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Migraine

Migraine is one of the most common neurological disorders. It is described as unilateral throbbing headaches with or without aura, and characterised by attacks. The current global prevalence of migraine is 10%. Migraine is more common among women and between the ages of 25 and 55.
Pain in migraine is thought to occur as a result of vasodilation (increase in size) in the intracranial vessels or release of vasoactive peptides (protein constituents affecting the blood vessels) as a result of activation of the perivascular fibres of the trigeminal cranial nerve.

One theory for the cause of vasodilation is that an increase in the concentration and activity of matrix metalloproteinase (MMP) in the pathogenesis of migraine has recently been proposed. MMPs are neutral proteases (enzymes that break down proteins) responsible for the proteolytic activity of extracellular matrix proteins. An increase in MMP production is known to result in tissue injury and inflammation.

Acupuncture is a treatment modality frequently employed in migraine and is known to be effective.[1] In an article in the British Medical Journal Acupucnture in Medicine published in 2014,[2] 27 patients with migraine were treated with acupuncture for 10 sessions over 5 weeks. Blood was sampled before treatment and after the first and last sessions of acupuncture to evaluate the effect of acupuncture on the serum matrix metalloproteinase-2 (MMP-2) concentration and activity in the patients Pain was measured using a visual analogue scale (VAS). Short form-36 (SF-36) was used to determine their quality of life. 

The mean VAS was 85.5±16.6 before acupuncture and was significantly decreased to 39.8±20.6 after 10 sessions of acupuncture (p<0.0001). There was a significant increase in all SF-36 scores after acupuncture compared with values before treatment (p<0.0001). No significant differences were found in MMP-2 concentrations before treatment and after the first and last sessions (p>0.05). However, there were significant changes in MMP-2 activity (p<0.0001).

The results of this study showed a clinically relevant decrease in MMP-2 activity in patients with migraine treated with acupuncture. The authors conclude that the mechanism underlying the effect of acupuncture in alleviating pain may be associated with a decrease in MMP-2 activity.

Osteopathic manipulative treatment may be useful in the treatment of migraine: in a study published in 2013,105 patients were randomised into three groups: osteopathic treatment (OMT) only, drugs (triptans) only and sham therapy. The results showed a significant difference between the patients in the OMT group compared to drug and sham therapy groups, suggesting that OMT can be considered a valid procedure for the management of patients with migraine.[3]

In another study published in 2011, 42 female patients with migraine received either five 50-minute OMT treatments over a 10-week period or no physical therapy. Both groups continued with previously prescribed medication. The OMT group reported decreased pain intensity and the reduction of number of days with migraine as well as working disability, and partly on improvement of health-related quality of life scores.[4]

References:
  1. Linde K, Streng A, Jurgens S, et al. Acupuncture for patients with migraine: a randomized controlled trial. JAMA 2005;293:2118–25. Abstract
  2. Cayir Y, Ozdemir G, Celik M, et. al. Acupuncture decreases matrix metalloproteinase-2 activity in patients with migraine. Acupunct Med 2014;32:376-380 doi:10.1136/acupmed-2014-010612 Free full text
  3. Cerritelli F,  Caprari E, Di Vincenzo M, et. al. "Is osteopathic manipulative treatment effective in migraine?" IJOM March 2013, 16(1) e1–e2. DOI: http://dx.doi.org/10.1016/j.ijosm.2013.01.001
  4. Voigt K, Liebnitzky J, Burmeister U, et. al. "Efficacy of osteopathic manipulative treatment of female patients with migraine: results of a randomized controlled trial. J Altern Complement Med. 2011 Mar;17(3):225-30. DOI: http://dx.doi.org/10.1089/acm.2009.0673
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