Pericranial Muscles Research Articles

Alexithymia Increases Pericranial and Cervical Muscle Tenderness in Women with Migraine.

Background/Objectives: Alexithymia is characterized by a deficit in identifying and communicating feelings. Emerging evidence suggests that alexithymia is highly prevalent in migraine, in a complex interplay with psychiatric comorbidity. Pericranial/cervical muscle tenderness is a remarkable clinical feature in a large proportion of migraine patients. This pilot study aimed at investigating the relationship between alexithymia and pericranial/cervical muscle tenderness in female migraineurs. Methods: A total of 42 female patients fulfilling the diagnostic criteria for migraine were enrolled into this pilot, observational, cross-sectional study after informed consent was obtained. Each patient underwent a psychological assessment to identify any alexithymia by means of TAS-20, anxiety/mood comorbidity (by means of STAI-Y1 STAI-Y2, BDI-II), and migraine-related disability (by means of HIT-6), and a physical cranial/cervical musculoskeletal examination. Palpation of pericranial and cervical muscles was carried out in the standardized manner. A Cumulative Muscle Tenderness (CUM) score (0-6) was calculated for each patient. A multivariate analysis was performed to investigate any association amongst the TAS-20 score, the CUM score, and the following covariates: BDI-II, STAI-Y1, STAI-Y2, and HIT-6 scores, age, disease duration, monthly migraine days, and average head pain intensity in the previous three months. Results: Overall, 35.6% of the sample had alexithymia. The multivariate analysis detected a linear and independent relationship between the TAS-20 and CUM scores, with a statistically significant (p = 0.017) association. Conclusions: This pilot study suggests that alexithymia plays a role in increasing pericranial/cervical muscle tenderness in migraine, independently from psychiatric comorbidity. A novel therapeutical approach, targeting alexithymia, may well reduce muscular tenderness in female migraineurs.

Pericranial Muscle Stiffness, Pain Thresholds, and Tenderness during a Treatment Cycle of OnabotulinumtoxinA for Chronic Migraine Prevention

Background: Treatment with OnabotulinumtoxinA (BoNT-A) is effective as a preventive treatment for chronic migraine (CM). Preclinical studies suggest that the mechanism of action of BoNT-A in migraine is based on blocking unmyelinated C fibers. We aimed to investigate whether the muscle-relaxing effect of BoNT-A is associated with the preventive mechanism in patients with chronic migraine by measuring the stiffness, pain thresholds, and tenderness of the BoNT-A-applied muscles. Methods: A total of 22 patients with CM who were already in BoNT-A treatment participated in this longitudinal prospective study. Pericranial muscle stiffness was measured using ultrasound shear wave elastography, which measures the speed of shear waves propagating through the muscle. Pressure pain thresholds (PPT) were obtained via algometry, and muscle tenderness was measured via manual palpation. Measurements were made before BoNT-A injections and six weeks after the treatment. The measurements were performed while the muscles were maximally relaxed. The patients also completed daily diaries on headache and neck pain. Results: No change was observed in muscle stiffness (p = 0.737) or pericranial muscle tenderness (p = 0.400). The PPT over the trapezius muscles increased from 250 kPa before treatment to 304 kPa six weeks after treatment (p = 0.027). No change was observed on the temporalis muscles (p = 0.200) nor the non-dominant index finger (p = 0.067). BoNT-A decreased neck pain (p = 0.008) and headache (p = 0.007). Conclusions: The findings suggest that BoNT-A leads to the desensitization of cutaneous and muscle nociceptors in the head and neck regions, whereas muscle relaxation might not be an important part of the anti-migraine effect.

