The role of myofascial trigger points in musculoskeletal pain syndromes of the head and neck

Abstract

Neck and head pain syndromes are common problems seen in clinical practice. Pain features of commonly designated idiopathic neck pain and some primary headaches (ie, tension-type headache or migraine) fit the descriptions of referred pain originating in muscle trigger points (TrPs). This article discusses the scientific evidence supporting the role of muscle TrPs in chronic musculo-skeletal disorders of the neck and head. The relevance of referred pain elicited by muscle TrPs in patients with neck pain has been investigated in few studies. Some authors found that both muscle TrPs in neck-shoulder muscles and cervical joint dysfunctions contribute at the same time to neck pain perception. Furthermore, it seems that referred pain originated in muscle TrPs could also contribute to neck symptoms perceived by subjects after a rear-end crash. In addition, several recent studies reported that both TTH and migraine are associated with referred pain from TrPs in the suboccipital, upper trapezius, sternocleidomastoid, temporalis, or superior oblique muscles. Referred pain elicited by active TrPs mimics the pain areas observed during head pain attacks in these primary headaches. Based on available data, it seems that the pain profile of neck and head syndromes may be provoked referred pain from TrPs in the posterior cervical, head, and shoulder muscles. Additional studies are needed to delineate more information on the relation between muscle TrPs and musculoskeletal pain syndromes of the head and neck.

Prevalence of Myofascial Trigger Points in Fibromyalgia: The Overlap of Two Common Problems

“…Furthermore, pain evoked from an MTrP by noxious electrical stimulation is associated with significantly enhanced activity in brain regions involved in sensorydiscriminative and affective processing compared with controls [29]. Headache pain can be reproduced by local and referred pain from active MTrPs [24], and migraine symptom resolution and PPT increase are achieved following consecutive MTrPs' anesthetic infiltration [30]. Even more, activation of a latent MTrP by sustained mechanical stimulation in the upper arm can decrease PPT in the tibialis anterior muscle in healthy subjects (Xu et al, unpublished data).…”

“…It is important to note that central sensitization mechanisms are not specific for FM; they also are involved in different regional musculoskeletal pain syndromes due to MTrPs, such as low back pain [22], neck shoulder pain [23], headaches [24], knee pain [25], and pelvic pain [26]. Central sensitization in FM and local pain syndromes may be one of degree and not of qualitative difference.…”

Effectiveness of Dry Needling on the Lower Trapezius in Patients With Mechanical Neck Pain: A Randomized Controlled Trial

“…[13][14][15] Although many studies [16][17][18][19] reported that patients with neck pain had trigger points in the cervical and shoulder muscles, such as the upper trapezius muscle, few authors have studied trigger points as the main cause of neck pain.…”

Dolor miofascial en el territorio craneocervical: una revisión de la patología y su relación con polimorfismos genéticos del sistema GABAérgico

“…Se ha descrito que el DMF proveniente de diferentes músculos craneales y cervicales puede jugar un rol importante en la génesis del dolor en la región craneocervical (9,11) representado a través de diferentes estudios epidemiológicos que lo consideran una importante fuente de dolor musculoesquelético (11). En la región orofacial y cervical, se ha sugerido que el DMF se puede expresar como una cefalea tipo tensional (12) dado que los impulsos nociceptivos periféricos de los músculos actúan como zonas de hiperalgesia primaria conduciendo a una sensibilización central y por consiguiente a una cefalea tipo tensional (13).…”