Two Recommendations a PT Can Make to Effectively Lessen a Patient’s Migraine Headache

Migraine headaches (MH) affect approximately 15% of the global population and are believed to be due to environmental and genetic factors. Neurologist and Family Practice physicians use a mnemonic device known as POUND to differentiate migraine headaches from other forms of primary headaches:

P – Is the headache pulsatile in quality?

O – Is the duration 4-72 hours?

U – Is the location unilateral?

N – Is there associated nausea or vomiting?

D – Is the intensity of the headache disabling?

naiomt-blog-headache-feb-2018-headacheMigraine headaches are typically managed by medications known as amitriptyline, which has its share of side-effects.

People with MH are treated in different clinical pathways. One of them is referral to a physical therapist for cervicogenic headaches. Cervicogenic headaches can also present with POUND-type characteristics. There are two holistic evidence-supported treatments a physical therapist can recommend to their MH patient, especially the ones with POUND-type complaints. One recommendation is to have your patient increase their daily water intake by 1.5 liters a day (Spigt et al.). The other recommendation is to take 2-3 mg of slow release melatonin at night prior to bedtime (Lyon,Langer). Both treatments have been tested in randomized control trials and have received a Level II in evidence ratings (Goncalve, et al.).

Our Cervical Spine I and II courses, which can be taken in any order, teach clinical pattern recognition of primary and secondary headaches, and also discuss and teach you holistic treatments, including the benefits of specific exercises and manual therapies. Join us on your journey to clinical excellence.

lucido175-Michael Lucido, PT, DPT, FAAOMPT
NAIOMT Faculty – Dallas, TX


Spigt, M. et al. A randomized trial on the effects of regular water intake in patients with recurrent headaches.

Family Practice 2012; 29:370–375

Lyon, C & Langner, S. Consider melatonin for migraine prevention. The Journal of Family Practice MAY 2017 VOL. 66, NO 5

Goncalve, AL, Martini Ferreira A, Ribeiro RT, et al. Randomized clinical trial comparing melatonin 3 mg, amitriptyline 25 mg and placebo for migraine prevention. J Neurol Neurosurg Psychiatry. 2016; 87:1127- 1132.1

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