Tension-Type Headaches are extremely common affecting the majority of the public at some time during their lifetime. It is commonly associated with Stress or more accurately how patients react to stressful periods.
The objective was to evaluate a supposed clinical interdependency of myofascial trigger points and migraine in children. Such interdependency would support an interaction of spinal and trigeminal afferences in the trigemino-cervical complex as a contributing factor in migraine.
Children ≤18 years with the confirmed diagnosis of migraine were prospectively investigated. Comprehensive data on medical history, clinical neurological and psychological status were gathered. Trigger points in the trapezius muscle were identified by palpation and the threshold of pressure pain at these points was measured. Manual pressure was applied to the trigger points, and the occurrence and duration of induced headache were recorded. At a second consultation (4 weeks after the first), manual pressure with the detected pressure threshold was applied to non-trigger points within the same trapezius muscle (control). Headache and related parameters were again recorded and compared to the results of the first consultation.
A total of 13 girls and 13 boys with migraine and a median age of 14.5 (Range 6.3-17.8) years took part in the study. Manual pressure to trigger points in the trapezius muscle led to lasting headache after termination of the manual pressure in 13 patients while no patient experienced headache when manual pressure was applied to non-trigger points at the control visit (p < 0.001). Headache was induced significantly more often in children ≥12 years and those with internalizing behavioural disorder.
We found an association between trapezius muscle myofascial trigger points and migraine, which might underline the concept of the trigemino-cervical complex, especially in adolescents.
In children with migraine headache can often be induced by pressure to myofascial trigger points, but not by pressure to non-trigger points in the trapezius muscle. This supports the hypothesis of a trigemino-cervical-complex in the pathophysiology of migraine, which might have implications for innovative therapies in children with migraine.
There is often considerable cross over between Tension-Type headaches and Medication Overuse Headache.
Tension-Type Headaches can be mild, moderate or severe to very severe and frequently patients refer to them as "my Migraine". Migraine in Children are often misdiagnosed Tension Type Headaches associated with Myofascial Trigger Points. Because Migraine pathogenesis is also not well understood there is a great deal of crossover diagnosis.
This recent study; Eur J Pain. 2018 Feb;22(2):385-392. doi: 10.1002/ejp.1127. Epub 2017 Sep 26. "CHILDREN WITH MIGRAINE: PROVOCATION VIA PRESSURE TO MYOFASCIAL TRIGGER POINTS IN THE TRAPZIUS MUSCLE?" is an excellent example of research which confuses or fails to clarify migraine and tension-type headaches. The article is excellent looking at headaches from triggerpoints in the Trapezius muscle. (abstract below at ent of post)
To understand Tension-Type Headaches I believe it is extremely important to understand and know all of the referral patterns identifies in MPD or Myofascial Pain. Any physician or dentist is compromised in their quality of care without this knowledge and is likely to prescribe excessive or inappropriate medications.
I believe it is impossible to make a proper diagnosis in many patients until both active and latent trigger points have been identified and managed. This is an essential step in the differential diagnosis and should be completed prior to medication prescriptions for triptans and other medications.
The website www.TriggerPoints.net is an excellent resource for patients and physicians dealing with Tension-Type Headaches and Migraines. It is taken from the testbook "Myofascial Pain and Dysfunction: A Trigger Point Manual"
I recommend that my patients buy this book to better understand their pain patterns, how they can prevent myofascial trigger points from forming and how they can improve the pain from these trigger points.
The precise mechanisms of Tension-type headaches are not well understood. There are many discussions that differentiate central and peripheral mechanisms.
The first known fact about Tension Headaches (and Migraines) is that they are primarily disorders of the Trigeminal Nervous System and the Trigeminal Vascular System.
There is also no question that the autonomic nervous system plays an enormous role especially the Sympathetic nervous system and the balance between the sympathetic and parasympathetic nervous system.
Chronic Tension Type Headaches are a serious condition that can severely decrease quality of life and cause considerable disability.
All patients with Tension-Type headaches of a severe or chronic nature should have the effects of the autonomic nervous system evaluated as part of the diagnostic work-up with a minimally invasive Diagnostic Sphenopalatine (Pterygopalatine) Ganglion Block. https://www.sphenopalatineganglionblocks.com/managing-chronic-headaches-spg-block-sphenopalatine-ganglion-block/
The use of self-administered Sphenopalatine Ganglion (SPG) Blocks can often have almost immediate relief of even severe pain and sometimes spontaneous remission of the underlying headache with repeated use.
These blocks reset the autonomic nervous system and help with stress response (sympathetic) turning off "Fight or Flight Reflex" and turn on the Parasympathetic Reflex ie "Feed and Breed or Eat and Digest Reflex"
There is an incredible histor of pain relief including a 1930 scientific article by Hiram Byrd on "Sphenopalatine Phenomena" and a 1986 popular book "Miracles on Park Avenue" documenting the practice of Dr Milton Reder who exclusively utilized SPG Blocks to treat patients varied types of pain.
Dr Ho published an extensive review Sphenopalatine Ganglion Blocks and Modulation in a 2017 paper. https://www.sphenopalatineganglionblocks.com/sphenopalatine-ganglion-block-radiofrequency-ablation-neurostimulation-systematic-review/
The concept of Neuromodulation is extremely important because it helps explain the amazing successes of neuromuscular dentistry in treating and eliminating headaches and migraines. A basic concept in Neuromuscular Dentistry is utilizing the Myomonitor to relax muslces inervated by Trigeminal and facial nerves to find neuromuscular rest and occlusion which serves to give a healthy reset to the trigeminal nervous system as a patient functions and swallows.
The Myomonitor also acts as a Neuromodulation device of the Sphenopalatine Ganglion. There is an incredible 50 year safety record of Sphenopalatine Stimulation with the Myomonitor when used by Neuromuscular Dentists.
Understanding how these processes work is important. It is also important to hear patients stories. This is a link to over 100 patient videos who have been treated with Neuromuscular Dentistry and SPG Blocks for Tension-Type Headaches, Migraines, TMJ disorders, Myofascial Pain and referred headaches and related sleep disorders.
https://www.youtube.com/channel/UCk9Bfz6pklC7_UluWFHzLrg/videos
PubMed Abstract
Eur J Pain. 2018 Feb;22(2):385-392. doi: 10.1002/ejp.1127. Epub 2017 Sep 26.
Children with migraine: Provocation of headache via pressure to myofascialtrigger points in the trapezius muscle? - A prospective controlled observational study.
Landgraf MN1,2, Biebl JT1,2, Langhagen T1,2, Hannibal I1,2, Eggert T2,3, Vill K1, Gerstl L1, Albers L4, von Kries R4, Straube A2,3, Heinen F1,2.
Abstract
BACKGROUND:
METHODS:
RESULTS:
CONCLUSION:
SIGNIFICANCE:
© 2017 European Pain Federation - EFIC®.
