Effects of kinesiotaping combined with physical therapy in patients with migraine-associated neck pain: a randomized controlled study

Abstract

Background

To investigate the effects of kinesiotaping (KT) combined with physical therapy (PT) on pain severity and frequency, pressure pain threshold (PPT), disability, and quality of life (QoL) in migraine patients with neck pain, in addition to pharmacologic treatment.

Methods

Sixty patients with migraine were randomly allocated to the three groups and received PT for 6 weeks (12 sessions, including cervical exercises and mobilizations): treatment group (TG; n = 20), placebo group (PG; n = 20), and control group (CG; n = 20). KT in TG and sham taping in PG were administered during each session. Headache frequency, pain severity (VAS-headache, VAS-neck pain), PPT, neck disability, and QoL were evaluated at baseline and posttreatment.

Results

The TG showed a clinically significant improvement in headache intensity (η2 = 0.432, p = 0.003), neck pain severity (η2 = 0.437, p < 0.001), and neck disability (η2 = 0.427, p = 0.005). Additionally, there was a significant increase in PPT for the trapezius and sternocleidomastoid muscles (p < 0.05). However, there were no significant differences between the groups in terms of headache frequency. Improvements were also observed in bodily pain and general health in QoL (p < 0.05).

Conclusion

The findings suggest that KT combined with PT and pharmacological treatment significantly improves clinical outcomes in migraineurs with neck pain. Specifically, the TG demonstrated greater reductions in intensity of headache and neck pain, along with increases in PPT and improvements in disability and QoL compared to both groups. These results can support the potential effectiveness of a combined treatment approach targeting both cervical musculoskeletal dysfunction and migraine symptoms. Nevertheless, further studies with longer follow-up periods are required to confirm of these benefits.

Trial registration

ClinicalTrials.Gov (NCT04185714), Date of Registration: 25/11/2019.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12891-025-08985-2.

Introduction

Migraine is a neurological disorder involving both peripheral and central mechanisms, including cortical hyperexcitability, altered thalamo-cortical processing, and impaired habituation to sensory input [1]. Central and peripheral sensitization, particularly within the trigemino-cervical system, are central features of its pathophysiology. Notably, the trigeminocervical complex, where afferents from the upper cervical spine converge with trigeminal inputs, has been proposed as a key anatomical and physiological feature contributing to migraine symptoms [2, 3]. This convergence of cervical and trigeminal nociception is supported by the frequent clinical presentation of migraine patients who also experience pain in the cephalic and cervical regions [3, 4].

Neck pain is a prominent feature of migraine headache, and activation of cervical and trigeminal nociception pathways is important to the clinical phenotype of migraine patients experiencing pain in the cephalic and cervical regions [3–6]. Neck pain has been linked to poor clinical outcomes in patients with episodic migraine attacks, such as increased headache duration, headache-related disability, and widespread pain sensitivity symptoms [7]. Recent research reported that migraine patients commonly have neck pain during a migraine attack [3], and other studies have shown that there are differences in the pressure pain threshold (PPT), pericranial muscle sensitivity, increased neck muscle stiffness, and forward head posture between migraine patients with neck pain [7–11]. Additionally, the presence of neck muscle sensitivity and stiffness is related to the severity of migraine attacks and the persistence of headaches [7, 11].

Neck pain might limit the response to pharmacological treatment in migraine patients and might exacerbate migraine’s negative effects on quality of life (QoL) [12]. Accordingly, physical therapy (PT) methods that target the craniocervical region might be beneficial in patients with migraine [13, 14]. PT interventions, including manual therapy, massage, spinal mobilization or manipulation, trigger point release, soft tissue release, electrotherapy, aerobic exercise, have shown promising benefits in the management of migraine, with some studies reporting effects comparable to pharmacological treatments. with some studies reporting effects comparable to pharmacological treatments [13–17].

Kinesiotaping (KT) is an elastic therapeutic tape to provide support and improvement at the applied area in the body. KT creates traction on the skin according to the level of tension. Traction promotes elevation of the epidermis and convolutions occur in the tape. These convolutions can inhibit nociceptive stimuli by reducing the pressure on mechanoreceptors under the dermis, thereby reducing pain and improving blood flow [18]. Recently, KT has been commonly used in the management of various musculoskeletal problems, such as the rehabilitation of several pain syndromes, and postural problems and for sports-related injuries [18–21]. Studies suggest that KT combined with other therapeutic protocols can decrease pain intensity and muscle sensitivity and increase range of motion, especially in patients with musculoskeletal problems [19–21]. Although the number of trials on different types of headaches and physical therapy has increased in recent years, the evidence is still insufficient. Moreover, the KT has also been widely used in physical therapy program to reduce pain. So, we wanted to see if KT could help people with migraine and neck pain. In light of these findings, the aim of this study was to investigate the effectiveness of Kinesio Taping (KT) in combination with physical therapy (PT) in individuals with migraine-associated neck pain. Specifically, the randomized controlled clinical trial (RCT) examined its effects on neck pain, pressure pain thresholds of cervical muscles, migraine characteristics (frequency and intensity), disability levels, and QoL.

