The effects of upper cervical spine manual therapy on central sensitization and brainstem auditory evoked potentials in subjects with migraine and neck pain

Background: Migraine is an important disease due to its impact on global health. Due to association of neck pain with migraine, manual therapy (MT) often used in management. The aim of this study was to evaluate the effects of upper cervical spine MT on specific mechanisms including central sensitization (CS) and brainstem auditory evoked potentials (BAEPs) in subjects with migraine and neck pain.

Methods: 30 subjects with migraine and neck pain (30 female, mean age 43.10 ± 8.13) were randomly assigned to a medication plus MT (MedMT) group, a medication plus sham manual therapy (sham MT) group, and a medication alone (Med) group. CS was evaluated using the Central Sensitization Inventory (CSI) and BAEP determined electrophysiologically in all subjects pre and post intervention. Subjects in MedMT and sham MT groups received either 4 sessions of MT or sham MT. All subjects received medication.

Results: Subjects in MedMT group had a significant reduction in CSI score (P < 0.05) compare to the other 2 groups. For BAEPs, MedMT and sham MT groups had significantly decreased wave V latency on the right side (P < 0.05) compared to Med group.

Discussion: Manual therapy plus medication may have beneficial effects in people with migraine and neck pain by normalizing central sensitization levels. Additionally, upper cervical manual therapy or sham manual therapy have demonstrable neurophysiological effects reflected by changes in the auditory transmission pathways in the brainstem. Further research is required to investigate the mechanisms of action of MT in migraine.