Патология шейного отдела позвоночника и головная больу пациентов с синдромом дисплазии соединительной ткани

This study aimed at evaluating the role of pathologic changes in the vertebral motor segment (VMS) of the cervical spine in the development of headache in patients with connective tissue dysplasia (CTD). 
 Materials and methods. The study involved 130 patients, aged 18-59, with complaints of headache. 100 patients (76.9 %) had clinical manifestations of CTD (main group). The control group consisted of 30 patients (23.1 %) without CTD manifestations. The presence of CTD was confirmed by phenotyping according to T.I. Kadurina’s tables. The headache nature, frequency, and intensity were analyzed in all patients, and standard neurological examination, manual testing, and neuroimaging studies of all patients were performed.
 In the study presented, it was found that chronic migraine, headache associated with temporomandibular joint dysfunction (TMJD) was more common in the group of patients with CTD. Patients with headache on the background of CTD had pathological changes in the cervical spine in the vast majority of cases. Functional blockade of the VMS of the cervical spine with the formation of myofascial trigger zones in the trapezius and pericranial muscles is detected significantly more often in patients with CTD.
 Thus, it is necessary to take into account the presence of functional disorders in the VMS of the cervical spine when diagnosing and treating headache in patients with CTD.

The relationship between myofascial trigger points sensitivity, cervical postural abnormality, and clinical tension-type headache parameters

ABSTRACT Background Myofascial Trigger Points (MTrPs) play a significant role in the pathogenesis of Tension Type Headache (TTH). Abnormal cranio-cervical posture has been linked to various types of headaches. However, the correlation between MTrPs sensitivity, cervical postural alignment, and clinical measures of headache has not been extensively studied in patients with TTH. Objectives To investigate the relationship between MTrPs sensitivity in cervical and pericranial muscles, cervical postural abnormality, and clinical headache parameters in patients with TTH. Furthermore, to investigate the effect of sex on the examined variables and their association with headache type (episodic vs chronic TTH). Methods A total of 72 patients with TTH of both sexes were enrolled in this study. Headache frequency and disability as clinical measures of headache, pressure pain threshold (PPT) of bilateral upper trapezius (UT) and suboccipital (SUB) muscles, cervical lordosis angle (CA), and anterior head translation (AHT) were measured. Results Pericranial MTrPs sensitivity did not demonstrate any correlation with clinical headache parameters or cervical postural abnormality. However, there was a significant correlation between the frequency of headaches and the level of disability (r = 0.32, P < 0.05). In addition, episodic TTH was more prevalent in females who exhibited greater AHT and MTrPs sensitivity of both bilateral UT and right SUB muscles than males. Conclusions There was no correlation found between the frequency of headaches and the level of disability with measures of cervical posture alignment or MTrPs sensitivity in individuals with TTH.. Based on findings, Clinicians should consider sex differences when assessing patients with TTH.

Структура головных болей у пациентов молодого и среднего возраста с дисплазией соединительной ткани

The purpose — to study the structure of headaches in patients with connective tissue dysplasia (CTD). Material and methods. 100 patients of both sexes aged from 18 to 55 years old with clinical manifestations of CTD and headache were examined. The control group consisted of 30 patients with headache without CTD. Results. Patients with CTD have higher prevalence of chronic migraine, headache associated with temporomandibular joint dysfunction (TMJD). There is a trend towards a higher incidence of cervicogenic headache in combination with TMJD. Also, primary and secondary headaches in patients with CTD were accompanied by predominant blocking of the spinal motion segments of the cervical spine and the upper thoracic spine, against the background of instability and violation of the statics of the cervical spine. Also, a predominant localization of myofascial trigger points in the area of the trapezius and pericranial muscles was found. There is a trend towards higher scores on the central sensitization scale of patients with CTD.

The Application of Botulinum Toxin in the Prophylactic Treatment of Migraine

Abstract Introduction: Migraine is a common disorder that affects about 2% of the general population, with a prevalence of 7% in men, 24% in women and 4% in children. Migraine is the fourth most disabling condition among women and the seventh most disabling worldwide. It is characterized by paroxysmal, throbbing headaches, often unilateral, accompanied by hypersensitivity to noise, light, nausea and vomiting. Migraine is divided into episodic and chronic, with chronic meaning headache for at least 15 days a month for more than 3 months, with 8 migraine days. Treatment includes non-pharmacological and pharmacological methods, but often ineffective and fraught with side effects. Chronic migraine can lead to significant disability. Material and methods: The purpose of this article is to discuss the treatment of migraine with botulinum toxin. Information was collected from the English-language databases Google Scholar, Scopus and PubMed. Results :Onabotulinum toxin A, approved for the treatment of migraine, works by blocking acetylcholine release at the synapse level, leading to reversible flaccid paralysis and blocking neurotransmitters such as CGRP. Injection sites include peri-cranial and neck muscles, allowing the toxin to be transported to the meninges and trigeminal ganglion. In recent years, injections near the cranial sutures have been preferred. BTX-A therapy has shown efficacy in reducing the frequency and severity of migraine pain, with fewer side effects compared to topiramate. Side effects, such as hematoma or ptosis, are rare and their frequency decreases with subsequent sessions. The cost of migraine treatment is high, but botulinum toxin reduces headache days and is cost-effective.

