Efficacy of cervical physical therapy on pain sensitivity in patients with migraine compared to no treatment, sham treatment or usual medical care: a systematic review and meta-analysis.

Only five studies were included, resulting in small sample sizes for each muscle group analysis. There was considerable heterogeneity in the types of physical therapy interventions and control conditions used across the studies. The timing of pressure pain threshold measurements relative to the migraine cycle was not reported, which may affect sensitivity results. Minimal clinically important differences for pressure pain thresholds in migraine have not been established, so it is unclear if the observed changes matter to patients. Risk of bias was rated as 'some concerns' or 'high' in all included studies.

Do not interpret the significant increase in pressure pain thresholds at the sternocleidomastoid muscle as proof that cervical physical therapy effectively treats migraine. The certainty of evidence is very low, the clinical importance of these threshold changes is unknown, and other key muscles showed no significant improvement.