Physical Therapy Management of Suboccipital Trigger Points and Upper Trapezius Tightness with Associated Migraines and Neck Pain.

Introduction. Affecting roughly 1 out of every 6 Americans, migraines are the eighth-highest specific cause of disability worldwide. The purpose of this case study is to discuss and review the role of physical therapy treatment on migraine symptoms. In evaluating the case of a female with suboccipital trigger points and upper trapezius tightness with associated migraines, neck, and shoulder pain, it will be detennined if physical therapy intervention can improve migraine symptoms along with improvement of cervical musculoskeletal impairment, and if so, what treatment methods are most effective. Case Description. Patient is a 62 year old female who presents to physical therapy evaluation with a long standing history of migraines and a current flare up of left upper trapezius pain. Upon examination and evaluation, the patient is given the physical therapy diagnosis of suboccipital trigger points and upper trap tightness with associated migraines, neck, and shoulder pain. Intervention. The patient was seen two days per week for four weeks. Sessions predominated in manual therapies with supplementary utilization of mechanical traction, cranio-cervical stretching, and postural strengthening. Outcomes. Over the course of treatment, the patient noted improved migraine duration, cervical lateral flexion and rotation (bilaterally by 6-10 and 7-13 degrees, respectively), neck pain, and trigger point quantity and severity. Discussion. In evaluating the case of a female with suboccipital trigger points and upper trapezius tightness with associated migraines, neck, and shoulder pain, it was determined that physical therapy intervention can moderately improve migraine symptoms along with the improvement of cervical musculoskeletal impairment, and that manual therapies, stretching, and postural training proved to be effective. Case findings congruent with current migraine related literature included reduction in migraine duration with physical therapy interventions and efficacy of manual therapy interventions. Further quality evidence is broadly needed within the topic of physical therapy prognosis, outcome assessment, and treatment of migraine diagnoses