p < 0.05
Full transcript