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Open Access 01-12-2019 | Magnetic Resonance Imaging | Research article

Quantitative magnetic resonance imaging of the upper trapezius muscles – assessment of myofascial trigger points in patients with migraine

Authors: Nico Sollmann, Nina Mathonia, Dominik Weidlich, Michaela Bonfert, Sebastian A. Schroeder, Katharina A. Badura, Tabea Renner, Florian Trepte-Freisleder, Carl Ganter, Sandro M. Krieg, Claus Zimmer, Ernst J. Rummeny, Dimitrios C. Karampinos, Thomas Baum, Mirjam N. Landgraf, Florian Heinen

Published in: The Journal of Headache and Pain | Issue 1/2019

Abstract

Background

Research in migraine points towards central-peripheral complexity with a widespread pattern of structures involved. Migraine-associated neck and shoulder muscle pain has clinically been conceptualized as myofascial trigger points (mTrPs). However, concepts remain controversial, and the identification of mTrPs is mostly restricted to manual palpation in clinical routine. This study investigates a more objective, quantitative assessment of mTrPs by means of magnetic resonance imaging (MRI) with T2 mapping.

Methods

Ten subjects (nine females, 25.6 ± 5.2 years) with a diagnosis of migraine according to ICHD-3 underwent bilateral manual palpation of the upper trapezius muscles to localize mTrPs. Capsules were attached to the skin adjacent to the palpated mTrPs for marking. MRI of the neck and shoulder region was performed at 3 T, including a T2-prepared, three-dimensional (3D) turbo spin echo (TSE) sequence. The T2-prepared 3D TSE sequence was used to generate T2 maps, followed by manual placement of regions of interest (ROIs) covering the trapezius muscles of both sides and signal alterations attributable to mTrPs.

Results

The trapezius muscles showed an average T2 value of 27.7 ± 1.4 ms for the right and an average T2 value of 28.7 ± 1.0 ms for the left side (p = 0.1055). Concerning signal alterations in T2 maps attributed to mTrPs, nine values were obtained for the right (32.3 ± 2.5 ms) and left side (33.0 ± 1.5 ms), respectively (p = 0.0781). When comparing the T2 values of the trapezius muscles to the T2 values extracted from the signal alterations attributed to the mTrPs of the ipsilateral side, we observed a statistically significant difference (p = 0.0039). T2 hyperintensities according to visual image inspection were only reported in four subjects for the right and in two subjects for the left side.

Conclusions

Our approach enables the identification of mTrPs and their quantification in terms of T2 mapping even in the absence of qualitative signal alterations. Thus, it (1) might potentially challenge the current gold-standard method of physical examination of mTrPs, (2) could allow for more targeted and objectively verifiable interventions, and (3) could add valuable models to understand better central-peripheral mechanisms in migraine.

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Title: Quantitative magnetic resonance imaging of the upper trapezius muscles – assessment of myofascial trigger points in patients with migraine
Authors: Nico Sollmann
Nina Mathonia
Dominik Weidlich
Michaela Bonfert
Sebastian A. Schroeder
Katharina A. Badura
Tabea Renner
Florian Trepte-Freisleder
Carl Ganter
Sandro M. Krieg
Claus Zimmer
Ernst J. Rummeny
Dimitrios C. Karampinos
Thomas Baum
Mirjam N. Landgraf
Florian Heinen
Publication date: 01-12-2019
Publisher: Springer Milan
Keywords: Magnetic Resonance Imaging
Magnetic Resonance Imaging
Migraine
Published in: The Journal of Headache and Pain / Issue 1/2019
Print ISSN: 1129-2369
Electronic ISSN: 1129-2377
DOI: https://doi.org/10.1186/s10194-019-0960-9

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Springer Medicine

Quantitative magnetic resonance imaging of the upper trapezius muscles – assessment of myofascial trigger points in patients with migraine

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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