Materials and methods

Study design and randomization

This study was a prospective, the RCT in which migraineurs with neck pain were randomly determined to receive KT plus physical therapy, placebo taping plus physical therapy, and only physical therapy. The Ethics Committee approved the working protocol in accordance with the Helsinki Protocol. The study protocol was approved by the Istanbul Medipol University, Clinical Research Ethics Committee (protocol no. 10840098–604.01.1-E.6803). All the participants provided written informed consent. This randomized-controlled study followed the checklist of the CONSORT statement [22]. This study conducted between 2021 and 2023.

Participants were recruited after their episodic migraine diagnosis was confirmed. Of the 69 patients with episodic migraine initially recruited, 60 met the study inclusion criteria. Before baseline assessment, patients were randomly distributed with 1:1:1 allocation ratio using a computer-based program to the Treatment group (TG, n = 20), Placebo group (PG, n = 20) and Control groups (CG, n = 20). Opaque sealed and sequentially numbered envelopes were used to hide the allocation. A physician-researcher not involved in the actual study evaluation and intervention was responsible for preparing the randomized the patients and group assignment.

Participants

The flow chart of the study was shown in Fig. 1. The study included outpatients with episodic migraine who were followed up by the Duzce University Hospital Neurology Department. Inclusion criteria were age 18–55 years who were diagnosed with episodic migraine-associated neck pain, had self-reported cervical pain persisting for a minimum of 3 months according to the International Classification of Headache Disorders, 3rd edition (ICHD-3) diagnosed by an expert neurologist with over 20 years of experience in headache diagnosis, migraine frequency of 5–15 d month^–1, and visual analog scale (VAS) headache and neck pain severity > 40 mm. Exclusion criteria were (1) any other primary or secondary headache according to the ICHD-III criteria; (2) a history of neck or head trauma (e.g., whiplash), diagnosis any of spine problems osteoporosis, disc herniation, myelopathy, spinal stenosis, spondylolisthesis, fractures, vertebral tumors and (3) systemic diseases (metabolic diseases, rheumatic and connective tissue diseases, systemic neuromuscular diseases), (4) temporomandibular joint dysfunction, (5) prolonged history of steroid use, (6) prior surgery to the cervical spine, (7) participants who had initiated treatment with antipsychotic, antidepressant, or antiepileptic medications within the three months prior to study enrollment were excluded, whereas those who had been on a stable dose of such medications for at least three months were eligible for inclusion, as their effects on migraine characteristics were considered to be stabilized, (8) application of other treatment methods such as physical therapy or anesthetic block to the head and neck area within the last 3 months prior to the study, (9) pregnancy.

Fig. 1.

Flow chart of the study procedure

All participants were asked to report the use of any prophylactic medications throughout the study period. Daily medication intake was recorded via patient diaries and reviewed at each visit. No new pharmacologic prophylaxis was initiated within 3 months prior to the study. Only participants who had been on a stable dose of prophylactic medication for at least three months were included. Baseline use of prophylactic drugs was documented and compared between groups to ensure balance. Despite no changes to regular prophylactic treatments, the participants continued to take prescription acute medications for migraine acute attack, such as triptans and NSAIDs (ibuprofen and naproxen), and paracetamol, prescribed by a neurologist specializing in headaches. Patients were instructed not to take any additional medication during the study period.

Data collection, including all outcome measurements, was performed by a physician (H.K.) who was blinded to group allocation and not involved in the intervention procedures. To ensure assessor blinding, all participants were instructed not to disclose their group assignment, and the randomization list was securely maintained by an independent researcher not involved in data collection or analysis.

The Migraine Disability Assessment Scale (MIDAS) is used to verify the severity of migraine-related disability. MIDAS scores are classified into 4 groups: no disability (0–5 points), mild disability (6–10 points), moderate disability (11–20 points), and severe illness severity (≥ 21 points). This scale is a reliable tool, with a Cronbach’s α coefficient of 0.83 and a Spearman’s correlation coefficient of 0.84 [23]. The Beck Depression Inventory-II (BDI) is used to identify major depressive symptoms. The scale’s 21 symptom items are scored as minimal to severe, as follows: 0–9: minimal; 10–16: mild; 17–29: moderate; 30–63: severe. The internal consistency of the BDI is good in non-psychiatric populations with a Cronbach’s α coefficient of 0.81 [24].

