Background
Migraine pain has a multidimensional dimension affecting the central nervous system (CNS) primary and secondary somatosensory cortices, thalamus, insula, anterior cingulate cortex and parietal and prefrontal cortices.
It is a chronic disease that reduces the quality of life (QoL) presenting nausea, vomiting, and/or photophobia. The origin of migraine is argued but there is evidence about a vegetative nervous system (VNS) especially in relation to the central sensitization for an alteration of the trigemino-vascular-nuclei and meninges’ inflammation (Fig. 1). Migraine occurs in about 15% of the general population with a total cost per year estimated of €18 billion in Europe, more than neurological disorders (multiple sclerosis, Parkinson’s disease and stroke or brain tumour). Migraine is usually managed by medication, but nonpharmacological management could be an alternative treatment option to reduce pain, disability, increase QoL and reduce costs.

Aims
The aim is to identify and critically evaluate the available literature regarding the effectiveness of osteopathic treatment (OMT) in patients affected by migraine with regards to pain and disability.

Methods
A systematic review has been conducted, screening and reviewing more than 10 among databases and journals to answer the aim.
Results
OMT may be considered a valid procedure for the management of migraineurs. All studies reflect a significant improvement in pain and disability level (p ≤ 0.01) (Fig. 2).

Conclusions
OMT through spinal manipulation technique or craniosacral therapy aims to influence the CNS altering somatosensory processing at the cortical level neuromuscular-autonomic regulatory mechanisms to reduce pain.
Although debate about the cause of migraine is still open, osteopathy would allow to address the pathology with a non-drug and non-invasively therapy.

References:
Posadzki, P. and Ernst, E. 2011. Spinal manipulations for the treatment of migraine: a systematic review of randomized clinical trials. Cephalalgia 31(8), pp. 964-970.
Voigt, K. et al. 2011. Efficacy of osteopathic manipulative treatment of female patients with migraine: results of a randomized controlled trial. J Altern Complement Med 17(3), pp. 225-230.
Mann, J. et al. 2012. P02.55. Craniosacral therapy for migraine: a feasibility study.BMC Complement Altern Med. Vol. 12. p. P111.
Arnadottir, T. S. and Sigurdardottir, A. K. 2013. Is craniosacral therapy effective for migraine? Tested with HIT-6 Questionnaire. Complement Ther Clin Pract 19(1), pp. 11-14.
Cerritelli, F. et al. 2015. Clinical effectiveness of osteopathic treatment in chronic migraine: 3-Armed randomized controlled trial. Complement Ther Med 23(2), pp. 149-156.
Adragna, V. et al. 2015. O052. Migraine without aura and osteopathic medicine, a non-pharmacological approach to pain and quality of life: open pilot study. J Headache Pain 16(Suppl 1).
Triggiani, L. and Giannotti, G. 2013. Efficacy of Osteopathic Manipulative Treatment in the Prophylaxis of Migraine without Aura. Cephalalgia 33(S8), pp. 260-261.

EFFECTIVENESS OF OSTEOPATHIC TREATMENT ON PAIN AND DISABILITY IN PATIENTS WITH MIGRAINE