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Sunday, April 3, 2011

HEADACHES AND MYOFASCIAL TRIGGER POINTS: HIGH POWER ULTRASOUND VS TRIGGER POINT INJECTIONS EQUIVILANT FOR TRAPEZIUS MUSCLE TPs

I have found that trigger point injections are extremely effective in reducing tension-type headaches and frequently can completely eliminate them when combined with a neuromuscular orthotic. This current study from the Archives of Physical Medicine and Rehabilitation shows high-power ultrasound as effective as trigger point injections in treating the Trapezius muscle.

The Trapezius muscle is a large easily treated muscle that can cause referred headache pain. Trigger point injections took less therapy sessions but there was equal effectiveness to both treatments. When treating headaches many of the muscles that cause tension-type headaches are not good candidates for high-power ultrasound. Treating headaches without medication usually requires elimination of muscle trigger points. Neuromuscular Dentistry uses Ultra-Low Frequency TENS to eliminate the underlying cause of Trigger Points and headaches. Trigger Point injections and and Spray and Stretch as described by Travell and Simons is extremely effective in eliminating and preventing re-occurence of trigger points that cause tension-type headaches.

This new study (see abstract below) shows that high-power ultrasound was as effective as trigger point injections when treating trapezius pain and reduction in motion. Treatment of headaches is usually much more effective with trigger point injections. Ultrasound is of little use in treating medial and lateral pterygoid muscles, TMJ oints, Temporalis Muscles, and supra and ifra hyoid muscles.

Tension-Type headaches and Myofascial trigger points are frequently triggers for Migraines.

The use of a diagnostic neuromuscular orthotic is a safe and effective method to evaluate patient's response to Neuromuscular Dentistry. I sometimes consider utilizing trigger point injections, spray and stretch techniques, SPG blocks and other treatment modalities as cheating. Neuromuscular dentistry is such a powerful tool but utilizing these other procedures can drastically enhance the therapeutic effect.


Arch Phys Med Rehabil. 2011 Apr;92(4):657-62.
Comparison of high-power pain threshold ultrasound therapy with local injection in the treatment of active myofascial trigger points of the upper trapezius muscle.
Unalan H, Majlesi J, Aydin FY, Palamar D.

Department of Physical Medicine and Rehabilitation, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey.
Abstract
Unalan H, Majlesi J, Aydin FY, Palamar D. Comparison of high-power pain threshold ultrasound therapy with local ınjection in the treatment of active myofascial trigger points of the upper trapezius muscle.

OBJECTIVE: To compare the effects of high-power pain threshold ultrasound (HPPTUS) therapy and local anesthetic injection on pain and active cervical lateral bending in patients with active myofascial trigger points (MTrPs) of the upper trapezius muscle.

DESIGN: Randomized single-blinded controlled trial.

SETTING: Physical medicine and rehabilitation department of university hospital.

PARTICIPANTS: Subjects (N=49) who had active MTrPs of the upper trapezius muscle.

INTERVENTIONS: HPPTUS or trigger point injection (TrP).

MAIN OUTCOME MEASURES: Visual analog scale, range of motion (ROM) of the cervical spine, and total length of treatments.

RESULTS: All patients in both groups improved significantly in terms of pain and ROM, but there was no statistically significant difference between groups. Mean numbers of therapy sessions were 1 and 1.5 in the local injection and HPPTUS groups, respectively.

CONCLUSIONS: We failed to show differences between the HPPTUS technique and TrP injection in the treatment of active MTrPs of the upper trapezius muscle. The HPPTUS technique can be used as an effective alternative to TrP injection in the treatment of myofascial pain syndrome.

Copyright © 2011 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.
PMID: 21440713 [PubMed - in process]

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posted by Dr Shapira at 9:39 AM

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