The curative effect of fire needling combined with filiform needling on tension-type headache and its effect on the tenderness of pericranial muscles.

To observe the curative effect of fire needling pricking pericranial tender points combined with filiform needling on tension-type headache (TTH) and its effect on pericranial muscle tenderness, and explore the correlation between changes of headache symptoms and pericranial muscle tenderness in TTH, to analyze the influence of pericranial muscle tenderness on TTH. A total of 41 TTH patients in the treatment group and 38 TTH patients in the control group completed the study. The patients in the treatment group were treated with fire needling at pericranial tender points combined with filiform needling at Baihui (GV20), Sishencong (EX-HN1), Shenting (GV24), Touwei (ST8) and Fengchi (GB20). The patients in the control group were only treated with the same filiform needling as the treatment group. Patients in the two groups were treated twice a week for 8 weeks. Before and after treatment, the days of headache onset, the number and distribution of pericranial muscle tender points were recorded, the degree of headache was evaluated by visual analogue scale and the threshold of pericranial muscle tender points were measured. The correlations between the changes of the days and degree of headache onset and the changes of the number and threshold of pericranial muscle tender points were analyzed. The effective rates in the two groups were calculated. Compared with those before treatment, the days of headache onset and the degree of headache were decreased (P<0.05) in the two groups；the number of pericranial muscle tender points was decreased (P<0.05) and the tenderness threshold was increased (P<0.05) in the treatment group. After treatment, compared with the control group, the days of headache onset, the degree of headache, and the number of pericranial muscle tender points were decreased (P<0.05), and the tenderness threshold was increased (P<0.05) in the treatment group. The decrease of the days and degree of headache was positively correlated with the decrease of number and the increase of tenderness threshold of pericranial muscle tender points (P<0.05). The effective rate in the treatment group was 87.80% (36/41), which was higher than 57.89% (22/38) in the control group (P<0.05). The most common anatomic location of tender points in baseline was superior trapezius muscle, followed by sternocleidomastoid muscle, superior nuchal line, temporal muscle, masseter muscle, etc. The fire needling at the pericranial muscle tender points combined with filiform needling on TTH patients can significantly improve the clinical symptoms and reduce the pericranial muscle tenderness. The pericranial muscle tenderness is an important factor in the pathogenesis of TTH.

Low-Frequency Repetitive Transcranial Magnetic Stimulation for Chronic Tension-Type Headache: A Randomized Controlled Study.

Nearly 1-3% of the population is affected by chronic tension-type headaches (CTTH). However, it is still difficult to treat owing to the lack of knowledge of the disease's pathophysiology. Available literature suggests a role for pericranial muscle activity and abnormal modulation of central pain. Repetitive transcranial magnetic stimulation (rTMS) therapy done at the dorsolateral prefrontal cortex (DLPFC) can help modulate pericranial muscle overactivity and central pain modulation in subjects with CTTH. This randomized controlled study aimed to assess the effect of rTMS used in the low-frequency dorsolateral prefrontal cortex on pain and muscle activity in subjects with a chronic tension-type headache. The present randomized controlled clinical study was commenced in a health care center on 20 subjects with chronic tension-type headaches who were given either sham or low-frequency repetitive transcranial magnetic stimulation at the right dorsolateral prefrontal cortex. The therapy effect was evaluated statistically using Welch's corrected t-test. The study results depicted that daily use of rTMS therapy for two weeks led to a considerable reduction in the intensity of the pain, the activity of pericranial muscles, and headache impact, along with an increase in the nociceptive excitability thresholds in subjects with CTTH, with p=0.001 compared to the sham group. Considering its limitations, the present study depicts that rTMS is an efficacious management tool for reducing pain associated with CTTHand can serve as the cornerstone for additional investigations.

