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Current Pain and Headache Reports
Published in: Current Pain and Headache Reports 7/2015

01-07-2015 | Secondary Headache (M Robbins, Section Editor)

Myofascial Head Pain

Author: César Fernández-de-las-Peñas

Published in: Current Pain and Headache Reports | Issue 7/2015

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Abstract

Muscle nociception is mainly characterized by local tenderness and referred pain. The neurophysiological basis of muscle pain supports a role of sensitization mechanisms. From a clinical viewpoint, muscle pain is represented by the presence of myofascial trigger points (TrPs). Evidence suggests that TrPs are able to start a peripheral nociceptive mechanism and hence contributing to changes in the central nervous system. Several studies demonstrated that the referred pain elicited by TrPs reproduces the headache pattern in patients with tension-type headache (TTH), migraine, cervicogenic headache and, in some individuals, with cluster headache. In fact, sensitization of nociceptive pain pathways in the central nervous system due to prolonged nociceptive stimuli from TrPs seems to be responsible for the conversion of episodic to chronic TTH. In other headaches, TrPs may be able to stimulate the trigeminal nucleus caudalis and hence triggering a migraine or cluster headache attack. Proper treatment directed towards TrP inactivation has documented positive effects in individuals with these headaches; however, longitudinal studies are needed to further determine the role of TrPs in head pain.
Literature
1.
Stovner LJ, Hagen K, Jensen R, Katsarava Z, Lipton R, Scher A, et al. The global burden of headache: a documentation of headache prevalence and disability worldwide. Cephalalgia. 2007;27:193–210.PubMedCrossRef
2.
Babenko V, Graven-Nielsen T, Svenson P, Drewes MA, Jensen TS, Arendt-Nielsen L. Experimental human muscle pain and muscular hyperalgesia induced by combinations of serotonin and bradykinin. Pain. 1999;82:1–8.PubMedCrossRef
3.
Mork H, Ashina M, Bendtsen L, Olesen J, Jensen R. Experimental muscle pain and tenderness following infusion of endogenous substances in humans. Eur J Pain. 2003;7:145–53.PubMedCrossRef
4.
Mense S, Gerwin RD. Muscle pain: understanding the mechanisms. Berlin: Springer; 2010.CrossRef
5.
Wall PD, Woolf CJ. Muscle but not cutaneous C-afferent input produces prolonged increases in the excitability of the flexion reflex in the rat. J Physiol. 1984;356:443–58.PubMedCentralPubMedCrossRef
6.
Gandevia SC, Phegan C. Perceptual distortions of the human body image produced by local anaesthesia, pain and cutaneous stimulation. J Physiol. 1999;15:609–16.CrossRef
7.
Arendt-Nielsen L, Ge HY. Patho-physiology of referred muscle pain. In: Fernández-de-las-Peñas C, Arendt-Nielsen L, Gerwin RD, editors. Tension type and cervicogenic headache: patho-physiology, diagnosis and treatment. Boston: Jones & Bartlett Publishers; 2009. p. 51–9.
8.
Graven-Nielsen T. Fundamental of muscle pain: referred pain and deep tissue hyperalgesia. Scand J Rheumatol. 2006;122:1–43.CrossRef
9.
Goadsby PJ, Bartsch T. The anatomy and physiology of the trigeminocervical complex. In: Fernández-de-las-Peñas C, Arendt-Nielsen L, Gerwin R, editors. Tension type and cervicogenic headache: pathophysiology, diagnosis and treatment. Boston: Jones & Bartlett Publishers; 2010. p. 109–16.
10.
Ge HY, Wang K, Madeleine P, Svensson P, Sessle BJ, Arendt-Nielsen L. Simultaneous modulation of the exteroceptive suppression periods in the trapezius and temporalis muscles by experimental muscle pain. Clin Neurophysiol. 2004;115:1399–408.PubMedCrossRef
11.
Simons DG, Travell J, Simons LS. Travell and Simons’ myofascial pain and dysfunction: the trigger point manual, vol. 1. 2nd ed. Baltimore: Williams & Wilkins; 1999.
12.•
Ge HY, Arendt-Nielsen L. Latent myofascial trigger points. Curr Pain Headache Rep. 2011;15:386–92. An important paper discussing the role of latent trigger points.PubMedCrossRef
13.•