Outcome measurements

Primary and secondary outcome measures were assessed in both groups at baseline and after 6 weeks of treatment.

Primary outcome measure

The primary outcomes of the study were the patients’ recorded migraine characteristics (headache frequency and intensity, and neck pain severity). All participants completed a headache diary reporting migraine frequency. The intensity of headache and neck pain during the last migraine attack was evaluated using a VAS.

PPT was measured using a digital manual dynamometer (Baseline Dolorimeter [DDK-10]). There has been prior research indicating that this threshold correlates with other neck pain measures and can predict shoulder or neck pain [25–28]. A 1-cm² rubber disk was attached to the metal point of the device to avoid any harm. Calibration of the device was in the range of 0-5 kg, with an accuracy of 0.05 kg. This measure has excellent reliability in patients with migraine, with an intraclass correlation coefficient of 0.74–0.98 [29]. The PPT of the participants was assessed by the same examiner. When the pressure sensation changed into a pain sensation, the patient was instructed to immediately report it, at which point the pressure was relieved and the score was recorded. PPT was performed with the patient supine and arms down alongside the body.PPT values (kg cm^–2) were recorded three times (PPT1, PPT2, and PPT3) in a random sequence and bilaterally for the upper trapezius, sternocleidomastoid (SCM), suboccipital, anterior temporalis, levator scapulae, and anterior scalene muscles (Fig. 2) [29]. The same site was measured at intervals of about 30s.

Fig. 2.

Anatomical sites of PPT assessment: X1 Sternocleidomastoid, X2 Levator Scapula, X3 Anterior Temporalis, X4 Suboccipital, X5 Upper Trapezius, X6 Anterior Scalene

Secondary outcome measure

Migraine-related productivity loss is common to people with migraine with neck pain [30]. The Neck Disability Index (NDI) measures neck-specific disabilities. The NDI is used to verify self-reported disability due to neck pain and how neck pain affects daily activities. NDI classifies disability as mild (5–14 points), moderate (15–24 points), severe (25–34 points), and complete (≥ 35 points). The total NDI score was calculated, with 0 showing the best score and 50 showing the worst score. The Turkish NDI is reported to be a reliable and valid instrument, with an intraclass correlation coefficient of 0.979 [31].

The Short Form-36 (SF-36) was used to assess health and health-related quality of life (HRQoL) at the end of the 6-week treatment. The 36-item SF-36 includes 4 physical domains (physical functioning, role physical, bodily pain, and general health) and 4 mental domains (vitality, social functioning, role emotional, and mental health) [32].

Intervention

All groups participated in a 6-week PT program. A senior physical therapist demonstrated the exercise program and administered the treatment in 45-min sessions twice a week for 6 weeks (12 PT sessions). The PT protocol was the same for all patients. The all-group patients were blinded, and information that could affect the patients, such as treatment options, was withheld. In addition to the PT program, sham taping was administered in the placebo group and KT (Kinesio Tex Gold® Beige) was administered to the treatment group.

The placebo group was administered sham taping twice a week and the practitioner knew that he/she was administering placebo taping; a KT (Kinesio Tex Gold® Beige) I Strip 5 cm wide and 0.5 mm thick was applied without having the proper position or tension in the cervical region. Physical therapy program and taping was applied researcher in this study (EKB).

Kinesiotaping technique

In the treatment group, KT was applied to the trapezius and posterior cervical muscles twice a week for 6 weeks. The KT used was a water-resistant, wave- pattern adhesive tape 5 cm × 5 cm (Kinesio Tex Gold® Beige). Upper trapezius and deep cervical muscle inhibition techniques were used for KT, with 10%−15% tension applied from the insertion to the origin of the related muscles. The trapezius muscle was taped using the I-strip technique, starting at the acromion and stretching the tape head as far as possible to maximize the inhibitory effect, while the patient was in cervical lateral flexion and ipsilateral rotation. A second tape (Y-strip) was placed over the posterior cervical extensor muscles and applied from the dorsal region (T1-T2) to the upper cervical region (C1-C2). Each tail of the first strip (Y-strip, 2-tailed) was applied with the patient’s neck in the cervical contralateral side-bending and rotation position. Patients were seated during taping application. For the control group, there is no taping in the cervical region.

Physical therapy program

Postural exercises for cervical region

Each 45-min PT session included cervical range of motion (ROM) exercises for warm-up, followed by stretching of the cervical and upper thoracic spine (trapezius, levator scapula, and sternocleidomastoid), and posture exercises (shoulder circumduction, scapular adduction, and pectoral stretching), and strengthening exercises (cervical isometric contraction and concentric contraction of the deep cervical flexor muscles), and then cervical ROM exercises (anterior, lateral, and rotational) for cool-down. Each exercise consisted of 3 sets of 10 repetitions and was performed with a 60-s rest period between sets [33]. Passive stretching was applied 3 times for neck flexion, extension, and rotation associated with the ipsilateral flexion directions, using moderate force within the patients’ pain limits, and was maintained for 30 s, per PT sessions (Supplement file).

