Myotensive Extraocular Muscle Techniques Added to Manual Therapy for Migraine Without Aura

Condition(s) studied

Investigational drug(s) / intervention(s)

Myotensive Extraocular Muscle Techniques + Manual Therapy: This intervention consists of six 55-minute sessions over eight weeks. It combines standard cranio-cervical manual therapy techniques-such as suboccipital inhibition, cervical traction, vertebral segmental mobilization, and temporomandibular joint decompression-with specific myotensive techniques applied to the extraocular muscles. The oculomotor component is performed in a supine position, using gentle isometric and eccentric tension-release maneuvers targeted to the most restricted eye movement directions. The goal is to modulate extraocular muscle tone, optimize the cervico-ocular proprioceptive relationship, and reduce migraine-related dysfunctions.

Standard Manual Therapy: This intervention consists of six 40-minute sessions over eight weeks, matching the experimental group in duration, frequency, and clinical environment. It includes suboccipital inhibition, cervical traction, segmental vertebral mobilization, and temporomandibular joint decompression techniques. No ocular or visual system intervention is performed. The purpose is to serve as an active control for the cranio-cervical component of the treatment.

Study summary

Migraine without aura is a highly prevalent and disabling primary headache that significantly affects quality of life. Many patients experience insufficient symptom control with pharmacological treatments or develop adverse effects, which has increased interest in safe, non-invasive therapeutic alternatives. Physiotherapy, and particularly manual therapy, has shown potential benefits in reducing pain and improving function in headache disorders. This randomized clinical trial will evaluate the effectiveness of adding specific myotensive techniques directed at the extraocular muscles to a craniocervical manual therapy program in adults with migraine without aura. The hypothesis is that targeting the oculomotor system may influence pain modulation and improve symptoms related to visual, cervical, and sensorimotor interactions.

Ninety participants aged 18 to 65 years with a medical diagnosis of migraine without aura according to the International Classification of Headache Disorders, Third Edition (ICHD-III), will be randomly assigned to an experimental group or a control group. Both groups will receive six physiotherapy sessions over approximately eight weeks. The experimental group will receive manual therapy on the craniocervical region and temporomandibular joint (TMJ) combined with myotensive techniques for the extraocular muscles, while the control group will receive only the standard manual therapy protocol. Evaluations will be conducted at baseline and post-intervention using validated instruments such as the Migraine Disability Assessment (MIDAS), Craniofacial Pain and Disability Inventory (CF-PDI), Migraine-Specific Quality of Life Questionnaire (MSQ), and Visual Analogue Scale (VAS) for pain. Cervical mobility and oculomotor function will also be assessed through standardized clinical tests.

All procedures will be carried out at the Faculty of Nursing, Physiotherapy and Podiatry of the University of Seville. Data will be collected and managed in digital format in compliance with the General Data Protection Regulation (GDPR) and Spanish data protection law. Study results are expected to clarify the role of the oculomotor system in migraine without aura and to determine whether incorporating extraocular myotensive techniques enhances the effects of manual therapy within a comprehensive physiotherapeutic approach.

Eligibility

Primary outcome measure(s)