Celik D, Mutlu EK. Clinical implication of latent myofascial trigger point. Curr Pain Headache Rep. 2013;17:353. Another relevant paper discussing the clinical role of latent trigger points.PubMedCrossRef
14.
Shah JP, Phillips TM, Danoff JV, Gerber L. An in vivo microanalytical technique for measuring the local biochemical milieu of human skeletal muscle. J Appl Physiol. 2005;99:1977–84.PubMedCrossRef
15.
Shah JP, Danoff JV, Desai MJ, Parikh S, Nakamura LY, Phillips TM, et al. Biochemicals associated with pain and inflammation are elevated in sites near to and remote from active myofascial trigger points. Arch Phys Med Rehabil. 2008;89:16–23.PubMedCrossRef
16.••
Hsieh YL, Yang SA, Yang CC, Chou LW. Dry needling at myofascial trigger spots of rabbit skeletal muscles modulates the biochemicals associated with pain, inflammation, and hypoxia. Evid Based Complement Alternat Med. 2012;2012:342165. A determinant paper supporting the decrease of algogenic substances after dry needling.PubMedCentralPubMed
17.
Li LT, Ge HY, Yue SW, Arendt-Nielsen L. Nociceptive and non-nociceptive hypersensitivity at latent myofascial trigger points. Clin J Pain. 2009;25:132–7.PubMedCrossRef
18.
Wang YH, Ding X, Zhang Y, et al. Ischemic compression block attenuates mechanical hyperalgesia evoked from latent myofascial trigger point. Exp Brain Res. 2010;202:265–7.PubMedCrossRef
19.
Kuan TS, Hong CZ, Chen JT, Chen SM, Chien CH. The spinal cord connections of the myofascial trigger spots. Eur J Pain. 2007;11:624–34.PubMedCrossRef
20.
Srbely JZ, Dickey JP, Bent LR, Lee D, Lowerison M. Capsaicin-induced central sensitization evokes segmental increases in trigger point sensitivity in humans. J Pain. 2010;11:636–43.PubMedCrossRef
21.
Xu YM, Ge HY, Arendt-Nielsen L. Sustained nociceptive mechanical stimulation of latent myofascial trigger point induces central sensitization in healthy subjects. J Pain. 2010;11:1348–55.PubMedCrossRef
22.
Niddam DM. Brain manifestation and modulation of pain from myofascial trigger points. Curr Pain Headache Rep. 2009;13:370–5.PubMedCrossRef
23.
Fernández-de-las-Peñas C, Schoenen J. Chronic tension type headache: what’s new? Curr Opin Neurol. 2009;22:254–61.PubMedCrossRef
24.•
Bendtsen L, Fernández-de-las-Peñas C. The role of muscles in tension-type headache. Curr Pain Headache Rep. 2011;15:451–8. A review discussing the role of muscle tissues in tension-type headache.PubMedCrossRef
25.
Marcus DA, Scharff L, Mercer S, Turk DC. Musculoskeletal abnormalities in chronic headache: a controlled comparison of headache diagnostic groups. Headache. 1999;39:21–7.PubMedCrossRef
26.
Fernández-de-las-Peñas C, Alonso-Blanco C, Cuadrado ML, Gerwin RD, Pareja JA. Trigger points in the suboccipital muscles and forward head posture in tension type headache. Headache. 2006;46:454–60.PubMedCrossRef
27.
Couppé C, Torelli P, Fuglsang-Frederiksen A, Andersen KV, Jensen R. Myofascial trigger points are very prevalent in patients with chronic tension-type headache: a double-blinded controlled study. Clin J Pain. 2007;23:23–7.PubMedCrossRef
28.
Fernández-de-las-Peñas C, Alonso-Blanco C, Cuadrado ML, Gerwin RD, Pareja JA. Myofascial trigger points and their relationship with headache clinical parameters in chronic tension type headache. Headache. 2006;46:1264–72.PubMedCrossRef
29.
Fernández-de-las-Peñas C, Ge H, Arendt-Nielsen L, Cuadrado ML, Pareja JA. The local and referred pain from myofascial trigger points in the temporalis muscle contributes to pain profile in chronic tension-type headache. Clin J Pain. 2007;23:786–92.PubMedCrossRef
30.
Fernández-de-las-Peñas C, Cuadrado ML, Gerwin RD, Pareja JA. Referred pain from the trochlear region in tension-type headache: a myofascial trigger point from the superior oblique muscle. Headache. 2005;45:731–7.PubMedCrossRef
31.
Fernández-de-las-Peñas C, Cuadrado ML, Gerwin RD, Pareja JA. Referred pain from the lateral rectus muscle in subjects with chronic tension type headache. Pain Med. 2009;10:43–8.PubMedCrossRef
32.
Ge HY, Wang Y, Fernández-de-las-Peñas C, Graven-Nielsen T, Danneskiold-Samsøe B, Arendt-Nielsen L. Reproduction of overall spontaneous pain pattern by manual stimulation of active myofascial trigger points in fibromyalgia patients. Arthritis Res Ther. 2011;13:R48.PubMedCentralPubMedCrossRef