Cervical mobilizations

With patients in the supine position and the cervical spine in a neutral position the physical therapist performed a mobilization technique, with slow, progressive, and regular stretching of the soft tissue. The physical therapist held the occipital region of the patient to stabilize and maintain the position of the upper cervical structures while applying a posteriorly directed force to the frontal area of the patient (anterior to posterior force) with the other hand [34] (Supplement file).

Statistical analysis

Statistical analysis was performed using IBM SPSS Statistics for Windows v.26.0 (IBM Corp., Armonk, NY, USA). The conformity of the variables to normal distribution was determined using the Shapiro–Wilk test. Categorical variables were compared using the chi-square test. Categorical data are presented as number and percentage. Continuous variables are shown as mean ± SD if normally distributed, otherwise as median (range). Non-parametric statistics were used when data were not normally distributed and could not be measured on ordinal scales. Intragroup differences in clinical outcomes were analyzed using the Wilcoxon test. Comparisons were made using the Kruskal–Wallis test to determine statistical significance. The level of statistical significance was set at P < 0.05. Post-hoc Bonferroni correction was used when there was a difference. To determine whether the sample size was adequate for detecting statistically significant differences between the groups, a post-hoc power analysis was performed. Based on the primary outcome of neck pain severity, the one-way ANOVA test and the observed effect size (η2 = 0.43) were used. The analysis revealed a statistical power (1 − β) of 88.8%, indicating that the study had adequate power to detect meaningful differences between groups. To determine the effect size, partial eta squared (η2) values were calculated. In accordance with the clinical interpretation framework proposed by Armijo-Olivo et al., an η2 value greater than 0.4 was considered to represent a moderate clinical effect and was used as the reference threshold in this study [35].

Results

The trial included 60 patients with migraine, and all patients were followed during the treatment sessions (52 females and 8 males) (Fig. 1) with a mean age of 31.25 ± 7.1 years (range: 18–55 years) and mean BMI of 23.07 ± 3.87 kg m^–2 (Table 1). Patient demographic data and clinical features are shown in Table 1. The MIDAS classification and neck disability in all patients at baseline did not differ significantly between the groups. The mean MIDAS score for all the patients at baseline was 20.25 ± 8.47 day (Table 1).

Table 1.

Baseline patient demographic and clinical characteristics

Characteristic	Treatment Group (TG) (n = 20)	Placebo Group (PG) (n = 20)	Control Group (CG) (n = 20)	p
Gender
Female	17 (85)	18 (90)	17 (85)	1.000χ2
Male	3 (15)	2 (10)	3 (15)
Age, years	31.6 ± 7.83	30.17 ± 6.19	31.6 ± 7.23	0.887t
BMI, kg m–2	22.81 ± 3.85	22.46 ± 3.39	23.75 ± 4.29	0.780t
Duration of Disease, years	9.1 ± 5.5	7 ± 3.8	8.22 ± 6.48	0.644t
Use of prophylactic medication (n, %)	12 (60)	11 (55)	11 (55)	0.934χ2
Type of migraine
Migraine with aura	13 (65)	11 (55)	10 (50)	0.310 χ2
Migraine without aura	7 (35)	9 (45)	10 (50)
Headache side
Unilateral	10 (50)	9 (45)	9 (45)	0.882χ2
Bilateral	10 (50)	11 (55)	11 (55)
MIDAS, day	19.5 ± 9.06	21.83 ± 7.05	19.9 ± 9.03	0.498t
No disability	0	0	0	0.282χ2
Mild disability	2 (10)	2 (10)	4 (20)
Moderate disability	10 (50)	8 (40)	6 (30)
Severe disability	8 (40)	10 (50)	10 (50)
BDI				0.951χ2
Minimal	8 (40)	8 (40)	9 (45)
Mild	8 (40)	7 (35)	7 (35)
Moderate	4 (20)	5 (25)	4 (20)
Severe	0	0	0
NDI
Mild	7 (35)	7(35)	8 (40)	0.860χ2
Moderate	10 (50)	9 (45)	9 (45)
Severe	3 (15)	4 (20)	3 (15)

X ± S.D Mean ± Standard Deviation; Values (Age, BMI and Duration of disease) are Mean ± Standard Deviation

t Independent Samples T Test, ^χ2 Chi-square statistical test, BDI Beck Depression Inventory, NDI Neck Disability Index; n (%)