ВОЗМОЖНОСТИ МАНУАЛЬНОЙ ТЕРАПИИ В ЛЕЧЕНИИ ПАЦИЕНТОВ С ХРОНИЧЕСКОЙ ГОЛОВНОЙ БОЛЬЮ НАПРЯЖЕНИЯ

The article presents the research materials of the manual and drug treatment effect on the pericranial muscles in patients with chronic tension-type headache. The study involved 60 patients. Average age was Me 36 (24-50) years. Duration of treatment - 5 weeks. An analysis of the total tenderness score, total bioelecrtric activity of the pericranial muscles before and after the treatment course, was performed. Definitely, the manual treatment leads to a decrease the intensity of headache and bioelectrical activity of the pericranial muscles.

КОМПЛЕКСНЫЙ ПОДХОД К РЕАБИЛИТАЦИИ ПАЦИЕНТОВ С ХРОНИЧЕСКОЙ ГОЛОВНОЙ БОЛЬЮ НАПРЯЖЕНИЯ

The article presents the research materials of the pharmacotherapy and manual treatment in combination with shock wave therapy effect on the pericranial muscles and pain intensity in patients with chronic tension-type headache. The study involved 60 patients. Average age was Me 35 (24-49) years. Duration of treatment - 5 weeks. An analysis of the numeric rating scale, total bioelecrtric activity of the pericranial muscles before and after the treatment course, was performed. Definitely, an integrated approach with the manual treatment and shock wave therapy leads to a decrease the intensity of pain and total bioelectrical activity of the pericranial muscles.

Mechanical sensitivity changes in pericranial muscles after local anesthesia and experimentally induced pain in the temporalis tendon: Implications for headache and facial pain.

To assess changes in mechanical sensitivity of the pericranial muscles in healthy individuals after a local anesthetic block of the temporalis tendon. In addition, to assess, if experimentally induced temporalis tendon pain, can lead to an increase in mechanical sensitivity of the pericranial muscles and reports of headache. 40 healthy participants were recruited for this randomized, double-blinded, controlled experiment, and were randomly injected with mepivacaine and isotonic saline into the dominant-side temporalis tendon in two different sessions, and either nerve growth factor (n = 20) or isotonic saline (n = 20) in a third session. Mechanical sensitivity was assessed in the temporalis, masseter, and trapezius muscles as well as in the temporalis tendon, on the dominant side, before and 10 minutes after each injection, and in a fourth session two days after the third session. Pain drawings and headache diaries were kept for 30 days after the final session to register any developing pain or headache. Mepivacaine injection into the temporalis tendon caused a significant decrease in mechanical sensitivity in the temporal tendon (-54.5%) and the masseter (-15.4%) muscle (P < 0.05) but not the temporalis (-12.1%) and trapezius muscles (-12.7%) (P > 0.05). Nerve growth factor injection into the temporalis tendon caused a significant increase in mechanical sensitivity in the tendon (+15.4%) and masseter muscle (+14.4%) (P < 0.05) but not the temporalis (+2.8%) or trapezius muscles (+3.1%) (P > 0.05). A significant increase was found for headache frequency in the first seven days (P < 0.05) after nerve growth factor injection compared to after isotonic saline injection, but not intensity (P > 0.05). These findings suggest that the therapeutic effect of temporalis tendon anesthetic injections on facial pain and headaches are most likely not only due to a direct effect of the local anesthetic on the temporalis tendon but rather to a more generalized block of the nerves in the area. In addition, the temporal tendon may contribute to the pathophysiological processes of headache.

