🇪🇸MIGRAÑA & 🇬🇧

Introducción:

El dolor tiene una dimensión multidimensional que afecta a los córtices somatosensoriales primarios y secundarios del sistema nervioso central (SNC), tálamo, ínsula, corteza cingulada anterior y córtices parietales y prefrontales (Coen et al., 2008; Longe et al., 2001; Petrovic et al., 2000; Borsook, Sava and Becerra, 2010; Sator-Katzenschlager, 2014).

La migraña definida por la Sociedad Internacional del Dolor de Cabeza (IHS) tiene características específicas como ser unilateral, pulsátil con intensidad moderada o severa; incrementa con la actividad física. Es una enfermedad crónica que reduce la calidad de vida (QoL) presentando náuseas, vómitos y/o fotofobia (Society, 2013). Se argumenta el origen de la migraña, pero hay evidencia sobre una disfunción del sistema nervioso vegetativo (Pietrobon and Striessnig, 2003; Dodick and Silberstein, 2006) especialmente en relación con la sensibilización central para una alteración de los núcleos trigemino-vasculares (Goadsby, 2002) y la inflamación de las meninges (Aurora and Wilkinson, 2007). La migraña se produce en aproximadamente el 15% de la población general con un coste total anual estimado en 18.000 millones de euros en Europa, más que trastornos neurológicos como la esclerosis múltiple, la enfermedad de Parkinson y el accidente cerebrovascular o tumor cerebral (Gustavsson et al., 2011). La migraña generalmente se maneja con medicamentos, pero el manejo no farmacológico podría ser una opción de tratamiento alternativo para reducir el dolor, la discapacidad, aumentar la QoL y reducir los costes.

La osteopatía dentro de la medicina integrativa y complementaria, y también si se compara con la terapia farmacológica, es relativamente nueva y todavía carece de una práctica completa basada en la evidencia (EBP).

El tratamiento osteopático (OT) a través de la técnica de manipulación espinal (SMT) o la terapia craneosacral (CST) tiene como objetivo influir en el SNC alterando el procesamiento somatosensorial a nivel cortical mecanismos reguladores neuromusculares-autónomos para reducir el dolor (Mueller, 2007; Lelic et al., 2016).

En la práctica clínica, el OT parece ser eficaz basado en las evaluaciones realizadas y sería interesante averiguar su uso para el manejo de la migraña crónica, ayudando al paciente a conseguir una homeostasis que reduzca el dolor y la discapacidad, ayudando así a aumentar la calidad de vida.

Métodos:

Se ha identificado y evaluado críticamente la literatura disponible sobre la eficacia del tratamiento osteopático en pacientes afectados por migraña con respecto al dolor y la discapacidad.

Se ha llevado a cabo una revisión sistemática, examinando y revisando más de 10 databases y revistas.

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The therapeutic application of manually guided forces by an osteopath (nonphysician) to improve physiological function and homeostasis that has been altered by somatic dysfunction. 

Osteopathic manipulative treatment (OMT): The therapeutic application of manually guided forces by an osteopathic physician (U.S. usage) to improve physiologic function and/or support homeostasis that has been altered by somatic dysfunction. OMT employs a variety of techniques.
Osteopathic Medicine: The preferred term for a complete system of medical care practiced by physicians with an unlimited license that is represented by a philosophy that combines the needs of the patient with the current practice of medicine, surgery and obstetrics. Emphasizes the interrelationship between structure and function, and has an appreciation of the body's ability to heal itself.
Osteopathic musculoskeletal evaluation: The osteopathic musculoskeletal evaluation provides information regarding the health of the patient.

Utilizing the concepts of body unity, self-regulation and structure-function interrelationships, the osteopathic physician uses data from the musculoskeletal evaluation to assess the patient's status and develop a treatment plan.

