Prevalence and Significance of Muscle Tenderness During Common Migraine Attacks

Abstract

SYNOPSIS To analyse from which extracranial tissues the pain of common migraine arises, 50 patients with typical common migraine were studied during the attack. Systematic recording of pain in 18 regions of the head and neck was followed by systematic palpation of 26 cranial and neck muscles and tendon insertions. All 50 patients were tender, and tenderness corresponded to pain in all but 2 cases. The most frequent sites of tenderness were: sternocleidomastoid, anterior temporal, neck and shoulder muscles, the coronoid process and occipital insertions. Referred pain was found in 73% of patients. Major pathways were sternocleidomastoid to temporofrontal area or occiput, occiput to vertex or temporofrontal area, neck to vertex or brow. The most tender spots were infiltrated with lidocaine 1.5% or saline double blindly. Results were judged clinically and by visual analog scales. 2648 patients were symptom free after 70 minutes which is significantly better than with medical treatment (p<0.01). There was no difference between lidocaine and saline. The study demonstrates that pericranial muscles and tendon insertions are important for common migraine pain.

Botulinum toxin injections for the treatment of frontal tension headache

“…However, beneficial effects of dry needling or injections of saline and local anesthetics into tender points in a muscle in TTH and a variety of myofascial pain conditions have been reported [26][27][28]. It should also be noted that the effect of botulinum toxin on the intensity of headache, although statistically significant, was relatively small.…”

“…The mechanism by which botulinum toxin type A may be effective in TTH and migraine is unclear, although a muscular component appears possible [16,28]. The studies performed thus far with botulinum toxin type A suggest that its effectiveness in treating headache may relate to a combination of its muscle relaxant and antinociceptive properties.…”

Botulinum Toxin as Preventive Treatment for Migraine: A Randomized Double-Blind Study

“…At week 12, patients and investigators also had to give a global rating of the treatment efficacy (1 = much better, 2 = slightly better, 3 = unchanged, 4 = slightly worse, 5 = much worse). In addition to a physical examination at each study visit, tenderness of cranial and facial muscles was assessed using a Total Tenderness Score [24]. …”

Treatment for chronic daily headache by using auxiliary and alternative methods

“…Мышечно-то-нический болевой синдром шейных мышц -фактор, несом-ненно способствующий учащению приступов мигрени [30,31]. В связи с этим в ряде случаев для лечения мигрени реко-мендуется комбинация стандартной терапии и лечебной гимнастики, метода релаксации и температурной БОС [29].…”