PTPilotThe Journal of manual & manipulative therapy2026

The effect of targeted upper cervical musculoskeletal management on the frequency and burden of migraine headache in adults - a single cohort pilot study.

Peter Farmer, Julia Treleaven, Zhiqi Liang and 2 others

PMID 41872760

WHAT IT FOUND

Eight of ten women with migraine and restricted upper neck rotation had at least 50% lower migraine frequency three months after four manual therapy sessions, exercises, and education.

Neck rotation symmetry improved in nine. Without a control group, this cannot show treatment caused these changes.

Key findings

01Eight of ten participants had at least a 50% reduction in migraine frequency three months after treatment.

02Upper cervical rotation symmetry was fully restored in nine participants after treatment.

03No adverse events were reported.

STILL TO COME

How it was doneWhat they foundWhat it means for PTs

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What it does not show

Only ten women took part, and there was no control group, so the changes cannot be compared with what would have happened without treatment. All participants received manual therapy, exercises, and education together, and treatment was tailored, so the contribution of any single component cannot be separated. Migraine frequency was based on recall over the previous 4 weeks rather than a diary. Follow-up was only 3 months, so longer-term benefit is unknown. The study included only women, so results may not apply to men. Not all outcome measures agreed: eight of ten had at least a 50% reduction in migraine frequency at 3 months, but only five reported overall improvement.

Declared interests

The authors reported no funding associated with this article.

The easy way to misread this

Do not conclude that upper cervical manual therapy reduces migraine. This pilot had ten women, no control group, and participants received manual therapy, exercises, and education together, so the changes cannot be credited to one component.

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