Chronic migraines are not well understood in the literature but are a severe issue for healthcare providers, as well as a socioeconomic burden for those who suffer with headaches.

Chronic headache is defined as having more than 15 headache days a month, over more than a 3-month period. It is hypothesised that neurological changes in the trigeminocervical caudalis nucleus of the brain can cause an increase in sensitivity threshold, in which an individual who suffers from chronic headaches becomes more likely to have reoccurring pain and headaches. 

A common treatment to address this sensitivity are injections of OnabotulinumtoxinA (commercially known as Botox) for management of the pain and musculature around the head and neck. In addition to pharmacological interventions, physiotherapy and pain management strategies such as TENS are often used as adjunctive therapies.

This study aimed to determine if manual therapy would offer greater benefit than TENS as an adjunctive therapy for pain management and quality of life improvement.