Quantitative magnetic resonance imaging of the upper trapezius muscles – assessment of myofascial trigger points in patients with migraine

Abstract

BackgroundResearch in migraine points towards central-peripheral complexity with a widespread pattern of structures involved. Migraine-associated neck and shoulder muscle pain has clinically been conceptualized as myofascial trigger points (mTrPs). However, concepts remain controversial, and the identification of mTrPs is mostly restricted to manual palpation in clinical routine. This study investigates a more objective, quantitative assessment of mTrPs by means of magnetic resonance imaging (MRI) with T2 mapping.MethodsTen subjects (nine females, 25.6 ± 5.2 years) with a diagnosis of migraine according to ICHD-3 underwent bilateral manual palpation of the upper trapezius muscles to localize mTrPs. Capsules were attached to the skin adjacent to the palpated mTrPs for marking. MRI of the neck and shoulder region was performed at 3 T, including a T2-prepared, three-dimensional (3D) turbo spin echo (TSE) sequence. The T2-prepared 3D TSE sequence was used to generate T2 maps, followed by manual placement of regions of interest (ROIs) covering the trapezius muscles of both sides and signal alterations attributable to mTrPs.ResultsThe trapezius muscles showed an average T2 value of 27.7 ± 1.4 ms for the right and an average T2 value of 28.7 ± 1.0 ms for the left side (p = 0.1055). Concerning signal alterations in T2 maps attributed to mTrPs, nine values were obtained for the right (32.3 ± 2.5 ms) and left side (33.0 ± 1.5 ms), respectively (p = 0.0781). When comparing the T2 values of the trapezius muscles to the T2 values extracted from the signal alterations attributed to the mTrPs of the ipsilateral side, we observed a statistically significant difference (p = 0.0039). T2 hyperintensities according to visual image inspection were only reported in four subjects for the right and in two subjects for the left side.ConclusionsOur approach enables the identification of mTrPs and their quantification in terms of T2 mapping even in the absence of qualitative signal alterations. Thus, it (1) might potentially challenge the current gold-standard method of physical examination of mTrPs, (2) could allow for more targeted and objectively verifiable interventions, and (3) could add valuable models to understand better central-peripheral mechanisms in migraine.

Phase‐based T2mapping with gradient echo imaging

“…Importantly, T 2 is well known to characterize a plethora of important disease processes such as iron deposition, fibrosis, edema, malignancy, and inflammation, among others. As a result, quantitative T 2 mapping with MRI has many applications, including assessment of neuro‐degenerative diseases and characterization of malignant lesions, detection of myocardial edema, detection of chronic rejection after heart transplant, detection of early cartilage degeneration, quantification of liver iron overload, and even identification of myofascial trigger points …”

Repetitive Peripheral Magnetic Stimulation (rPMS) in Subjects With Migraine—Setup Presentation and Effects on Skeletal Musculature

“…Second, the exact localization of stimulation was defined according to previous manual palpation performed to detect active or latent mTrPs. Manual palpation is considered the gold standard for the identification of mTrPs since decades (25, 66); however, novel techniques like qualitative magnetic resonance imaging (MRI) or quantitative MRI using T2 mapping might be capable of visualizing and determining mTrPs more objectively, thus paving the way for navigated rPMS interventions (11, 12, 67). Third, this study only involves a certain neck muscle, the trapezius muscle, as a structure being part of the TCC and only one muscle, the deltoid muscle, that is not supposed to be involved in the TCC.…”

Increased neck muscle stiffness in migraine patients with ictal neck pain: A shear wave elastography study

“…Still, it is unknown if neck pain directly contributes to migraine pain or is a consequence of it. Only a few MRI studies have reported hyperintense signals in the trapezius muscle in migraine patients (8,9), but the implications of these signal changes are not fully known. Thus, neck pain in migraine is, despite being a very frequent symptom, an under-investigated field of research in migraine.…”