Trigger Point Injections for Headache Disorders: Expert Consensus Methodology and Narrative Review

Robbins, Matthew S.; Kuruvilla, Deena; Blumenfeld, Andrew; Charleston, Larry; Sorrell, Michael R.; Robertson, Carrie E.; Grosberg, Brian M.; Bender, Steven D.; Napchan, Uri; Ashkenazi, Avi

doi:10.1111/head.12442

Cited by 67 publications

(52 citation statements)

References 59 publications

(81 reference statements)

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“…However, in the last decade, many clinical studies have demonstrated the existence of active TrPs in TTH in adults [3,7,16,64,65]. Similar findings have been confirmed in children [66] who similarly to adults develop pericranial tenderness [67].…”

Section: Trps and Tension Type Headachementioning

confidence: 67%

“…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]. In the appropriate setting and with the proper expertise, injections of local analgesics in TrPs seem to play a role in the adjunctive treatment of the most common headache disorders [65].…”

Section: Modulation Trps In Tthmentioning

confidence: 99%

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

Arendt-Nielsen

Castaldo

Mechelli

et al. 2016

The Clinical Journal of Pain

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Understanding the possible triggers in TTH, muscle hyperalgesia, and widespread pain sensitization, may help to develop better management regimes and possibly prevent TTH from developing into more chronic conditions. Currently, there is a striking difference between the clinical observational studies favoring the role of muscle triggers in TTH and the intervention studies generally not supporting the role of muscle triggers in TTH.

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Section: Trps and Tension Type Headachementioning

confidence: 67%

Section: Modulation Trps In Tthmentioning

confidence: 99%

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

Arendt-Nielsen

Castaldo

Mechelli

et al. 2016

The Clinical Journal of Pain

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show abstract

“…25,26 In a recent survey of American Headache Society members, threequarters of responders indicated that they perform this intervention in patients with headaches, particularly in CTTH. 7 With appropriate training, this intervention can be readily implemented by clinicians in the South African primary health care setting. Clinicians should simultaneously identify and address perpetuating factors such as abnormal posture, stress, mood disorders and poor sleep, which may contribute to MPS and MTrPs.…”

Section: Conclusion and Recommendationsmentioning

confidence: 99%

“…Latent MTrPs do not produce spontaneous pain and lack the referral pattern seen in active MTrPs. 5,7,8 Simons et al published a comprehensive manual of the patterns of referred pain from different MTrPs throughout the body. 5 Active MTrPs may develop after an injury to muscle fibres, which may be a single traumatic event or repetitive micro-trauma to muscles, which then is followed by local muscle contraction.…”

Section: Introductionmentioning

confidence: 99%

Active myofascial trigger points in head and neck muscles of patients with chronic tension-type headache in two primary health care units in Tshwane

Joseph

Hitchcock

Meyer

et al. 2016

South African Family Practice

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Background:The management of patients presenting with chronic tension-type headache (CTTH) can be challenging for primary health care practitioners. As with most chronic pain disorders, a multimodal management approach is frequently required. It has been postulated that myofascial pain syndrome (MPS) and its hallmark myofascial trigger points (MTrPs) found in specific muscle tissues may play a role in the chronic pain experienced by patients with CTTH. Little is known about the prevalence of MTrPs in patients with CTTH, in primary health care settings on the African continent. This study therefore aimed to investigate the prevalence of active MTrP's in specific head and neck muscles/muscle groups in patients with CTTH. Methods: A prospective, cross-sectional and descriptive study was done in two primary health care facilities situated in Tshwane, South Africa. The sample included 97 adult patients with CTTH. Five head and neck muscles/muscle groups were examined bilaterally for active MTrPs. Outcome measures were the prevalence and distribution of active MTrPs in these patients. Results: Active MTrPs were found in 95.9% of the patients, the majority (74.2%) having four or more active MTrPs. The temporalis muscles and suboccipital muscle group exhibited the highest number of active MTrPs (prevalence 87.6% and 80.4% respectively). Conclusion: Our study suggests a strong association between MPS and CTTH in patients, presenting in the primary health care setting. This indicates the importance of a musculoskeletal assessment of neck and pericranial muscles in patients with CTTH. This can assist in determining the most appropriate treatment strategy in these patients.

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“…Among these impairments, trigger points (TrPs) have received particular attention in the headache literature [13][14][15] . Methods: One hundred and forty-three women, aged 18-60 years, suffering from migraine were recruited to participate.…”

mentioning

confidence: 99%

Myofascial Trigger Points and Migraine-related Disability in Women With Episodic and Chronic Migraine

Ferracini¹,

Florêncio

Dach

et al. 2017

The Clinical Journal of Pain

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Women with episodic and chronic migraine had a similar number of TrPs. TrPs may be considered a trigger factor that can facilitate the onset of migraine or also can potentially be a promoting factor for pain once the migraine attack has started and hence may contribute to related disability. Nevertheless, we observed that the number of TrPs in the head and neck-shoulder muscles in an interictal state was not associated with the degree of migraine-related disability, suggesting a multifactorial nature of self-perceived disability in this population.

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Trigger Point Injections for Headache Disorders: Expert Consensus Methodology and Narrative Review

Cited by 67 publications

References 59 publications

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

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

Active myofascial trigger points in head and neck muscles of patients with chronic tension-type headache in two primary health care units in Tshwane

Myofascial Trigger Points and Migraine-related Disability in Women With Episodic and Chronic Migraine

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