Possibilities of colecalciferol therapy for tension type headache combined with hypovitaminosis D

Introduction. Modern studies indicate the therapeutic effect of vitamin D (VD) in chronic pain conditions, but there is no data on the use of VD in chronic tension type headache (CTTH) treatment.Objective: comparative evaluation of the effectiveness of various options for preventive treatment of CTTH: the use of colecalciferol, standard therapy of the disease and a combination of these methods.Materials and methods. 125 women with CTTH and hypovitaminosis D were treated in the study. The frequency, duration and intensity of headache (HF, HD and HI, respectively), HIT index, frequency of analgesics taking, pericranial muscle dysfunction were evaluated. The VD level was measured by the concentration of 25-hydroxyvitamin D [25(OH)D]. The patients received differentiated therapy for 16 weeks: group 1 – colecalciferol, group 2 – amitriptyline, group 3 – a combination of these medicines. Results. In group 1, HF, HD, HIT-index and the frequency of analgesics taking decreased, all p ≤ 0.001. In groups 2 and 3, the values of all CTTH-parameters decreased, all p &lt; 0.05. HF, HIT-index and the frequency of analgesics taking in group 3 decreased more than in group 2, all p &gt;&lt; 0.017. In women who had VD deficiency before treatment, the decrease in HF from the initial one was 36% in group 1, 55% in group 2, and 74% in group 3. In patients who had VD deficiency before treatment, the effectiveness of therapy in group 3 was higher than in group 2: 74% vs. 55%, respectively, p &gt;&lt; 0.001.Conclusions. Treatment of hypovitaminosis D in women with CTTH is accompanied by a decrease in HF, the effect of headache on the quality of life of patients and the frequency of taking analgesics. In CTTH and VD deficiency normalization of 25(OH)D level contributes to higher efficiency of standard therapy.

Особенности болевого синдрома у пациентов с эпизодической и хронической головной болью напряжения

Актуальность. Головная боль напряжения (ГБН) — наиболее распространенный в популяции тип головной боли (ГБ). Некоторые исследования показали, что мышечное напряжение значительно возрастает с увеличением частоты ГБН, болезненность мышц может расти во время приступов ГБ. Высказано предположение, что непрерывный ноцицептивный вклад периферических миофасциальных структур может вызвать центральную сенсибилизации и, возможно, хронизацию ГБ. Целью исследования было изучение особенностей болевого синдрома у пациентов с эпизодической и хронической головной болью напряжения. Материалы и методы. Было обследовано 108 пациентов (55 мужчин, 53 женщины) с диагнозами «частая эпизодическая головная боль напряжения» (ЭГБН) (группа I, n = 64) и «хроническая головная боль напряжения» (ХГБН) (группа II, n = 44). Проводилось клинико­неврологическое обследование, пальпация перикраниальных и шейных мышц с обеих сторон с подсчетом числа болезненности перикраниальных мышц (ЧБПМ) и числа болезненности мышц шеи (ЧБМШ) для каждого пациента и их среднее значение в группе. Для оценки субъективной выраженности боли использовался метод визуальной аналоговой шкалы (ВАШ), для качественной характеристики боли — болевой опросник Мак­Гилла. Результаты. Пациенты обследованных групп по интенсивности ГБ по ВАШ существенно не отличались, показатель был в пределах умеренного с тенденцией к более выраженному в группе II. В обеих группах при пальпации перикраниальных и шейных мышц с обеих сторон болезненность при пальпации в основном была в пределах от слабой до умеренной, кроме трапециевидной и ременной мышц головы, где болезненность носила характер от умеренной до выраженной. В группе I по сравнению с группой II выявлено достоверное превышение показателя ЧБПМ и ЧБМШ слева, ЧБПМ справа и не отмечено различий между ЧБМШ групп I и II справа. У пациентов с ЭГБН выраженность мышечной болезненности снижалась с возрастом, были выше показатели, описывающие сенсорные и психоэмоциональные характеристики боли, выявлена положительная корреляционная связь между болезненностью перикраниальных мышц и интенсивностью и частотой ГБ в месяц. У пациентов с ХГБН обнаружены корреляционные связи между интенсивностью, средней продолжительностью ГБ в месяц и сенсорными и психоэмоциональными характеристиками боли, что может свидетельствовать о вовлечении центральных и периферических ноцицептивных механизмов в патогенез хронической ГБН. Выводы. Наличие мышечной болезненности, сенсорные и психоэмоциональные характеристики ГБ необходимо учитывать при планировании лечебных и реабилитационных стратегий, что будет препятствовать прогрессированию и хронизации ГБ и способствовать повышению качества жизни пациентов.

