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The Journal of Headache and Pain

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Open Access 01-12-2013 | Research article

Lidocaine injection of pericranial myofascial trigger points in the treatment of frequent episodic tension-type headache

Authors: Ömer Karadaş, Hakan L Gül, Levent E İnan

Published in: The Journal of Headache and Pain | Issue 1/2013

Abstract

Background

The present study aimed to evaluate the efficacy of local lidocaine injections into the myofascial trigger points (TPs) located at the pericranial muscles in patients with episodic tension-type headache (ETTH).

Methods

The study included 108 patients with frequent ETTH that were randomized into 4 groups. One injection of saline (NaCl 0.9%) was administered to group 1 (n = 27), 1 injection of lidocaine (0.5%) was administered to group 2 (n = 27), group 3 (n = 27) received 5 injections of saline (NaCl 0.9%), and group 4 (n = 27) received 5 injections of lidocaine (0.5%); on alternate days 2 mL for each muscle was injected into the frontal, temporal, masseter, sternocleidomastoid, semispinalis capitis, trapezius and splenius capitis muscles bilaterally. The frequency of painful days per month (FPD) and the patients’ visual analogue scales (VAS) were evaluated before treatment, and 2, 4 and 6 months after treatment.

Results

Mean age of the patients was 36.28 ± 9.41 years (range: 18–54 years). FPD scores improved significantly in group 2, 3 and 4 at 2 months posttreatment compared to pre- treatment (all P < 0.05), and also VAS scores improved significantly in group 2 and 4 at 2 months posttreatment (P < 0.05) but this improvement insisted at the 6 month only in group 4. Group 2 had better VAS and FPD than group 1 only at 2. and 4. months after treatment (for VAS P < 0.0121, P = 0.0232; for FPD P = 0.0003, P = 0.0004, respectively). Group 4 had better scores than group 3 at the 2., 4. and 6. months after treatment in both parameters (all P < 0.05). Group 2 had better scores than group 1 in FPD at the 2. and 4. months posttreatment (P = 0.0003, P = 0.0004, respectively), but not at the 6. month.

Conclusion

Local lidocaine injections into the myofascial TPs located in the pericranial muscles could be considered as an effective alternative treatment for ETTH.

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Inan LE: Gerilim tip baş ağrıları. Turkiye Klinikleri J Neurol-Special Topics 2003,1(2):127–132.

Schwartz BS, Stewart WF, Simon D, Lipton RB: Epidemiology of tension-type headache. JAMA 1998,279(5):381–383. 10.1001/jama.279.5.381PubMedCrossRef

Silberstein SD, Lipton RB, Goadsby PJ: Tension-Type Headache: Diagnosis and treatment. In Clinical Practice of Headache. 2nd edition. Oxford: Martin Dunitz; 2002:113–128.

Lipton RB, Hamelsky SW: Epidemiology and impact of headache. In Wolff’s Headache and Other Head Pain. 7th edition. Edited by: Silberstein SD, Lipton RB, Dalessio DJ. New York: Ny. Oxford University Press; 2001:85–107.

Olesen J, Langemark M: Mechanisms of tension headache. A speculativehypothesis. In Basic mechanisms of headache. Edited by: Olesen J, Edvinsson L. Amsterdam: Elsevier; 1988:457–461.

Jensen K: Quantification of tenderness by palpitation and use of pressure algometers. In Adv Pain Res Ther, vol 17. Edited by: Fricton JR, Awad E. New York: Raven; 1990:165–181.

Bendtsen L, Schoenen J: Synthesis of tension-type headache mechanisms. In The Headaches. 3rd edition. Edited by: Olesen J, Goadsby PJ, Ramadan N. Philadelphia: Lippincott Williams & Wilkins; 2005:677–681.

Schmidt-Wilcke T, Leinisch E, Straube A, Kämpfe N, Draganski B, Diener HC, Bogdahn U, May A: Gray matter decrease in patients with chronic tension type headache. Neurology 2005,65(9):1483–1486. 10.1212/01.wnl.0000183067.94400.80PubMedCrossRef

Buchgreitz L, Lyngberg AC, Bendtsen L, Jensen R: Increased prevalence of tension-type headache over a 12-year period is related to increased pain sensitivity. A population study. Cephalalgia 2007,27(2):145–152. 10.1111/j.1468-2982.2006.01248.xPubMedCrossRef

10.

Mense S: Nociception from skeletal muscle in relation to clinical muscle pain. Pain 1993,54(3):241–289. 10.1016/0304-3959(93)90027-MPubMedCrossRef

11.

Schmidt RF: Sensitization of peripheral nocisensors in muscle. In Tension-type headache: classification, mechanisms and treatment. Edited by: Olesen J, Schoenen J. New York: Raven; 1993:47–59.

12.

Jensen R, Olesen J: Initiating mechanisms of experimentally induced tension-type headache. Cephalalgia 1996,16(3):175–182. 10.1046/j.1468-2982.1996.1603175.xPubMedCrossRef

13.