33.
Alonso-Blanco C, Fernández-de-las-Peñas C, Morales-Cabezas M, Zarco-Moreno P, Ge HY, Florez-García M. Multiple active myofascial trigger points reproduce the overall spontaneous pain pattern in women with fibromyalgia and are related to widespread mechanical hypersensitivity. Clin J Pain. 2011;27:405–13.PubMedCrossRef
34.
Fernández-de-las-Peñas C, Ge H, Arendt-Nielsen L, Cuadrado ML, Pareja JA. Referred pain from trapezius muscle trigger point shares similar characteristics with chronic tension type headache. Eur J Pain. 2007;11:475–82.PubMedCrossRef
35.
Fernández-de-las-Peñas C, Alonso-Blanco C, Cuadrado ML, Pareja JA. Myofascial trigger points in the suboccipital muscles in episodic tension type headache. Man Ther. 2006;11:225–30.PubMedCrossRef
36.
Fernández-de-las-Peñas C, Cuadrado ML, Pareja JA. Myofascial trigger points, neck mobility and forward head posture in episodic tension type headache. Headache. 2007;47:662–72.PubMedCrossRef
37.
Sohn JH, Choi H, Lee S, Jun A. Differences in cervical musculoskeletal impairment between episodic and chronic tension-type headache. Cephalalgia. 2010;30:1514–23.PubMedCrossRef
38.••
Alonso-Blanco C, de-la-Llave-Rincón AI, Fernández-de-las-Peñas C. Muscle trigger point therapy in tension-type headache. Expert Rev Neurother. 2012;12:315–22. An updated review on the role of trigger points in tension-type headache.PubMedCrossRef
39.
Von Stülpnagel C, Reilich P, Straube A, et al. Myofascial trigger points in children with tension-type headache: a new diagnostic and therapeutic option. J Child Neurol. 2009;24:406–9.CrossRef
40.
Fernández-de-las-Peñas C, Fernández-Mayoralas DM, Ortega-Santiago R, Ambite-Quesada S, Palacios-Ceña D, Pareja JA. Referred pain from myofascial trigger points in head and neck-shoulder muscles reproduces head pain features in children with chronic tension type headache. J Headache Pain. 2011;12:35–43.PubMedCentralPubMedCrossRef
41.
Alonso-Blanco C, Fernández-de-las-Peñas C, Fernández-Mayoralas DM, de-la-Llave-Rincón AI, Pareja JA, Svensson P. Prevalence and anatomical localization of muscle referred pain from active trigger points in head and neck musculature in adults and children with chronic tension-type headache. Pain Med. 2011;12:1453–63.PubMedCrossRef
42.••
Abboud J, Marchand AA, Sorra K, Descarreaux M. Musculoskeletal physical outcome measures in individuals with tension-type headache: a scoping review. Cephalalgia. 2013;33:1319–36. An excellent review summarizing the relevance of musculoskeletal disorders in tension type headache.PubMedCrossRef
43.
Fernández-de-las-Peñas C, Cuadrado ML, Arendt-Nielsen L, Simons DG, Pareja JA. Myofascial trigger points and sensitization: an updated pain model for tension-type headache. Cephalalgia. 2007;27:383–93.PubMedCrossRef
44.
Moraska A, Chandler C. Changes in clinical parameters in patients with tension-type headache following massage therapy: a pilot study. J Man Manip Ther. 2008;16:106–12.PubMedCentralPubMedCrossRef
45.••
Moraska AF, Stenerson L, Butryn N, Krutsch JP, Schmiege SJ, Mann JD. Myofascial trigger point-focused head and neck massage for recurrent tension-type headache: a randomized, placebo-controlled clinical trial. Clin J Pain. 2015;31:159–68. The first randomized controlled trial investigating the effects of trigger point therapy in tension-type headache.PubMedCrossRef
46.
Ghanbari A, Rahimijaberi A, Mohamadi M, Abbasi L, Sarvestani FK. The effect of trigger point management by positional release therapy on tension type headache. Neurorehabilitation. 2012;30:333–9.PubMed
47.
Fernández-de-las-Peñas C, Cleland JA, Cuadrado ML, Pareja J. Predictor variables for identifying patients with chronic tension type headache who are likely to achieve short-term success with muscle trigger point therapy. Cephalalgia. 2008;28:264–75.PubMedCrossRef
48.