REDUCE trial: the effects of perineural dexamethasone on scalp nerve blocks for relief of postcraniotomy pain\u2014a study protocol for a randomized controlled trial

BackgroundPain is common in the first 2 days after major craniotomy. Inadequate analgesia may lead to an increased risk of postoperative complications. Most pain following craniotomy arises from the pericranial muscles and soft tissues of the scalp. Scalp nerve blocks with local anesthesia seem to provide effective, safe, however, transient postoperative analgesia which does not seem to meet the requirements of craniotomy. Currently, peripheral dexamethasone has been observed to significantly prolong the duration of analgesia of nerve blocks (e.g., saphenous nerve block, adductor canal block, thoracic paravertebral block, brachial plexus nerve block). On the contrary, a study reported that perineural dexamethasone did not appear to prolong the analgesic time after supratentorial craniotomy. However, all patients in this study were given 24 mg of oral or intravenous dexamethasone regularly for at least 7 days during the perioperative period, which possibly masked the role of single local low doses of perineural dexamethasone. Therefore, the analgesic effect of single dexamethasone for scalp nerve blocks without the background of perioperative glucocorticoid deserves further clarification.MethodsThe REDUCE trial is a prospective, single-center, parallel-group randomized controlled trial involving a total of 156 adults scheduled for elective craniotomy with general anesthesia. Patients will be randomly divided among two groups: the control group (n = 78) will receive scalp nerve blocks with 0.5% bupivacaine, plus normal saline with epinephrine at 1:200,000; the DEX4mg group (n = 78) will receive scalp nerve blocks with 0.5% bupivacaine, plus 4 mg dexamethasone with epinephrine at 1:200,000. The primary outcome will be the duration of analgesia, defined as the time between the performance of the block and the first analgesic request.DiscussionThe REDUCE trial aims to further assess the analgesic effect of single dexamethasone as an adjuvant to scalp nerve blocks for relief of postcraniotomy pain without the background of perioperative glucocorticoid.Trial registrationClinicalTrials.govNCT04648358. Registered on November 30, 2020.

Diagnostic value of migraine biomarker — calcitonin-gene-related peptide

Objective — to study the diagnostic significance of the serum level of calcitonin‑gene‑related peptide as a tool for the differential diagnosis of migraine with comorbid neck pain and tension of the pericranial muscles and cervicogenic headache. Methods and subjects. The study included 112 patients (84 women, 28 men) aged from 18 to 58 years. In 77 patients episodic migraine was diagnosed (with a typical aura in 17 and without aura in 60 patients), in 35 patients suffered from cervicalgia with muscle‑tonic syndromes and cervicogenic headache. Among patients with migraine, 42 had concomitant cervicalgia with muscle‑tonic dysfunction. The examined patients were distributed into 3 clinical groups: I — combination of episodic migraine with cervicalgia, II — episodic migraine, III — cervicalgia without migraine. In all patients, pain intensity was assessed using a visual analogue scale, the effect of migraine on daily activity and performance using the MIDAS and HIT‑6 scales, and the Neck Disability Index. The control group for comparing the serum level of CGRP consisted of 30 clinically healthy persons. The serum level of CGRP was determined by enzyme‑linked immunosorbent assay using the sandwich ELISA principle. Results. In the group of patients with a combination of episodic migraine with cervicalgia and cervicogenic headache, compared with the group with isolated migraine, the number of days with headache over the last 3 months was higher (р &lt; 0.001), the influence of headache on daily activity and performance according to the MIDAS scales and HIT‑6 was more significant (both р &lt; 0.001) and the number of combined analgesics used was higher (р &lt; 0.001). Plasma level of CGRP was statistically significantly higher in patients with episodic migraine compared with the group with cervicalgia without migraine (р &lt; 0.05), where it did not differ from the control. The CGRP level was statistically significantly higher in women with migraine compared to men (р &lt; 0.001), but did not differ in patients with migraine with and without aura (р &gt; 0.05). Conclusions. The serum level of calcitonin‑gene‑related peptide is a reliable diagnostic and differential diagnostic laboratory biomarker of episodic migraine. The presence of concomitant cervicalgia in patients with episodic migraine significantly affects the level of CGRP in the blood plasma and the course of the disease (an increase in the number of days with headache, the amount of analgesic use, decreased performance and daily activity).

