Physiotherapy Interventions for Migraine: A Systematic Review of Clinical Trials

Background: Migraine is one of the leading causes of disability worldwide and significantly reduces quality of life. Standard pharmacological treatment is often associated with adverse effects and does not always provide satisfactory long-term outcomes. Consequently, increasing attention has been directed toward non-pharmacological interventions such as physiotherapy. The aim of this systematic review was to evaluate the effectiveness of physiotherapy used as a standalone or complementary treatment for migraine. Methods: A systematic review of randomized controlled trials (RCTs) published between 2015 and 2025 was conducted in accordance with PRISMA 2020 guidelines. Electronic databases (PubMed, Cochrane Library, Scopus and PEDro) were searched using predefined search strategies. Studies involving adults diagnosed with migraine who received physiotherapy interventions (e.g., manual therapy, exercise therapy) were included. Two reviewers independently screened records and extracted data. Methodological quality of included studies was assessed using the PEDro scale. Results: Thirteen clinical trials (including 12 RCTs) involving 1021 participants were included. The most frequently investigated interventions were manual therapy and exercise therapy. Improvements in at least one primary clinical outcome (migraine frequency, pain intensity, or disability scores such as MIDAS or HIT-6) were observed in 8 out of 13 studies. A reduction in migraine frequency was reported in 4 studies. However, results were inconsistent across trials, and several studies found no statistically significant differences between the intervention and control groups. Conclusions: Physiotherapy may represent a beneficial complementary approach in migraine management, particularly for improving pain intensity and disability outcomes. However, the available evidence is limited by significant heterogeneity in intervention protocols, outcome measures, and follow-up duration, as well as the lack of quantitative synthesis. Further high-quality randomized trials with standardized methodology and longer follow-up periods are required to strengthen the evidence base.