Hu JW, Sessle BJ, Raboisson P, Dallel R, Woda A: Stimulation of craniofacial muscle afferents induces prolonged facilitatory effects in trigeminal nociceptive brain-stem neurones. Pain 1992,48(1):53–60. 10.1016/0304-3959(92)90131-TPubMedCrossRef

14.

Zissis NP, Harmoussi S, Vlaikidis N, Mitsikostas D, Thomaidis T, Georgiadis G, Karageorgiou K: A randomized, double-blind, placebo-controlled study of venlafaxine XR in out-patients with tension-type headache. Cephalalgia 2007,27(4):315–324. 10.1111/j.1468-2982.2007.01300.xPubMedCrossRef

15.

Silver N: Headache (chronic tension-type). Am Fam Physician 2007,76(1):114–116.PubMed

16.

Headache Classification Subcommittee of the International Headache Society: The International Classification of Headache Disorders: 2nd edition. Cephalalgia 2004,24(suppl1):16–22.

17.

Jaeger B: Head and Neck Pain, Travell & Simons’Myofascial pain and dysfunction the triger point manual. II edition. Edited by: Simons DG, Travell JG, Simons LS. Pennsylvania: Lippincott Williams&Wilkins; 1999:237–484.

18.

Kayaalp O: Lokal Anestezikler: in Kayaalp O (ed): Kayalalp Rasyonel Tedavi Yönünden Tıbbi Farmakoloji, ed 10. Hacettepe-TAŞ: Ankara; 2002:792–806.

19.

Catterall WA, Kenneth M: local anesthetics. In Goodman & Gilman's the pharmacological basis of therapeutics. 11th edition. Edited by: Brunton LL, Lazo JS, Parker KKL. Texas: The Mcgraw-hill Mompanies Inc; 2006:241–251.

20.

Bendtsen L: Central sensitization in tension-type headache-possible pathophysiological mechanisms. Cephalalgia 2000,20(5):486–508. 10.1046/j.1468-2982.2000.00070.xPubMedCrossRef

21.

Jensen R: Peripheral and central mechanisms in tension-type headache: an update. Cephalalgia 2003,23(Suppl 1):49–52.PubMedCrossRef

22.

Shah JP, Phillips TM, Danoff JV, Gerber LH: An in vivo microanalytical technique for measuring the local biochemical milieu of human skeletal muscle. J Appl Physiol 2005,99(5):1977–1984. 10.1152/japplphysiol.00419.2005PubMedCrossRef

23.

Venâncio Rde A, Alencar FG, Zamperini C: Different substances and dry-needling injections in patients with myofascial pain and headaches. Cranio 2008,26(2):96–103.PubMed

24.

Huguenin KL: Myofascial trigger points: the current evidence. Phys Ther Sport 2004,5(1):2–12. 10.1016/j.ptsp.2003.11.002CrossRef

25.

Giamberardino MA, Affaitati G, Fabrizio A, Costantini R: Myofascial pain syndromes and their evaluation. Best Pract Res Clin Rheumatol 2011,25(2):185–198. 10.1016/j.berh.2011.01.002PubMedCrossRef

26.

Venancio Rde A, Alencar FG Jr, Zamperini C: Botulinum toxin, lidocaine, and dry-needling injections in patients with myofascial pain and headaches. Cranio 2009,27(1):46–53.PubMed

27.

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. 10.1186/1746-160X-4-32PubMedCentralPubMedCrossRef

28.

Giamberardino MA, Tafuri E, Savini A, Fabrizio A, Affaitati G, Lerza R, Di Ianni L, Lapenna D, Mezzetti A: Contribution of myofascial trigger points to migraine symptoms. J Pain 2007,8(11):869–878. 10.1016/j.jpain.2007.06.002PubMedCrossRef

29.

Tfelt-Hansen P, Olesen J, Lous I: Lignocaine versus saline in migraine pain. Lancet 1980,1(8178):1140.PubMedCrossRef

30.

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(1):65–70. 10.1111/j.1526-4637.2007.00251.xPubMedCrossRef

31.

Martín-Herrero C, de Souza DP R, Alburquerque-Sendín F, Ortega-Santiago R, Fernández-de-Las-Peñas C: Myofascial trigger points, pain, disability and quality of sleep in patients with chronic tension-type headache: a pilot study. Rev Neurol 2012,55(4):193–199.PubMed

32.

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(3):315–322. 10.1586/ern.11.138PubMedCrossRef

33.

Lyngberg AC, Rasmussen BK, Jørgensen T, Jensen R: Incidence of primary headache: a Danish epidemiologic follow-up study. Am J Epidemiol 2005,161(11):1066–1073. 10.1093/aje/kwi139PubMedCrossRef

Title: Lidocaine injection of pericranial myofascial trigger points in the treatment of frequent episodic tension-type headache
Authors: Ömer Karadaş
Hakan L Gül
Levent E İnan
Publication date: 01-12-2013
Publisher: Springer Milan
Published in: The Journal of Headache and Pain / Issue 1/2013
Print ISSN: 1129-2369
Electronic ISSN: 1129-2377
DOI: https://doi.org/10.1186/1129-2377-14-44

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Lidocaine injection of pericranial myofascial trigger points in the treatment of frequent episodic tension-type headache

Abstract

Background

Methods

Results

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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