Effects of topical vs injection treatment of cervical myofascial trigger points on headache symptoms in migraine patients: a retrospective analysis

• Published in: Journal of headache and pain Vol. 19; no. 1; p. 104
• Main Authors: Affaitati, Giannapia, Costantini, Raffaele, Tana, Claudio, Lapenna, Domenico, Schiavone, Cosima, Cipollone, Francesco, Giamberardino, Maria Adele
• Format: Journal Article
• Language: English
• Published: Milan Springer Milan 08.11.2018; BMC
• Subjects: Administration, Topical; Adult; Anesthetics, Local - administration & dosage; Bupivacaine injection; Cervical Vertebrae; Electric Stimulation - methods; Female; Follow-Up Studies; Humans; Hyperalgesia; Injections; Internal Medicine; Male; Medicine; Medicine & Public Health; Middle Aged; Migraine; Migraine Disorders - diagnosis; Migraine Disorders - drug therapy; Migraine Disorders - epidemiology; Myofascial Pain Syndromes - diagnosis; Myofascial Pain Syndromes - drug therapy; Myofascial Pain Syndromes - epidemiology; Myofascial trigger points; Neurology; Nimesulide gel; Pain Medicine; Pain Threshold - drug effects; Pain Threshold - physiology; Pain thresholds; Research Article; Retrospective Studies; Treatment Outcome; Trigger Points - physiology; Bupivacaine injection; Pain thresholds; Nimesulide gel; Migraine; Myofascial trigger points; Hyperalgesia
• ISSN: 1129-2369; 1129-2377
• DOI: 10.1186/s10194-018-0934-3

Background In migraine patients with cervical myofascial trigger points whose target areas coincide with migraine sites (M + cTrPs), TrP anesthetic injection reduces migraine symptoms, but the procedure often causes discomfort. This study evaluated if a topical TrP treatment with 3% nimesulide gel has similar efficacy as the injection but produces lesser discomfort with higher acceptability by the patients. Methods Retrospective analysis of medical charts of M + cTrPs patients in the period January 2012–December 2016 at a single Headache Center. Three groups of 25 patients each were included, all receiving migraine prophylaxis (flunarizine 5 mg/day) for 3 months and symptomatic treatment on demand. Group 1 received no TrP treatment, group 2 received TrP injections (bupivacaine 5 mg/ml at basis, 3rd, 10th, 30th and 60th day), group 3 received daily TrP topical treatment with 1.5 g of 3% nimesulide gel for 15 consecutive days, 15 days interruption and again 15 consecutive days. The following were evaluated: monthly number of migraine attacks and rescue medications, migraine intensity; pain thresholds to skin electrical stimulation (EPTs) and muscle pressure stimulation (PPTs) in TrP and target (basis, 30th, 60th and 180th days); discomfort from, acceptability of and willingness to repeat treatment (end of study). ANOVA for repeated measures and 1-way ANOVA were used to assess temporal trends in each group and comparisons among groups, respectively. Significance level was set at p  < 0.05. Results Migraine improved over time in all groups, but significantly more and earlier in those receiving TrP treatment vs no TrP treatment (0.02 <  p  < 0.0001, 30–180 days for intensity and rescue medication, 60–180 days for number). All thresholds in the non-TrP-treated group did not change over time, while significantly improving in both the injection and nimesulide gel groups (0.01 <  p  < 0.0001, 30–180 days). Improvement of migraine and thresholds did not differ in the two TrP-treated groups. Discomfort was significantly lower, acceptability and willingness to repeat treatment significantly higher (0.05 <  p  < 0.0001) with gel than injection. Conclusion In migraine patients, topical treatment of cervical TrPs with 5% nimesulide gel proves equally effective as TrP injection with local anesthetics but more acceptable by the patients. This treatment could be effectively associated to standard migraine prophylaxis to improve therapeutic outcomes.