Four articles on PainSci cite Do 2018: 1. Massage Therapy for Tension Headaches 2. The Complete Guide to Trigger Points & Myofascial Pain 3. The Complete Guide to Chronic Tension Headaches 4. The Complete Guide to Neck Pain & Cricks
PainSci commentary on Do 2018: ?This page is one of thousands in the PainScience.com bibliography. It is not a general article: it is focused on a single scientific paper, and it may provide only just enough context for the summary to make sense. Links to other papers and more general information are provided wherever possible.
There is extensive evidence that people who get headaches — both migraine and “tension” — also have a lot of trigger points in the musculature of the head and neck. Unfortunately, we still have no idea which came first, the chicken or the egg: headaches might be causing trigger points, or trigger points might be causing headache. There is evidence pointing each direction, and of course all of it is generally low quality. However, the simple correlation is relatively unambiguous. We know that much at least.
Although the authors of this review are likely somewhat biased — “believers” in the clinical significance of trigger points, and interpreting the evidence through that lens — their conclusions are appropriately cautious, acknowledging the limitations of the evidence.
~ Paul Ingraham
original abstract †Abstracts here may not perfectly match originals, for a variety of technical and practical reasons. Some abstacts are truncated for my purposes here, if they are particularly long-winded and unhelpful. I occasionally add clarifying notes. And I make some minor corrections.
BACKGROUND: A myofascial trigger point is defined as a hyperirritable spot in skeletal muscle that is associated with a hypersensitive palpable nodule in a taut band. It has been suggested that myofascial trigger points take part in chronic pain conditions including primary headache disorders. The aim of this narrative review is to present an overview of the current imaging modalities used for the detection of myofascial trigger points and to review studies of myofascial trigger points in migraine and tension-type headache.
FINDINGS: Different modalities have been used to assess myofascial trigger points including ultrasound, microdialysis, electromyography, infrared thermography, and magnetic resonance imaging. Ultrasound is the most promising of these modalities and may be used to identify MTrPs if specific methods are used, but there is no precise description of a gold standard using these techniques, and they have yet to be evaluated in headache patients. Active myofascial trigger points are prevalent in migraine patients. Manual palpation can trigger migraine attacks. All intervention studies aiming at trigger points are positive, but this needs to be further verified in placebo-controlled environments. These findings may imply a causal bottom-up association, but studies of migraine patients with comorbid fibromyalgia syndrome suggest otherwise. Whether myofascial trigger points contribute to an increased migraine burden in terms of frequency and intensity is unclear. Active myofascial trigger points are prevalent in tension-type headache coherent with the hypothesis that peripheral mechanisms are involved in the pathophysiology of this headache disorder. Active myofascial trigger points in pericranial muscles in tension-type headache patients are correlated with generalized lower pain pressure thresholds indicating they may contribute to a central sensitization. However, the number of active myofascial trigger points is higher in adults compared with adolescents regardless of no significant association with headache parameters. This suggests myofascial trigger points are accumulated over time as a consequence of TTH rather than contributing to the pathophysiology.
- “Myofascial trigger points in subjects presenting with mechanical neck pain: A blinded, controlled study,” C Fernández-de-Las-Peñas, C Alonso-Blanco, and JC Miangolarra, Manual Therapy, 2007.
- “Myofascial trigger points and their relationship to headache clinical parameters in chronic tension-type headache,” César Fernández-de-Las-Peñas, Cristina Alonso-Blanco, Maria Luz Cuadrado, Robert D Gerwin, and Juan A Pareja, Headache, 2006.
- “Myofascial trigger points in cluster headache patients: a case series,” Elena P Calandre, Javier Hidalgo, Juan M Garcia-Leiva, Fernando Rico-Villademoros, and Antonia Delgado-Rodriguez, Head & Face Medicine, 2008.
This page is part of the PainScience BIBLIOGRAPHY, which contains plain language summaries of thousands of scientific papers & others sources. It’s like a highly specialized blog. A few highlights:
- No long-term effects after a three-week open-label placebo treatment for chronic low back pain: a three-year follow-up of a randomized controlled trial. Kleine-Borgmann 2022 Pain.
- Exercise and education versus saline injections for knee osteoarthritis: a randomised controlled equivalence trial. Bandak 2022 Ann Rheum Dis.
- Association of Lumbar MRI Findings with Current and Future Back Pain in a Population-based Cohort Study. Kasch 2022 Spine (Phila Pa 1976).
- A double-blinded randomised controlled study of the value of sequential intravenous and oral magnesium therapy in patients with chronic low back pain with a neuropathic component. Yousef 2013 Anaesthesia.
- Is Neck Posture Subgroup in Late Adolescence a Risk Factor for Persistent Neck Pain in Young Adults? A Prospective Study. Richards 2021 Phys Ther.