Osteopathic philosophy: A concept of health care supported by expanding scientific knowledge that embraces the concept of the unity of the living organism's structure (anatomy) and function (physiology). Osteopathic philosophy emphasizes the

following principles:

I. The human being is a dynamic unit of function.

II. The body possesses self-regulatory mechanisms that are self-healing in nature.

III. Structure and function are interrelated at all levels.

IV. Rational treatment is based on these principles.

Osteopathic physician: A person with full unlimited medical practice rights who has achieved the nationally recognized academic and professional standards within his or her country to practice diagnosis and treatment based upon the principles of osteopathic philosophy. Individual countries establish the national academic and professional standards for osteopathic physicians practicing within their countries.
Osteopathic practitioner: Refers to an osteopath, an osteopathic physician or an allopathic physician who has been trained in osteopathic principles, practices and philosophy.
Osteopathic structural examination: The examination of a patient by an osteopathic practitioner with emphasis on the neuromusculoskeletal system including palpatory diagnosis for somatic dysfunction and viscerosomatic change within the context of total patient care. The examination is concerned with finding somatic dysfunction in all parts of the body, and is performed with the patient in multiple positions to provide static and dynamic evaluation.
Osteopathy in the Cranial Field (OCF), A system of diagnosis and treatment by an osteopathic practitioner using the primary respiratory mechanism and balanced membranous tension.
Osteopathy: Archaic usage. No longer a preferred term in the United States. See Osteopathic Medicine.
Pain: An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage
Primary machinery of life: The neuromusculoskeletal system. A term used to denote that body parts act together to transmit and modify force and motion through which man acts out his life. This integration is achieved via the central nervous system acting in response to continued sensory input from the internal and external environment.
Primary respiratory mechanism: A conceptual model that describes a process involving five interactive, involuntary functions: (1). The inherent motility of the brain and spinal cord. (2). Fluctuation of the cerebrospinal fluid. (3). Mobility of the intracranial and intraspinal membranes. (4). Articular mobility of the cranial bones. (5). Mobility of the sacrum between the ilia (pelvic bones) that is interdependent with the motion at the sphenobasilar synchondrosis.

This mechanism refers to the presumed inherent (primordial) driving mechanism of internal respiration as opposed to the cycle of diaphragmatic respiration (inhalation and exhalation). It further refers to the innate interconnected movement of every tissue and structure of the body. Optimal health promotes optimal function and the inherent function of this interdependent movement can be negatively altered by trauma, disease states or other pathology. The mechanism is thought to affect cellular respiration and other body processes. In the original definition, the following descriptions were given: primary, because it is directly concerned with the internal tissue respiration of the central nervous system; respiratory, because it further concerns the physiological function of the interchange of fluids necessary for normal metabolism and biochemistry, not only of the central nervous system, but also of all body cells; mechanism, because all the constituent parts work together as a unit carrying out this fundamental physiology.

Reciprocal tension membrane: The intracranial and spinal dural membrane including the falx cerebri, falx cerebelli, tentorium and spinal dura.
Sensitization: Hypothetically, a short lived (minutes or hours) increase in central nervous system (CNS) response to repeated sensory stimulation that generally follows habituation.
Soft tissue (ST): A system of diagnosis and treatment directed toward tissues other than skeletal or arthrodial elements.
Somatic dysfunction: Impaired or altered function of related components of the somatic (body framework) system: skeletal, arthrodial and myofascial structures, and their related vascular, lymphatic, and neural elements. Somatic dysfunction is treatable using osteopathic manipulative treatment. The positional and motion aspects of somatic dysfunction are best described using at least one of three parameters: 1). The position of a body part as determined by palpation and referenced to its adjacent defined structure, 2). The directions in which motion is freer, and 3). The directions in which motion is restricted.
Spinal facilitation: 1. The maintenance of a pool of neurons (e.g., premotor neurons, motor neurons or preganglionic sympathetic neurons in one or more segments of the spinal cord) in a state of partial or subthreshold excitation; in this state, less afferent stimulation is required to trigger the discharge of impulses.

2. A theory regarding the neurophysiological mechanisms underlying the neuronal activity associated with somatic dysfunction.

3. Facilitation may be due to sustained increase in afferent input, aberrant patterns of afferent input, or changes within the affected neurons themselves or their chemical environment. Once established, facilitation can be sustained by normal central nervous system (CNS) activity.

Traube-Herring-Mayer wave: An oscillation that has been measured in association with blood pressure, heart rate, cardiac contractility, pulmonary blood flow, cerebral blood flow and movement of the cerebrospinal fluid, and peripheral blood flow including venous volume and thermal regulation. This whole-body phenomenon, which exhibits a rate typically slightly less than and independent of respiration, bears a striking resemblance to the primary respiratory mechanism.
Visceral manipulation (VIS): A system of diagnosis and treatment directed to the viscera to improve physiologic function. Typically, the viscera are moved toward their fascial attachments to a point of fascial balance.

Source: Medicine (2011) and Society (2013).

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