Table 2 Inclusion and exclusion criteria

Inclusion Criteria

• Females over 18 years of age

• A good command of English (to enable informed consent)

• Existing patients with chronic migraine as diagnosed by a clinical interview with a neurologist in line with the International Classification of Headache Diagnosis criteria (ICHD)

• Undergoing care as usual from the neurologist

• Must have had at least one cycle of treatment from neurologist and not be a new patient

Exclusion Criteria

• Currently having or had manual therapy to the neck or shoulder in the previous six weeks.

• A new patient without any existing management by neurologist

• Having a condition contraindicated for manual therapy including, but not limited to, inflammatory disorders, severe osteoporosis and tumours.

• Identification of any medical ‘red flags’ by the neurologist.

• Evidence of any central nervous system involvement for example:

 o Facial palsy (presence of ptosis/Horner’s syndrome)

 o Visual disturbance (presence of blurred vision, diplopia, hemianopia)

 o Speech disturbance (presence of dysarthria, dysphonia, dysphasia such as expressive or receptive)

 o Balance disturbance (presence of dizziness, imbalance, unsteadiness, falls)

 o Paraesthesia (presence, location such as upper limb/lower limb, face)

 o Weakness (presence, location such as upper limb/lower limb)

 o Known major psychiatric or psychological conditions not under control