Fernández-de-las-Peñas C, Cleland JA, Palomeque-del-Cerro L, Caminero AB, Guillem-Mesado A, Jiménez-García R. Development of a clinical prediction rule for identifying women with tension-type headache who are likely to achieve short-term success with joint mobilization and muscle trigger point therapy. Headache. 2011;51:246–61.PubMedCrossRef
49.
Venancio Rde A, Alencar Jr FG, Zamperini C. Botulinum toxin, lidocaine, and dry-needling injections in patients with myofascial pain and headaches. Cranio. 2009;27:46–53.PubMed
50.
Harden RN, Cottrill J, Gagnon CM, et al. Botulinum toxin a in the treatment of chronic tension-type headache with cervical myofascial trigger points: a randomized, double-blind, placebo-controlled pilot study. Headache. 2009;49:732–43.PubMedCrossRef
51.
Karadaş Ö, Gül HL, Inan LE. Lidocaine injection of pericranial myofascial trigger points in the treatment of frequent episodic tension-type headache. J Headache Pain. 2013;14:44.PubMedCentralPubMedCrossRef
52.••
France S, Bown J, Nowosilskyj M, Mott M, Rand S, Walters J. Evidence for the use of dry needling and physiotherapy in the management of cervicogenic or tension-type headache: a systematic review. Cephalalgia. 2014;34:994–1003. The first systematic review on dry needling in patients with tension-type headache.PubMedCrossRef
53.
Fernández-de-las-Peñas C, Cuadrado ML, Pareja J. Myofascial trigger points, neck mobility and forward head posture in unilateral migraine. Cephalalgia. 2006;26:1061–70.PubMedCrossRef
54.
Fernández-de-las-Peñas C, Cuadrado ML, Gerwin RD, Pareja JA. Myofascial disorders in the trochlear region in unilateral migraine: a possible initiating or perpetuating factor. Clin J Pain. 2006;22:548–53.PubMedCrossRef
55.
Calandre EP, Hidalgo J, García–Leiva JM, Rico-Villademoros F. Trigger point evaluation in migraine patients: an indication of peripheral sensitization linked to migraine predisposition? Eur J Neurol. 2006;13:244–9.PubMedCrossRef
56.
Tali D, Menahem I, Vered E, Kalichman L. Upper cervical mobility, posture and myofascial trigger points in subjects with episodic migraine: case-control study. J Bodyw Mov Ther. 2014;18:569–75.PubMedCrossRef
57.
Calandre EP, Hidalgo J, García-Leiva JM, Rico-Villademoros F. Effectiveness of prophylactic trigger point inactivation in chronic migraine and chronic daily headache with migraine features. Cephalalgia. 2003;23:713.
58.
Mellick GA, Mellick LB. Regional head and face pain relief following lower cervical intramuscular anesthetic injection. Headache. 2003;43:1109–11.PubMedCrossRef
59.
Giamberardino M, Tafuri E, Savini A, et al. Contribution of myofascial trigger points to migraine symptoms. J Pain. 2007;8:869–78.PubMedCrossRef
60.
García-Leiva JM, Hidalgo J, Rico-Villademoros F, Moreno V, Calandre EP. Effectiveness of ropivacaine trigger points inactivation in the prophylactic management of patients with severe migraine. Pain Med. 2007;8:65–70.PubMedCrossRef
61.
Jaeger B. Are cervicogenic headache due to myofascial pain and cervical spine dysfunction? Cephalalgia. 1989;9:157–64.PubMedCrossRef
62.
Roth R, Roth J, Simons D. Cervicogenic headache caused by myofascial trigger points in the sternocleido-mastoid: a case report. Cephalalgia. 2007;27:375–80.PubMedCrossRef
63.•
Bodes-Pardo G, Pecos-Martín D, Gallego-Izquierdo T, Salom-Moreno J, Fernández-de-las- Peñas C, Ortega-Santiago R. Effectiveness of manual treatment in patients with cervicogenic headache and active trigger points in the sternocleidomastoid muscle: a pilot randomized clinical trial. J Manip Physiol Ther. 2013;36:403–11. The first randomized clinical trial supporting a role of trigger point treatment in patients with cervicogenic headache.CrossRef
64.
Calandre EP, Hidalgo J, Garcia-Leiva JM, Rico-Villademoros F, Delgado-Rodriguez A. Myofascial trigger points in cluster headache patients: a case series. Head Face Med. 2008;4:32.PubMedCentralPubMedCrossRef
Metadata
Title
Myofascial Head Pain
Author
César Fernández-de-las-Peñas
Publication date
01-07-2015
Publisher
Springer US
Published in
Current Pain and Headache Reports / Issue 7/2015
Print ISSN: 1531-3433
Electronic ISSN: 1534-3081
DOI
https://doi.org/10.1007/s11916-015-0503-2

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