• Visual Analog Scale (VAS) — Baseline (pre-intervention, prior to the first treatment session) and immediately after each treatment session, through study completion.
  This continuous quantitative variable assesses the intensity of pain experienced by the patient. The VAS consists of a 10 cm horizontal line whose endpoints are anchored by the expressions "no pain" on the left end and "worst pain imaginable" on the right end. The patient is asked to mark the point along this line that best represents their subjective perception of pain at that moment, and the score is obtained by measuring in centimeters from the left end to the mark made.
• Score obtained from the Craniofacial Pain and Disability Inventory (CF-PDI) — Baseline (pre-intervention, prior to the first treatment session) and immediately after completion of the final treatment session.
  This discrete quantitative variable, originally named the Craniofacial Pain and Disability Inventory (CF-PDI), is a questionnaire specifically designed to assess pain and disability in patients suffering from craniofacial pain, such as headaches, temporomandibular disorders, and related conditions. The aim of the questionnaire is to evaluate the severity of craniofacial pain and its impact on patients' functional, emotional, and social activities. It is structured into items grouped into four dimensions: the impact on daily activities, work, interpersonal relationships, and emotional state. Each item is rated on a 5-point Likert scale ranging from 0 to 4, where 0 indicates minimal impact and 4 indicates maximum perceived impact in each dimension. The total score can reach up to 84 points, with higher scores reflecting greater levels of disability and impact of craniofacial pain on the patient's life. This tool has demonstrated excellent psychometric properties, with high reliability i
• Score obtained from the Migraine-Specific Quality of Life Questionnaire (MSQ) — Baseline (pre-intervention, prior to the first treatment session) and immediately after completion of the final treatment session.
  This continuous quantitative variable corresponds to a tool used to assess the impact of migraine on patients' quality of life. The MSQ includes 14 items that explore the frequency and intensity of migraine episodes and their impact on work activities, social relationships, emotional well-being, and overall health status. Responses are rated using a Likert-type scale. The questionnaire is divided into subscales corresponding to different domains of life affected by migraine: physical functioning, emotional functioning, and social functioning. The total score is obtained by summing the subscale scores. Each of the 14 items is rated on a 6-point Likert scale ranging from 1 = "all the time" to 6 = "never," thus evaluating how frequently migraine interferes with different aspects of the patient's life. To facilitate interpretation and standardization, raw scores from the MSQ are transformed to a standardized 0-100 scale. This transformation is achieved by subtracting the minimum possible
• Score obtained from the Short Form-36 Health Survey (SF-36) — Baseline (pre-intervention, prior to the first treatment session) and immediately after completion of the final treatment session.
  This continuous quantitative variable is used to measure health-related quality of life, encompassing multiple aspects of physical and mental well-being. The SF-36 consists of 36 items divided into eight subscales evaluating different dimensions of health: Physical Functioning (PF), Social Functioning (SF), Role Emotional (RE), Vitality (VT), Mental Health (MH), Bodily Pain (BP), General Health (GH), and Physical Health (PH). Each subscale is scored from 0 to 100, where higher scores indicate better quality of life in that particular domain. Subscale scores can be analyzed individually or combined to generate an overall quality of life index. The SF-36 was developed by Ware et al. (1992) and adapted and validated into Spanish as part of the international IQOLA project by Vilagut et al. The SF-36 has demonstrated excellent reliability and validity across diverse populations and clinical contexts. It shows high internal consistency, with Cronbach's alpha coefficients generally above 0.8
• Score obtained from the Migraine Disability Assessment Questionnaire (MIDAS) — Baseline (pre-intervention, prior to the first treatment session) and immediately after completion of the final treatment session.
  This continuous quantitative variable is a self-administered tool designed to evaluate the impact of migraine on patients' daily activities over the past three months. It consists of five questions assessing the number of days lost in work, household, and social activities due to migraine. The total score is obtained by summing responses to these five questions and is classified into four disability grades: 0-5 points: little or no disability 6-10 points: mild disability 11-20 points: moderate disability ≥21 points: severe disability Additionally, the questionnaire includes two supplemental questions that gather information on the frequency of migraine episodes and the average pain intensity on a 0-10 scale. The MIDAS has shown moderately high test-retest reliability and good convergent validity.
• Score obtained from the Headache Impact Test (HIT-6) — Baseline (pre-intervention, prior to the first treatment session) and immediately after completion of the final treatment session.
  This continuous quantitative variable consists of a questionnaire with six items assessing the impact of headaches across various aspects of a patient's life, including pain, functional limitation, fatigue, cognition, and emotional status, providing a global overview of headache burden. Each item is rated on a 5-point frequency scale: never (6 points), rarely (8 points), sometimes (10 points), very often (11 points), and always (13 points). The total score ranges from 36 to 78 and is interpreted as follows: ≤49: little or no impact 50-55: some impact 56-59: substantial impact ≥60: severe impact The HIT-6 has demonstrated excellent psychometric properties, with internal consistency (Cronbach's alpha) ranging from 0.78 to 0.90 across studies, strong validity through correlations with other migraine assessment scales such as MIDAS and SF-36, and high reproducibility, with test-retest coefficients above 0.80.

Trial sites (1)

Other trials for the same condition