The Efficacy of Physical Therapy and Rehabilitation Approaches in Chronic Migraine: A Systematic Review and Meta-Analysis.

Chronic migraine is usually managed with medication, but many people also try physical therapy approaches alongside their drugs, and this review asked whether that combination actually helps. Researchers pulled together seven randomized controlled trials testing things like aerobic exercise, osteopathic manipulation, occipital electrical stimulation, hydrotherapy, acupressure, and various manual therapy techniques, all used together with medication rather than instead of it. Across the studies, several approaches, including aerobic exercise, osteopathic manipulation, and hydrotherapy, were linked to improvements in headache intensity, frequency, or quality of life when added to medication, while acupressure showed no added benefit. A pooled analysis of five studies found that manual or aerobic exercise combined with medication reduced headache days per month, a statistically significant result, though the effect on headache intensity did not reach statistical significance.

The evidence base remains small and varied, so these findings should be read as promising rather than conclusive.

If you live with chronic migraine, you probably already take medication, and you might wonder whether physical therapies like exercise, manual therapy, or massage could help on top of that. This review looked at seven small studies testing exactly that question, combining approaches such as aerobic exercise, osteopathic manipulation (a type of hands-on treatment), electrical stimulation at the back of the head, hydrotherapy, acupressure, and other manual techniques with ongoing medication. The combined results suggested that adding physical therapy approaches, particularly manual therapy or aerobic exercise, to medication was linked to fewer headache days per month, a difference that reached statistical significance.

Effects on how intense headaches felt were less clear cut. Acupressure alongside medication didn't show extra benefit for headache intensity or quality of life. Because the number of studies was small and the treatments varied quite a bit, these results point in a hopeful direction without being the final word.

More and larger studies would be needed before drawing firm conclusions about which approach helps most.

This is a summary of research, not medical advice. Talk to your own healthcare provider about anything affecting your care.

This systematic review and meta-analysis identified seven randomized controlled trials evaluating physical therapy modalities as adjuncts to pharmacological treatment in chronic migraine, with five trials contributing to quantitative synthesis. Interventions spanned aerobic exercise, osteopathic manipulative treatment, occipital transcutaneous electrical stimulation, hydrotherapy, acupressure, instrument-assisted soft tissue mobilization, facial proprioceptive neuromuscular facilitation, and connective tissue massage, methodological quality assessed via the PEDro scale. Pooled analysis showed manual or aerobic exercise combined with medication reduced headache days per month with statistical significance (p = 0.047), while manual physical therapy combined with medication reduced headache intensity, though this did not reach statistical significance (p = 0.0796).

Individual trials reported improvements in quality of life, disability, and pain intensity with osteopathic manipulation and hydrotherapy, while occipital electrical stimulation alone produced conflicting findings on disability and intensity, and acupressure showed no additional benefit over medication alone. Given the small number of pooled trials, heterogeneous interventions, and mixed significance across outcomes, this body of evidence should be regarded as preliminary. It supports further investigation into optimal dosing, duration, and modality selection rather than firm clinical conclusions.