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Jose G. Veliz, M.D. M.S.A.
Medical Director
Palomar Pain Management Center
Pomerado Pain Management Center

Posted April 3, 2009 11:40 AM

Italian investigators have found that migraine symptoms can be reduced with injection of a local anesthetic into myofascial trigger points in the cervical spine (neck).

Trigger points are focal, hyperirritable spots located in a tight band of skeletal muscle.  They may produce pain locally or may cause referred pain at a distant site.  They may occur with acute musculoskeletal trauma, but are more often seen with chronic musculoskeletal disorders.  Trigger points may form when muscle fibers are stressed from acute trauma or repetitive overuse trauma.  In addition, pain and decreased range of motion in the affected muscles may occur.  Abnormal body posture may occur if muscles in the neck, shoulders and pelvic girdle are affected. 

Trigger points may also lead to tinnitus (ringing of the ears), temporomandibular joint pain, tension headaches, low back pain and decreased range of motion in the legs.  Trigger points are nodules of muscle fiber which are harder than normal consistency.  When pressure is placed directly over the trigger point, pain may occur in close proximity or radiate to a further removed location.  Trigger points may be treated with ultrasound, manipulative therapy, Spray and Stretch, and with trigger point injections.

Italian researchers from “G. D’Annuncio” University performed trigger point injections with local anesthetic, in the cervical spine (neck).  The number of migraine attacks was decreased in patients who received trigger point injections in the cervical spine with local anesthetic.  In addition, their medication requirements were also lessened during the treatment period.  The significance of the findings is that trigger point injections may reduce the frequency of use of migraine drugs.  This is important because many headaches are actually caused by medication overuse.  Medication overuse headaches are difficult to treat.

References:

J. Pain 2007; 8: 869-878.
Alvarez DJ, Rockwell PG, et al.  Trigger Point: Diagnosis and Management.  American Family Physician 2002; Volume 65, Number 4; 653-660.