Abstract
BackgroundResearch in migraine points towards central-peripheral complexity with a widespread pattern of structures involved. Migraine-associated neck and shoulder muscle pain has clinically been conceptualized as myofascial trigger points (mTrPs). However, concepts remain controversial, and the identification of mTrPs is mostly restricted to manual palpation in clinical routine. This study investigates a more objective, quantitative assessment of mTrPs by means of magnetic resonance imaging (MRI) with T2 mapping.MethodsTen subjects (nine females, 25.6 ± 5.2 years) with a diagnosis of migraine according to ICHD-3 underwent bilateral manual palpation of the upper trapezius muscles to localize mTrPs. Capsules were attached to the skin adjacent to the palpated mTrPs for marking. MRI of the neck and shoulder region was performed at 3 T, including a T2-prepared, three-dimensional (3D) turbo spin echo (TSE) sequence. The T2-prepared 3D TSE sequence was used to generate T2 maps, followed by manual placement of regions of interest (ROIs) covering the trapezius muscles of both sides and signal alterations attributable to mTrPs.ResultsThe trapezius muscles showed an average T2 value of 27.7 ± 1.4 ms for the right and an average T2 value of 28.7 ± 1.0 ms for the left side (p = 0.1055). Concerning signal alterations in T2 maps attributed to mTrPs, nine values were obtained for the right (32.3 ± 2.5 ms) and left side (33.0 ± 1.5 ms), respectively (p = 0.0781). When comparing the T2 values of the trapezius muscles to the T2 values extracted from the signal alterations attributed to the mTrPs of the ipsilateral side, we observed a statistically significant difference (p = 0.0039). T2 hyperintensities according to visual image inspection were only reported in four subjects for the right and in two subjects for the left side.ConclusionsOur approach enables the identification of mTrPs and their quantification in terms of T2 mapping even in the absence of qualitative signal alterations. Thus, it (1) might potentially challenge the current gold-standard method of physical examination of mTrPs, (2) could allow for more targeted and objectively verifiable interventions, and (3) could add valuable models to understand better central-peripheral mechanisms in migraine.
Highlights
Research in migraine points towards central-peripheral complexity with a widespread pattern of structures involved
Cohort characteristics and physical examination We included ten right-handed subjects, all diagnosed with migraine according to ICHD-3, who reported on migraine since 13.0 ± 9.1 years on average
A clear Myofascial trigger point (mTrP) was detected in nine subjects within the right-sided trapezius muscle, whereas seven subjects showed a mTrP in the left-sided trapezius
Summary
Research in migraine points towards central-peripheral complexity with a widespread pattern of structures involved. Research on the development and maintenance of primary headache increasingly points towards a widespread pattern including structures beyond the central nervous system, with neck and shoulder muscle pain, clinically often represented by the presence of myofascial trigger points (mTrPs), getting in the focus [5, 6, 9, 10]. Such mTrPs are regarded as hyperirritable spots associated with a taut band of skeletal muscle, reacting painful on compression or stretch, and leading to typical referred pain patterns [5,6,7,8]. Manual palpation is limited due to missing objective verifications, making controlled studies difficult or even impossible
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