Clinical observation of warming acupuncture and moxibustion at the temples combined with Deanxit in the treatment of tension headache with anxiety and depression: a retrospective study.

Tension-type headache (TTH), also called muscle contraction headache or neurological headache, is mainly characterized by chronic and persistent bilateral headache in the neck and a severe sense of restraint in the head. This study aims to analyze the effect of warming acupuncture and moxibustion at temples combined with Deanxit on tension headache. A total of 252 patients with anxiety and tension headache were randomly divided into routine group and study group. The study group was treated with Dailixin on the basis of warm acupuncture and moxibustion. The headache score, pericranial muscle tenderness score, therapeutic effect, tension headache attack times and duration, HAMD and HAMA scores were analyzed before and after treatment. The effective cure rate of the study group was significantly higher than that of the routine group. The pericranial muscle tenderness scores of the study group were significantly lower than those of the routine group. Furthermore, the headache degree score, number of attacks, and duration of the study group after treatment were significantly lower than those of the routine group. And the HAMD and HAMA scores in the study group was significantly lower than those in the routine group. The use of warming acupuncture and moxibustion at temples combined with Deanxit in the treatment of tension headache significantly reduces the number and duration of headache attacks and decreases the degree of headache.

Cerebrospinal Fluid Leaks and Pseudomeningocele after Posterior Fossa Surgery: Effect of an Autospray Dural Sealant.

BackgroundPosterior fossa craniotomies can be complicated by cerebrospinal fluid (CSF) leaks, infection, meningitis, neurologic deficits, and intracranial hypotension caused by defective closure of the dura. Secondary dural closures such as pericranial graft, muscle graft, glue, sealants, or fat graft are used. However, there have been few studies examining the use of sealants with a polyethylene glycol and polyethylenimine component.ObjectiveWe studied the effect of one such sealant, Adherus® (HyperBranch Medical Technology, Durham, NC, USA), as an adjunct to secondary closure methods in the reduction of the use of abdominal fat grafting and lumbar puncture/drains.MethodsWe retrospectively reviewed the surgical records of all patients undergoing posterior fossa cranial surgery during a two-year period at a tertiary university affiliated medical center.ResultsOverall, data a total of 122 patients (62 in the no Adherus and 60 in the Adherus group) were collected. There was no statistically significant difference in the 30-day incisional CSF leak rate (4.1% vs. 6.5%; p=0.183), 30-day non-incisional CSF leak rate (11.3% vs. 5.0%; p=0.205), and 30-day pseudomeningocele rate (16.1% vs. 13.3%; p=0.663) in the no Adherus and Adherus groups, respectively. However, there was a significant reduction in the use of abdominal fat grafting (0% vs. 30.7%; p<0.001) and intraoperative CSF diversion techniques (58.1% vs. 23.3%; p<0.001). Every instance of the use of Adherus saved on average, $809.36.ConclusionsA statistically significant reduction in the use of CSF shunting procedures during posterior fossa craniotomy/craniectomy was achieved after the introduction of Adherus with no increase in CSF leak rate.

Standard Correction of Vision Worsens EMG Activity of Pericranial Muscles in Chronic TMD Subjects

Recent studies showed an evident correlation between the stomatognathic system and the visual system. These results suggest that subjects who are affected by both temporomandibular (TMD) disorders and refractive disorders present with altered control of pericranial musculature tone and higher open-eye electromyographic (EMG) values. The objective of this work was to evaluate the effects of standard vision correction on EMG in subjects suffering from TMD compared with application of the same vision treatments to non-TMD subjects. 40 subjects were enrolled in this study. The test group included 20 myopic subjects and also included patients with TMD. The control group included 20 healthy myopic subjects. All of the participants underwent a complete ocular examination and a sEMG analysis. The results showed that TMD subjects with vision disorders that are corrected with standard glasses present EMG values that are significantly higher than those presented by non-TMD subjects with vision disorders and standard glasses. Infact, in TMD subjects, eye correction did not have a positive effect on the stomatognathic or pericranial musculature.