Primary clinical outcomes

Headache frequency (days), headache intensity and neck pain severity scores decreased significantly in all three groups after 12 sessions of physiotherapy, as assessed by the Wilcoxon signed-rank test (p < 0.05). When considering headache frequency, no significant differences were observed among the three groups (p > 0.05). However, within-group changes between pre- and post-treatment measurements were significant. After 12-session, there was a significant difference in headache intensity among the three groups (effect size η2 = 0.432; p = 0.001). The TG group showed the greatest reduction in headache intensity compared to the PG and CG groups (Table 2). Pairwise comparisons showed significant differences in headache intensity after treatment (treatment group versus placebo group (p = 0.010) and treatment group versus control group (p < 0.001). Neck pain severity differed significantly based on pairwise comparison (treatment group versus placebo group, p = 0.009 and treatment group versus control group, p = 0.001) (Table 2). According to post-hoc Bonferroni correction analysis, headache intensity and neck pain severity were not significantly different between the placebo and control groups (Table 2).

Table 2.

Intragroup and intergroup differences between baseline and posttreatment in all groups

Clinical Outcomes	TG (n = 20)				PG (n = 20)			CG (n = 20)			Intergroup	Between TG and PG	Between TG and CG	Between PG and CG
	Baseline	Post	p•	Baseline		Post	p•	Baseline	Post	p•	p*(95% CI)	p(95% CI)	p(95% CI)	p(95% CI)
Frequency, d month–1	6.00 ± 1.78	4.83 ± 1.65	0.001	6.0 ± 1.65		5.08 ± 1.44	0.011	6.44 ± 2.83	5.72 ± 2.44	0.001	0.226	0.408	0.094	0.420
Headache intensity	7.61 ± 1.04	5.02 ± 1.02	< 0.001	7.42 ± 0.79		5.75 ± 0.70	0.002	7.39 ± 0.78	5.97 ± 0.94	0.001	0.001*†	0.010µ	0.000µ	0.826
Neck Pain Severity	5.11 ± 0.76	3. 35 ± 0.64	< 0.001	4.88 ± 0.80		3.67 ± 0.72	0.002	4.78 ± 0.86	3. 80 ± 0.81	< 0.001	0.000*†	0.009µ	0.001µ	0.627
NDI	15.0 ± 6.45	9.78 ± 4.22	< 0.001	15.25 ± 6.36		12.33 ± 5.33	0.003	13.50 ± 6.09	10.67 ± 5.25	< 0.001	0.005*	0.038µ	0.009µ	0.860

TG Treatment group, PG placebo group, CG control group, d day, NDI Neck Disability Index

^•The Wilcoxon signed-rank test was used to determine p-values for within-group comparisons (p < 0.05)

*Kruskal–Wallis one-way analysis-of-variance-by-ranks test (p < 0.05)

^µP < 0.017: significance was determined according to Bonferroni correction for multiple tests

†Clinically relevant difference and effect size > 0.4

There was an increase in the PPT of muscles in all 3 groups after 6 weeks of treatment. The increase in PPT of the upper trapezius (effect size η² = 0.530; p = 0.001) and SCM muscles (effect size η² = 0.307; p = 0.003) was significantly higher in the treatment group than in the placebo and control groups. Moreover, pairwise comparisons revealed significant differences in pressure pain threshold (PPT) of the upper trapezius between the treatment group and both the placebo group (p = 0.008) and the control group (p = 0.001). Similarly, for the sternocleidomastoid (SCM) muscle, significant differences in PPT were found between the treatment group and the placebo group (p = 0.013), as well as between the treatment group and the control group (p = 0.004). There weren’t any significant differences in change in the pain threshold of the suboccipital, levator scapula, or anterior temporalis muscles between the 3 groups posttreatment (P > 0.05) (Table 3, Fig. 3).

Table 3.

Intergroup changes in PPT from baseline to posttreatment in all groups

Muscles	TG (n = 20) Δ (range)	PG (n = 20) Δ (range)	CG (n = 20) Δ (range)	p	Between TG and PG	Between TG and CG	Between PG and CG
Upper Trapezius	–0.35 (–0.45 to –0.15)	–0.20 (–0.25 to – 0.10)	–0.15 (–0.30 to –0.10)	0.001*†	0.008µ	0.001µ	0.689
SCM	–0.35 (–0.60 to –0.15)	–0.20 (–0.40 to –0.05)	–0.18 (–0.40 to 0.00)	0.003*	0.013µ	0.004µ	0.903
Suboccipital	–0.10 (–0.25 to –0.00)	–0.05 (–0.15 to 0.00)	–0.07 (–0.15 to 0.00)	0.388	0.178	0.354	0.693
Levator Scapulae	–0.25 (–0.75 to 0.05)	–0.18 (–0.30 to –0.05)	–0.20 (–0.30 to –0.05)	0.193	0.113	0.192	0.518
Ant. Temporalis	–0.25 (–0.40 to –0.05)	–0.15 (–0.30 to –0.10)	–0.2 (–0.45 to –0.15)	0.263	0.112	0.387	0.365
Ant. Scalene	–0.22 (–0.45 to –0.05)	–0.20 (–0.30 to –0.05)	–0.15 (–0.40 to 0.00)	0.069	0.112	0.387	0.365

