The purpose of this study was to evaluate
pain hypersensitivity in chronic
migraine patients 3 months after undergoing
onabotulinumtoxin-A therapy, physical therapy (PT), or the combination of the two. Pressure pain threshold (PPT) was assessed in accordance with Andersen's guidelines, focusing on five muscles in the trigeminocervical area (namely, trapezius, levator scapulae, temporalis, sub-occipitalis, and scalenus medius) and one muscle outside of the area, (i.e., tensor fasciae latae). Moreover, three
headache parameters, namely, attack frequency, duration, and
pain intensity, were recorded in an ad hoc diary kept by the patients. A total of 30 patients were included in three treatment groups: 1.
onabotulinumtoxin-A therapy, 2. PT, and 3. a combination of
onabotulinumtoxin-A and PT. The results show that, at the final assessment, the PPT was significantly reduced in the combined treatment group compared to the two single-
therapy groups. As regards
headache parameters, frequency and duration of the attacks were decreased significantly in all three treatment groups, whereas in
pain intensity, the reduction was statistically significant in the combined treatment group and the
onabotulinumtoxin-A therapy. Results suggest that a better
pain modulation in patients with chronic
migraine can be achieved with a combined treatment of
onabotulinumtoxin-A and
physical therapy. Indeed, the combination of both pharmacological and non-pharmacological treatments results in the reduction of both
headache-related parameters and widespread pressure
hyperalgesia.