Myofascial Trigger Points, Neck Mobility and Forward Head Posture in Unilateral Migraine

Abstract

This paper describes the differences in the presence of myofascial trigger points (TrPs) in the upper trapezius, sternocleidomastoid, temporalis and suboccipital muscles between unilateral migraine subjects and healthy controls, and the differences in the presence of TrPs between the symptomatic side and the non-symptomatic side in migraine subjects. In addition, we assess the differences in the presence of both forward head posture (FHP) and active neck mobility between migraine subjects and healthy controls and the relationship between FHP and neck mobility. Twenty subjects with unilateral migraine without side-shift and 20 matched controls participated. TrPs were identified when there was a hypersensible tender spot in a palpable taut band, local twitch response elicited by the snapping palpation of the taut band and reproduction of the referred pain typical of each TrP. Side-view pictures were taken in both sitting and standing positions to measure the cranio-vertebral angle. A cervical goniometer was employed to measure neck mobility. Migraine subjects showed a significantly greater number of active TrPs (P<0.001), but not latent TrPs, than healthy controls. Active TrPs were mostly located ipsilateral to migraine headaches (P<0.01). Migraine subjects showed a smaller cranio-vertebral angle than controls (P<0.001), thus presenting a greater FHP. Neck mobility in migraine subjects was less than in controls only for extension (P=0.02) and the total range of motion in flexion/extension (P=0.01). However, there was a positive correlation between the cranio-vertebral angle and neck mobility. Nociceptive inputs from TrPs in head and neck muscles may produce continuous afferent bombardment of the trigeminal nerve nucleus caudalis and, thence, activation of the trigeminovascular system. Active TrPs located ipsilateral to migraine headaches might be a contributing factor in the initiation or perpetuation of migraine.

Influence of craniomandibular and cervical pain on the activity of masticatory muscles in individuals with Temporomandibular Disorder

“…The higher prevalence of TMD in subjects with cervical pain shows a relationship that should be further investigated. Nociceptive impulses from the head and neck muscles can produce a continuous afferent bombardment for the caudal trigeminal nucleus (20) and generate pain in the orofacial region (21) . The nociceptive input can be adjusted to a condition of pathological hyperexcitability and contribute to the development or maintenance of chronic pain, but also increase the likelihood of other pain disorders (22) .…”

Myofascial trigger points in children with tension-type headache: a new diagnostic and therapeutic option?

“…Recently, research findings by Fernández-de-las-Penas et al emphasized the clinical importance of the role of myofascial trigger points in adult patients with migraine as well as in adult patients with tension-type headache. [7][8][9][10][11][12][13][14]20 Until now, the epidemiological data of myofascial trigger points in children with headache are still lacking, even though headache is one of the leading symptoms for pediatric consultation. There are only a small number of evidence-based studies on the medication used to treat headache syndromes in children.…”

“…8 Regarding this concept, it is conceivable that myofascial trigger points in pericranial and cervical muscles in patients with tension-type headache may also change the nociceptive input of trigeminal afferents by a central sensitization phenomenon. 20,21 Recently, Fernández-de-las-Penas has proposed an updated pain model for tension-type headache. They hypothesized that myofascial trigger points would be the primary hyperalgesic zone.…”

Ultrassom estático e terapia manual para tratamento da enxaqueca refratária. Relato de caso

“…Accordingly, peripheral nociceptive input, including input from the muscles, may be of importance in the pathophysiology of migraine 4,5 . Of interest is that palpation of trigger points often initiates or worsens headaches 6 .…”

“…Patients with migraine often present lower craniocervical muscles pressure pain thresholds (PPT) as well as forward head position 6 . Additionally, they often have several active myofascial trigger points in the craniocervical region 4 . Static Ultrasound is a non-invasive method, sometimes used to deactivate trigger points, since it yields increased muscular temperature which, in turn, accelerates muscular metabolic rates, reducing spasms, pain and chronic inflammation, while increasing local blood flow 7,8 .…”