TG Treatment group, PG placebo group, CG control group

Values are median (range) change or difference

^*P < 0.05; Kruskal–Wallis one-way analysis-of-variance-by-ranks test

^µP < 0.017; significance was determined according to Bonferroni correction for multiple tests

†Clinically relevant difference and effect size > 0.4

Fig. 3.

PPT changes across groups from baseline to posttreatment

Secondary outcome

The NDI scores showed a significant decrease in the TG group compared to the PG and CG (Table 2).

There were significant increases in the SF-36 domains of bodily pain (effect size η² = 0.487; p = 0.000) and general health (effect size η² = 0,65; p = 0.015) after 6 weeks of treatment, with the greatest increases in the treatment group. SF-36 physical functioning, role-physical, vitality, mental health, social functioning, and role-emotional domains did not change significantly after 6 weeks of treatment in any other the groups. There weren’t any significant differences in any of the SF-36 domains between the placebo and control groups after 6 weeks of treatment (Table 4).

Table 4.

SF-36 domain (QoL) scores in all groups

HR-QoL	TG (n = 20)		PG (n = 20)		CG (n = 20)		Between Groups	Between TG and PG	Between TG and CG	Between PG and CG
	Baseline	6 weeks	Baseline	6 weeks	Baseline	6 weeks	p (95% CI)	p (95% CI)	p (95% CI)	p (95% CI)
Physical functioning	89.17 ± 7.90	91.67 ± 6.86	85.9 ± 7.02	89.5 ± 5.80	89.17 ± 6.70	90.30 ± 6.52	0.209	0.519	0.144	0.126
Role-physical	70.83 ± 19.6	81.9 ± 14.36	68.75 ± 15.54	81.25 ± 18.8	72.78 ± 19.1	79.17 ± 19.6	0.334	0.819	0.242	0.175
Bodily pain	51.11 ± 9.82	78.47 ± 8.10	52.70 ± 8.80	62.08 ± 8.97	52.22 ± 10.84	60.83 ± 8.40	0.000*†	0.002µ	0.001µ	0.559
General Health	64.72 ± 11.30	76.11 ± 11.06	60.9 ± 11.04	67.50 ± 11.58	61.11 ± 12.05	67.22 ± 10.03	0.015*	0.014µ	0.010µ	0.713
Vitality	65.0 ± 9.55	68.7 ± 8.37	70.0 ± 10.44	73.75 ± 9.32	62.50 ± 10.3	65.56 ± 11.4	0.764	0.853	0.597	0.481
Social functioning	59.17 ± 10.90	78.45 ± 12.09	55.21 ± 12.45	62.50 ± 11.92	54.97 ± 9.50	62.50 ± 10.50	0.046*	00.74	00.151	0.473
Role-emotional	61.09 ± 32.84	75.92 ± 27.54	55.55 ± 25.95	66.66 ± 37.6	61.05 ± 30.0	72.36 ± 29.10	0.643	0.491	0.883	0.474
Mental health	64.10 ± 14.30	73.17 ± 12.87	68.00 ± 9.50	71.50 ± 12.28	64.13 ± 13.53	69.28 ± 11.13	0.505	0.259	0.405	0.798

TG Treatment group, PG placebo group, CG control group. Values are mean change ± SD or difference (95% CI)

*P < 0.05

^†Clinically relevant difference and effect size > 0.4

^µp < 0.017; significance was determined according to Bonferroni correction for multiple tests

Discussion

This study examined the effects of kinesiotaping on the cervical spine in conjunction with an exercise program for migraine sufferers with associated neck pain. We also had a look at whether there was a placebo effect. Primarily, this combined approach appeared to effectively reduce the severity of neck pain and increase the pressure pain threshold of cervical muscles. Secondarily, it might also contribute to a decrease in headache intensity and positive effects on disability while enhancing overall QoL. These results highlighted the potential benefits of integrating KT and PT into a comprehensive treatment plan for migraine patients with cervical problems. These results suggested that KT combined with physical therapy (PT) may have a positive effect on patients with migraine-related neck pain.

