Abstract
Active myofascial trigger points (MTrPs) have been found to contribute to chronic tension-type headache and migraine. The purpose of this case series was to examine if active trigger points (TrPs) provoking cluster-type referred pain could be found in cluster headache patients and, if so, to evaluate the effectiveness of active TrPs anaesthetic injections both in the acute and preventive headache's treatment. Twelve patients, 4 experiencing episodic and 8 chronic cluster headache, were studied. TrPs were found in all of them. Abortive infiltrations could be done in 2 episodic and 4 chronic patients, and preemptive infiltrations could be done in 2 episodic and 5 chronic patients, both kind of interventions being successful in 5 (83.3%) and in 6 (85.7%) of the cases respectively. When combined with prophylactic drug therapy, injections were associated with significant improvement in 7 of the 8 chronic cluster patients. Our data suggest that peripheral sensitization may play a role in cluster headache pathophysiology and that first neuron afferent blockade can be useful in cluster headache management.
Highlights
Many advances have been made concerning the pathophysiology of cluster headache, the process is still only partially understood [1]
Active myofascial trigger points (MTrPs) whose pressure provoked referred pain reproducing the typical patient's headache, have been described both in chronic tension type headache [7] and in migraine [8], indicating that peripheral sensitization may play a role in the pathophysiology of headache
The use of anaesthetic injections associated to prophylactic drug treatment in the eight chronic cluster headache patients, was shown to reduce attacks' frequency in at least 50% from their baseline status, in 7 (88%) of them and, in most of the cases, the severity of the attacks, as well as their usual duration, were decreased
Summary
Many advances have been made concerning the pathophysiology of cluster headache, the process is still only partially understood [1]. In 9 (75%) patients the location of active TrPs was consistent with pain laterality; in three cases, this correlation failed: two patients suffering right side cluster headache had bilateral active TrPs and one patient with bilateral alternating cluster attacks had active TrPs located exclusively on the left side As it is shown, in 6 patients we could perform an anaesthetic injection just at the beginning of the attack and in 5 (85%) of them the cluster was aborted in a period of time which varied from patient to patient but never exceeded 15 minutes in the most refractory cases. The use of anaesthetic injections associated to prophylactic drug treatment in the eight chronic cluster headache patients, was shown to reduce attacks' frequency in at least 50% from their baseline status, in 7 (88%) of them and, in most of the cases, the severity of the attacks, as well as their usual duration, were decreased. Pain at injection site was reported by one patient, and rebound headache following injection was reported by four patients
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