Hypovitaminosis D effect on pericranial muscle dysfunction in women with chronic tension headache

Background. Nowadays there are a large number of studies revealing the significance of hypovitaminosis D in chronic pain conditions and diseases, in which musculoskeletal factors are dominant in the formation of pain. In chronic tension type headache (CTTH) pathogenesis the role of muscular factor is well-established. However there is insufficient data regarding the interrelations between hypovitaminosis D, headache and pericraial muscle dysfunction (PMD) in CTTH.Objective. To investigate the effect of vitamin D level on PMD and cephalgia parameters in CTTH.Methods. One hundred twenty women with CTTH aged 25 to 55 years were enrolled. Evaluated parameters were the following: pericranial muscle tenderness (PMT), headache frequency (HF), headache duration (HD), headache intensity (HI). Vitamin D level measured by 25-hydroxyvitamin D [25(OH)D] of serum blood samples.Results. Number of CTTH with DPM cases in the group of vitamin D deficiency (serum level of 25(OH)D less than 20 ng/mL) was equal to one in normal vitamin group (higher than 30 ng/mL), p &gt; 0.05. Greater degree of DPM was identified in vitamin D deficiency than in normal level: total PMT score 5.0 vs 3.0 score (р &lt; 0.001). At the same time significant difference was observed in cephalgia parameters between groups of deficiency and normal vitamin D level: HF 28.0 and 23.0 days per month (р &lt; 0.001), HD 14.5 and 10.0 hours per day respectively. Also daily headache was associated with vitamin D deficiency with a risk ratio 4.4 (95 % CI: 1.4–14,0) as compared to the normal level. Middle-power negative correlation was noted between serum vitamin D levels and total PMT score (Spearman’s r = –0.55; р &lt; 0,001), HF (r = –0.65; р &lt; 0,001) and HD (r = 0.67; р &lt; 0,001).Conclusion. Vitamin D deficiency leads to increased degree of pericraial muscle dysfunction in CTTH women. That may result in rising central sensitization and finally be a reason of more severe headache.

The Effectiveness of Complex Non-Pharmacological Treatment in Patients with Episodic Migraine and Neck Pain

Introduction: Comorbidities and co-occurring conditions contribute to the overall burden of migraine. Treatment co-occurring condition is an important part in providing optimal care. Aim: To investigate the effectiveness of complex non-pharmacological treatment and impact it on daily activities and concomitant anxiety and depression in patients with episodic migraine and co-occurring neck pain. Materials and Methods: We evaluated 56 patients with episodic migraine (with aura 18 and 38 without aura) and co-existing neck pain, 21 men, 35 women, age from 18 to 55 years. Examination including radiography of the cervical spine, visual analogue scale for the pain, “HIT-6”, Beck Depression Inventory and Spilberger-Hanin’s anxiety scale. The Kolmogorov-Smirnov test was used to compare the data. Results: Patients were divided into two treatment groups: the first group of patients 28 patients received only the specified complex of manual therapy, second group - 28 patients underwent a set of manual therapy and acupuncture. After treatment in first group observed decrease of frequency and severity of migraine attacks and a reduce number of days with a headache, but level of anxiety and depressive manifestations less decreased. In second group was more significant reduce the intensity, duration and frequency of migraine, more significant dynamics of anxiety disorders and general well-being. Conclusions: Non-pharmacological treatment neck-pain syndrome in patients with episodic migraine not only to be effective in symptomatic control of pericranial muscles tension but influence on decrease of frequency and severity migraine attacks. Adding acupuncture to manual techniques more significant reduce pain syndrome and psychological disorders that possible lead to reduce drug intake.