The literature suggests that various approaches, including aerobic exercise, manual therapy and medication, have beneficial effects on headache frequency, severity, duration and disability in migraineurs [13, 36–39]. However, directly comparing and generalizing our results with previous studies is challenging due to the heterogeneity of treatment techniques and differences in comparison groups, particularly in studies focusing on the cervical spine in migraine patients [40]. Although several randomized controlled trials and meta-analyses have demonstrated the beneficial effects of exercise and physical therapy interventions in migraine patients with neck dysfunction, further high-quality studies are still needed to establish standardized protocols and determine long-term efficacy [40–44]. Despite this, physical therapy approaches such as spinal manipulation, strength training exercise and aerobic exercises show promise in improving headache symptoms, reducing disability, and enhancing QoL in migraine [42, 43, 45].

Recent evidence supports the effectiveness of aerobic exercise in reducing migraine-related outcomes. In a RCT study by Eslami et al. (2021) [45], the effects of two different intensities of aerobic training were compared in women with migraine. Both moderate- and high-intensity aerobic exercise protocols significantly reduced headache frequency, duration, and intensity. Interestingly, moderate-intensity aerobic training was found to be more effective than high-intensity training in reducing pain severity and duration [45]. However, neither protocol led to significant changes in serum levels of neuropeptides suggesting that the beneficial effects may be mediated through mechanisms unrelated to these biomarkers [45]. These findings support the potential role of aerobic exercise—particularly at moderate intensities—as a non-pharmacological strategy for managing migraine, and support the rationale for incorporating physical therapy modalities into multimodal treatment approaches [45]. Another study demonstrated that both amitriptyline alone and combined with aerobic exercise significantly improved clinical outcomes in chronic migraine patients [17]. Notably, the combination therapy resulted greater reductions in headache frequency and disability, suggesting that aerobic exercise provides an additional benefit [17]. These findings support the role of aerobic exercise as a valuable adjunct to pharmacological treatment, potentially through modulation of pain pathways and improvement of associated psychosocial factors [17]. A recent RCT assessing the effects of a three-month aerobic exercise program on individuals with migraine, coexisting tension-type headache (TTH), and neck pain demonstrated the exercise group showed reductions in headache frequency, headache intensity and neck pain intensity, though these changes were not statistically significant compared to the control group [46]. Moreover, no significant changes were observed in pericranial tenderness or pain pressure thresholds [46]. They suggested that the benefits of aerobic exercise may stem from overall health improvements rather than direct effects on pain perception [46]. Chaibi et al. [13] reported that spinal manipulative therapy targeting the cervical region significantly reduced migraine frequency from baseline to post-treatment. Another study was investigated tension-type headaches with cervical dysfunction, that showed that manipulation and exercise, in addition to pharmacologic treatment in those patients, appear to be a supportive approach [47]. Results from a RCT indicated that both transcutaneous occipital nerve stimulation and instrument-assisted soft-tissue mobilization (IASTM) are effective in reducing headache impact and intensity in chronic migraineurs. However, while IASTM contributed to pain relief, it did not lead to significant improvements in overall health perception [48].

Similarly, trials of the combination of PT and medication for migraine found significant reductions in headache frequency in the PT plus medication group and the control group [38]. However, the difference between the two groups was not statistically significant, their findings suggesting that PT might not provide additional benefits beyond medication alone in reducing headache frequency [38]. In contrast, previous study on migraine patients demonstrated that combined physiotherapy approaches, including myofascial trigger point therapy and pain-relieving techniques, effectively reduced headache frequency, intensity, and duration compared to control groups [49, 50]. Despite these benefits, some research has indicated that such interventions do not significantly impact migraine-related disability [49]. A four-session manual therapy program led to improvements in the physical and general quality of life, as well as a reduction in the disability associated with migraine [51]. Some studies found that neck exercises and myofascial trigger point therapy were not effective in reducing migraine-related disability or improving quality of life in people with migraine and neck pain. This contrasts with previous research that suggests these interventions may have positive effects [44, 52]. There are conflicting results in the literature, as previous studies have shown. In the current study, the treatment group (KT + PT) showed improvements in headache intensity, disability and neck pain severity. However, there was no significant change in headache frequency. In the current study, there was a reduction in the severity of neck pain in all three groups, and the results suggest that neck exercises had a positive effect in all groups. In addition, in migraine-associated neck pain, the observed reduction in neck pain may have had an indirect beneficial effect on headache severity.

