Lidocaine injection of pericranial myofascial trigger points in the treatment of frequent episodic tension-type headache

Abstract

BackgroundThe present study aimed to evaluate the efficacy of local lidocaine injections into the myofascial trigger points (TPs) located at the pericranial muscles in patients with episodic tension-type headache (ETTH).MethodsThe study included 108 patients with frequent ETTH that were randomized into 4 groups. One injection of saline (NaCl 0.9%) was administered to group 1 (n = 27), 1 injection of lidocaine (0.5%) was administered to group 2 (n = 27), group 3 (n = 27) received 5 injections of saline (NaCl 0.9%), and group 4 (n = 27) received 5 injections of lidocaine (0.5%); on alternate days 2 mL for each muscle was injected into the frontal, temporal, masseter, sternocleidomastoid, semispinalis capitis, trapezius and splenius capitis muscles bilaterally. The frequency of painful days per month (FPD) and the patients’ visual analogue scales (VAS) were evaluated before treatment, and 2, 4 and 6 months after treatment.ResultsMean age of the patients was 36.28 ± 9.41 years (range: 18–54 years). FPD scores improved significantly in group 2, 3 and 4 at 2 months posttreatment compared to pre- treatment (all P < 0.05), and also VAS scores improved significantly in group 2 and 4 at 2 months posttreatment (P < 0.05) but this improvement insisted at the 6 month only in group 4. Group 2 had better VAS and FPD than group 1 only at 2. and 4. months after treatment (for VAS P < 0.0121, P = 0.0232; for FPD P = 0.0003, P = 0.0004, respectively). Group 4 had better scores than group 3 at the 2., 4. and 6. months after treatment in both parameters (all P < 0.05). Group 2 had better scores than group 1 in FPD at the 2. and 4. months posttreatment (P = 0.0003, P = 0.0004, respectively), but not at the 6. month.ConclusionLocal lidocaine injections into the myofascial TPs located in the pericranial muscles could be considered as an effective alternative treatment for ETTH.

Myofascial Head Pain

“…Venâncio et al found that TrP dry needling was equally effective for decreasing headache and for the use of rescue medication than lidocaine or corticoid injections [49]. These results are similar to those also observed after the application of botulinum toxin A injections over active TrP in individuals with TTH [50,51]. Nevertheless, a recent systematic review concluded that although the literature suggests that TrP dry needling may be a useful addition to conventional physiotherapy in headaches, further research with a stronger methodological design is required [52••].…”

Greater occipital nerve blockade for the treatment of chronic migraine: a randomized, multicenter, double-blind, and placebo-controlled study

“…The efficacy of GON blockade in the treatment of various types of headache has been assessed in a number of studies (9)(10)(11)(12)(13)(14)(15)(16)(17)(18). However, few of these studies were controlled studies.…”

Muscle Triggers as a Possible Source of Pain in a Subgroup of Tension-type Headache Patients?

“…A recent study has demonstrated that local lidocaine injections into the TrPs could be considered an effective treatment for episodic TTH [98]. Recently, the Special Interest Section of the American Headache Society concluded that TrP injections (trapezius, sternocleidomastoid, and temporalis muscles) with bupivacaine and lidocaine may be effective for the management of TTH: however, evidence-based and standardized treatment protocols are still needed [65].…”