Contribution of myofascial trigger points to migraine symptoms.
This study evaluated the contribution of myofascial trigger points (TrPs) to migraine pain. Seventy-eight migraine patients with cervical active TrPs whose referred areas (RAs) coincided with migraine sites (frontal/temporal) underwent electrical pain threshold measurement in skin, subcutis, and muscle in TrPs and RAs at baseline and after 3, 10, 30, and 60 days; migraine pain assessment (number and intensity of attacks) for 60 days before and 60 days after study start. Fifty-four patients (group 1) underwent TrP anesthetic infiltration on the 3rd, 10th, 30th, and 60th day (after threshold measurement); 24 (group 2) received no treatment. Twenty normal subjects underwent threshold measurements in the same sites and time points as patients. At baseline, all patients showed lower than normal thresholds in TrPs and RAs in all tissues (P < .001). During treatment in group 1, all thresholds increased progressively in TrPs and RAs (P < .0001), with sensory normalization of skin/subcutis in RAs at the end of treatment; migraine pain decreased (P < .001). Threshold increase in RAs and migraine reduction correlated linearly (.0001 < P < .006). In group 2 and normal subjects, no changes occurred. Cervical TrPs with referred areas in migraine sites thus contribute substantially to migraine symptoms, the peripheral nociceptive input from TrPs probably enhancing the sensitization level of central sensory neurons.


CONCLUSIONS
This article shows the beneficial effects of local therapy of active myofascial trigger points (TrPs) on migraine symptoms in patients in whom migraine sites coincide with the referred areas of the TrPs. These results suggest that migraine pain is often contributed to by myofascial inputs that enhance the level of central neuronal excitability.
Giamberardino
Maria Adele
MA
Headache Center, Department of Medicine and Science of Aging, G. D'Annunzio University; Ce.S.I., G. D'Annunzio Foundation, Chieti, Italy. mag@unich.it
Tafuri
Emmanuele
E
Savini
Antonella
A
Fabrizio
Alessandra
A
Affaitati
Giannapia
G
Lerza
Rosanna
R
Di Ianni
Livio
L
Lapenna
Domenico
D
Mezzetti
Andrea
A
D000293:Adolescent; D000328:Adult; D000704:Analysis of Variance; D000772:Anesthesia, Local / Q000379:methods*; D004558:Electric Stimulation / Q000379:methods; D005069:Evaluation Studies as Topic; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008881:Migraine Disorders / Q000209:etiology*; D018482:Muscle, Skeletal / Q000294:innervation; D009209:Myofascial Pain Syndromes / Q000150:complications* / Q000628:therapy*; D010147:Pain Measurement / Q000379:methods; D017288:Pain Threshold / Q000502:physiology*; D053591:Referred Pain / Q000209:etiology*; D012867:Skin / Q000294:innervation; D013997:Time Factors