The study by Bevilaqua-Grossi et al., investigated whether adding exercises and manual therapy to standard medication treatment would provide additional benefits for individuals with migraine and associated neck pain. Results showed that while PT did not significantly reduce headache frequency compared to medication alone, it led to increased pressure pain thresholds (indicating improved pain tolerance) and a better perception of recovery among patients [38]. Our findings in the current study demonstrated significant and beneficial effects of Kinesio taping (KT) on pain thresholds in the cervical muscles. Specifically, improvements were seen in the upper trapezius and sternocleidomastoid (SCM) muscles, with the KT group showing greater reductions in pain sensitivity compared to both the control and placebo groups. The results of the study may suggest that KT, a superficial therapeutic approach, may not have a significant effect on the pressure pain threshold of the deep cervical muscles due to its limited application. Furthermore, the lack of significant effects of KT combined with PT on the pressure pain threshold (PPT) of deep cervical muscles may be due to the absence of direct application to these muscles. However, the positive impact of KT + PT on neck pain and PPT could be explained that this combination effectively reduces nociceptive input in the cervical region in patients with episodic migraine and neck pain. Despite these improvements, headache frequency did not decrease, suggesting that a longer intervention period may be necessary to achieve meaningful functional recovery.

A systematic review evaluating the effectiveness of KT for mechanically induced neck pain suggests that KT may provide short-term pain relief and improve neck function, but its long-term benefits remain unclear [53]. Similarly, Ünlü et al. found that KT, when combined with cervical stabilization exercises, enhances QoL and reduces disability in individuals with neck pain [54]. Consistent with these findings, the present study demonstrated that the combination of KT + PT effectively decreased neck pain severity and disability level while also improving general health and social functioning of QoL. Based on the present findings, we thouht that the reduction in headache intensity and neck pain and the increasing in PPT of the cervical muscles contributed to the improvement and had a positive effect on QoL as a secondary effect.

Limitations

The primary limitation of this study is the lack of follow-up, as the long-term effects of KT on the cervical region were not assessed. Long-term follow-up could be useful for understanding how the results change over time after PT is completed. Another limitation of the present study is that the practitioner who applied both the real and placebo taping was not blinded. Although standardized procedures were followed, blinded therapist bias in treatment delivery cannot be completely ruled out. However, even sham KT can have proprioceptive or psychological effects. It could be controversial that complete placebo equivalency is questionable. Therefore, we (the physiotherapists) ensured that the sham KT technique avoided tension and therapeutic positioning rigorously. This was taken into consideration during taping. Although the use of prophylactic medications was monitored and balanced between groups, reliance on self-reported data may still introduce recall bias. KT is a superficial approach; therefore, future studies could explore physical therapy approaches and taping techniques targeting deep cervical muscles to improve treatment efficacy. In addition, further research with objective assessments and various rehabilitation methods is needed to better understand the link between migraine and muscle tenderness.

Conclusion

KT combined with PT for cervical muscles might have a positive effect on nociceptive afferents in the cervical region by increasing the pressure pain threshold in patients with migraine-associated neck pain. The present findings, we believe that the improvements in headache symptoms, reduced neck pain, and increased PPT of the cervical muscles positively impacted QoL and decreased disability level. KT appears to be an effective adjunct therapy for reducing headache intensity, neck pain severity, and disability, although it did not significantly affect headache frequency. Cervical musculoskeletal issues should not be disregarded in migraine sufferers. Moreover, continuing to take prophylaxis and NSAIDs together with PT might have been supported positively in migraine patients with neck pain. Nevertheless, additional longer-term follow-up studies are needed to clarify KT’s long-term effects.

Abbreviations

KT

Kinesiotaping

PPT

Pressure pain threshold

PT

Physical therapy

QoL

Quality of life

TG

Treatment group

PG

Placebo group and

CG

Control group

VAS

Visual analog scale

NDI

Neck disability index

SF-36

Short Form-36

HRQoL

Health-related quality of life

SCM

Sternocleidomastoid

TTH

Tension-type headache

IASTM

Instrument-assisted soft-tissue mobilization

RCTs

Randomized controlled trials

Authors’ contributions

All authors have made a substantial, direct, intellectual contribution to this study. EKB, BP: study concept and design. EKB: data analysis, interpretation of data, and drafting of the original manuscript. BP: revision of the manuscript. All the authors read and approved the final version of the manuscript.

Funding

None.

Data availability

The datasets generated and/or analysed during the current study are not publicly available because of legal and clinical research ethical constraints. Still, they are available from the corresponding author on reasonable request.

Declarations

Ethics approval and consent to participate

The Ethics Committee approved the working protocol in accordance with the Helsinki Protocol. The study protocol was approved by the Istanbul Medipol University, Clinical Research Ethics Committee (protocol no. 10840098–604.01.1-E.6803). All the participants provided written informed consent.

Consent for publication

We confirm that written informed consent was obtained from the patient herself for the publication of all personal and clinical details, including the use of identifying images in this study. The consent specifically covers the publication of the patient’s photograph for academic and scientific purposes.

Competing interests

The authors declare no competing interests.