Effectiveness of Cranio-Cervical Osteopathic Techniques in Combination with Transcranial Direct Current Stimulation (tDCS) for Migraine: A Randomized Controlled Trial

<ns3:p> Background Migraine is a leading cause of disability worldwide, often complicated by cervical dysfunction and central sensitization. Non-phamacological strategies such as transcranial direct current stimulation (tDCS) and osteopathic manual therapy show promise, but their combined efficacy remains underexplored. This study aims to evaluate the effectiveness of combining active tDCS with physiotherapy compared to sham tDCS plus physiotherapy in patients with chronic migraine. Methods A single-center, single-blind randomized controlled trial was conducted at Sri Aurobindo University, India. A total of 160 participants with chronic migraine were randomized into two groups: Experimental Group A (Active tDCS + Cranio-cervical osteopathic therapy) and Control Group B (sham tDCS + Cranio-cervical osteopathic therapy). Interventions were delivered over six weeks (18 sessions). The outcomes were pain intensity measured by the Visual Analogue Scale (VAS), headache frequency and duration, pressure pain threshold (PPT), balance (MiniBESTest), quality of life (SF-36), Migraine Disability Assessment Score (MIDAS), Pittsburgh Sleep Quality Index (PSQI), Migraine Symptom Severity Score (MSSS). Statistical analyses employed ANCOVA and linear mixed-effects models with false discovery rate correction. Results Compared with controls, GroupA demonstrated significantly greater reduction in VAS (= 2.10, <ns3:italic>p &lt;</ns3:italic> 0 <ns3:italic>.</ns3:italic> 001, d = 1.15), headache frequency (∆ = 1.85/week, <ns3:italic>p &lt;</ns3:italic> 0 <ns3:italic>.</ns3:italic> 001) and duration (∆ =9.45 minutes/day, <ns3:italic>p &lt;</ns3:italic> 0 <ns3:italic>.</ns3:italic> 001). Significant improvements were also observed in trapezius PPT, balance (+4.30 points, <ns3:italic>p &lt;</ns3:italic> 0 <ns3:italic>.</ns3:italic> 001), quality of life, dsability and symptom severity. No between-group differences was noted for the sub-occipital PPT, anterior scalene PPT and PSQI. Conclusion Active tDCS combined with physiotherapy provides superior clinical benefits over sham stimulation, reducing migraine intensity, frequency, disability and improving function and qulaity of life. This multimodal approach addresses both central sensitization and peripheral dysfunction, support its role as an effective non-phamacological strategy in migrain management. Trial Registration Enrolled in the International Clinical Trials Registry on December 20, 2021 (CTRI/2021/12/038734). On July 18, 2020, the Sri Aurobindo Institute of Allied Health &amp; Paramedical Sciences’ Research &amp; Ethical Committee gave its approval. </ns3:p>