A Dual Intervention in Migraine Treatment: Tens and Exercise

Pain intensity, frequency, duration and medication use of the individuals will be evaluated every week with a pain diary. Numeric Pain Scale will be used to assess pain intensity. Individuals will be asked to mark their pain intens

Migraine Disability Assessment Questionnaire (MIDAS) was developed by Stewart et al. (56) in 1999 to measure migraine-related disability. The Turkish validity and reliability of the scale was studied by Ertaş et al. in 2004 (57). Gedikoğlu et al. (58) demonstrated the validity and reliability of the scale in migraine patients in 2005. The questions in the scale provide the determination of the number of days they cannot participate in school/work, home and leisure time activities due to migraine pain. A total score is obtained with the average score of these five questions. Scoring is divided into 4 groups; Group 1: Little or no impairment (0-5 days missing) Group 2: Mild impairment (6-10 days missing) Group 3: Moderate impairment (11-20 days missing) Group 4: Severe impairment (21 days or more).

Cranio Cervical Flexion Test will be used to evaluate the performance of the cervical region muscles. "The Stabilizer Pressure Biofeedback Unit" (Chattanoga Group, serial no: 5338276, place of manufacture: U.S) will be used for this test ."It consists of a combined manometer/inflation balloon connected to a pressure cell. In the assessment, the individual will be asked to lie supine on a bed with flexed knees. Then the pressure cell of the instrument will be placed under the suboccipital region without inflating. The manometer will be inflated to 20 mmHg, taking care that the pressure cell does not slip into the lower cervical region. Individuals will be asked to press their chin towards their neck without lifting their head as if saying "yes". They will be asked to repeat this movement 10 times for 10 seconds. The test has 5 stages from 20 mmHg to 30 mmHg. When the patient completes 10 repetitions, the test continues at 22, 24, 26, 28 and 30 mmHg.

Back scratch test will be used to assess upper extremity flexibility. In this test, the individual is asked to try to reach the lowest point on his/her back by external rotation of one arm over his/her shoulder with the palm facing his/her back while standing, and to reach the highest point on his/her back by internal rotation of the other arm with the palm facing forward. The distance between the middle fingers of both hands is measured with a tape measure. If the middle fingers do not touch each other, the distance is recorded as "minus" in centimeters, 'zero' if they can reach each other, and "plus" in centimeters if the fingers cross each other

The Pittsburgh Sleep Quality Index (PSQI), developed by Buysse et al. (1989), will be used to assess sleep quality. Its Turkish validity and reliability were confirmed by Ağargün et al. The PSQI consists of 24 questions, with 19 self-rated items and 5 answered by a bed partner or roommate (not included in scoring). Of the 19 self-rated questions, 18 are used to calculate the score across seven components: subjective sleep quality, sleep latency, sleep duration, sleep efficiency, sleep disturbances, use of sleep medication, and daytime dysfunction. Each component scores 0-3, with a total score range of 0-21. Higher scores indicate poorer sleep quality; scores 0-4 reflect good, and 5-21 poor sleep quality.

The Mini-BESTest, developed by Franchignoni et al. (2010), will be used to assess performance-oriented balance. It is a shortened version of the original BESTest, developed using Rasch analysis. The test includes 14 items grouped into four domains: anticipatory postural adjustments (e.g., sit-to-stand, standing on tiptoes, single-leg stance), reactive postural control (e.g., stepping responses in multiple directions), sensory orientation (e.g., standing on firm/foam/inclined surfaces with eyes open or closed), and dynamic gait (e.g., walking with speed changes, head turns, pivot turns, obstacle navigation, and dual-task walking). Each item is scored on a 3-point scale (0-2), with 0 indicating severe impairment and 2 indicating normal performance. A score of 0 is given if physical assistance is required. The total score ranges from 0 to 28. The Turkish validated version of the Mini-BESTest will be used in the study.

Headache Impact Test-6 (HIT-6) will be used to evaluate the impact of headache on quality of life (66). The Turkish validity and reliability study of this test was conducted by Dikmen et al. In addition to vitality, pain and psychological distress, areas such as sociability, role and cognitive functioning are evaluated with the HIT-6. While 3 of the 6 items in the test specifically addressed the previous 4 weeks, no specific time interval was specified for the remaining 3 questions. Each item is answered on a 5-point Likert scale (6=never, 8=rarely, 10=sometimes, 11=very often, 13=always). When calculating the total score, the scores of the six items are summed. The total score is between 36 and 78 points. A total score of less than 49 points indicates little or no impact, 50-55 points indicates a little impact, 56-59 points indicates a considerable impact, and 60 points and above indicates a severe impact on quality of life