Migraines are a complex neurological condition characterised by recurrent episodes of moderate to severe headache, often accompanied by nausea, visual disturbances, and sensitivity to light or sound.
Globally, migraines affect around 15% of the population, with women being affected about three times more often than men. The World Health Organization ranks migraine among the top causes of disability worldwide.
Migraines are thought to arise from abnormal activation of the trigeminovascular system, leading to neurogenic inflammation, changes in blood flow, and altered pain processing within the brainstem. Genetics, hormones, sleep, and stress all play a role in triggering or worsening attacks.
Common migraine subtypes include:
Migraine without aura – the most frequent form, marked by unilateral throbbing pain and nausea.
Migraine with aura – preceded by transient neurological symptoms such as visual flashes, zigzag lines, or tingling sensations.
Chronic migraine – headaches occurring on ≥15 days per month for more than three months.
Moderate to severe, often one-sided headache lasting 4–72 hours.
Throbbing or pulsating pain aggravated by movement or light/sound exposure.
Nausea, vomiting, visual aura, dizziness, or sensitivity to smell.
Fatigue and difficulty concentrating post-attack (“migraine hangover”).
Functional impact: Migraine can severely affect daily life, leading to missed workdays, reduced concentration, and impaired sleep and mood.
Red flags: Sudden severe (“thunderclap”) headache, new headache after age 50, or one accompanied by fever, vision loss, or neurological symptoms should be medically evaluated immediately.
Genetic predisposition – family history significantly increases risk.
Hormonal fluctuations – menstrual cycle changes, pregnancy, or menopause.
Stress and emotional load – can trigger or intensify attacks.
Musculoskeletal tension – cervical and cranial strain patterns may influence neural and vascular dynamics.
Sleep disturbances – irregular sleep or fatigue are common triggers.
Dietary and environmental factors – caffeine withdrawal, alcohol, dehydration, certain foods, or bright light.
Migraine is best understood as a multifactorial neurological disorder, where central sensitisation interacts with vascular and musculoskeletal influences.
Osteopathic care for migraine aims to support the body’s self-regulatory capacity by addressing mechanical and circulatory imbalances that may contribute to headache frequency or intensity.
A typical osteopathic assessment includes:
Evaluation of cranial, cervical, and thoracic regions to identify restrictions affecting blood flow and neural dynamics.
Consideration of posture, breathing mechanics, and stress-related muscular tension.
Gentle manual techniques (soft-tissue, joint mobilisation, cranial or functional methods) to improve tissue mobility and autonomic balance.
Education about contributing factors such as sleep, hydration, and ergonomics — always individually adapted.
Osteopathic treatment is complementary, not a replacement for medical migraine management. It may be especially helpful for patients with overlapping neck tension or musculoskeletal components.
The evidence base for manual and osteopathic interventions in migraine has grown, though results remain mixed due to heterogeneity in study designs.
Several systematic reviews and randomised trials suggest potential benefits of osteopathic and manual therapy in reducing attack frequency, pain intensity, and medication use, particularly when used alongside conventional care.
Steiner TJ, Stovner LJ, Jensen R, Uluduz D, Katsarava Z. Headache disorders are third cause of disability worldwide. J Headache Pain. 2020;21(1):137. Link
Cerritelli F, Ruffini N, Lacorte E, Vanacore N. Osteopathic manipulative treatment in patients with migraine: a systematic review. Complement Ther Med. 2017;33:33–37. Link
Chaibi A, Tuchin PJ, Russell MB. Manual therapies for migraine: a systematic review. J Headache Pain. 2011;12(2):127–133. Link
Cerritelli F, Mariani N, Bartoloni A, et al. Osteopathic manipulative treatment in chronic migraine: a randomized controlled trial. Complement Ther Med. 2015;23(2):149–156. Link
Chaibi A, Russell MB. Manual therapies for migraine: a systematic review of randomized controlled trials. J Headache Pain. 2014;15(1):67. Link
Luedtke K, Allers A, Schulte LH, May A. Physiotherapy and manual therapy for headache: a systematic review and meta-analysis. J Headache Pain. 2020;21(1):102. Link
Cerritelli F, Pizzolorusso G, Turi P, et al. Osteopathic treatment of migraine: a randomized controlled trial. J Am Osteopath Assoc. 2011;111(7):503–512. Link
Xie Y, Chen Z, Yang Z, et al. Comparative safety and efficacy of manual therapy interventions for migraine and cervicogenic headache: a network meta-analysis. Front Neurol. 2025;16:1566764. Link
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