Fernández-de-Las-Peñas César, Cuadrado Maria Luz, Gerwin Robert D, Pareja Juan A
Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation of Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain.
Clin J Pain. 2006 Jul-Aug;22(6):548-53. doi: 10.1097/01.ajp.0000210697.53874.cb.
Some patients with trochlear disorders have been found to suffer from concurrent migraine. However, a trochlear examination is not systematically done in patients with migraine. Moreover, a search for myofascial trigger points in the superior oblique muscle has never been reported in these patients.
The trochlear region was examined in 20 participants with strictly unilateral migraine without side-shift and in 20 controls. Referred pain elicited by different maneuvers during manual palpation (ie, maintained pressure, active muscle contraction, and stretching of the superior oblique muscle) was assessed with a visual analog scale. All participants were headache free on the day of evaluation.
Sixteen participants with migraine (80%) perceived referred pain on examination of the trochlear area. It was described as a tightening sensation in the retro-orbital region, sometimes extending to the supraorbital region and the homolateral forehead. In 15 participants with migraine, both the active contraction and the stretching of the muscle increased the referred pain, which was consistent with definite myofascial trigger points. All the definite trigger points were ipsilateral to the side of the headache. Conversely, only 5 controls (20%) had referred pain. None of them had definite myofascial trigger points because muscle stretching did not increase the intensity of pain. The intensity of referred pain at each stage of the trochlear examination was greater in subjects with migraine than in controls (P<0.001).
Patients with unilateral migraine commonly perceive referred pain from the trochlear area that probably comes from the myofascial trigger points. Myofascial disorders in the trochlear region might contribute to the perpetuation of concomitant migraine.
已发现一些患有滑车紊乱的患者同时患有偏头痛。然而，偏头痛患者并未系统地进行滑车检查。此外，从未有报道对这些患者的上斜肌肌筋膜触发点进行检查。
对20名严格单侧偏头痛且无侧移的参与者和20名对照者进行滑车区域检查。在手法触诊期间（即持续按压、主动肌肉收缩和上斜肌拉伸）通过视觉模拟量表评估不同动作引发的牵涉痛。所有参与者在评估当天均无头痛。
16名偏头痛参与者（80%）在滑车区域检查时感觉到牵涉痛。其被描述为眶后区域的紧绷感，有时延伸至眶上区域和同侧前额。在15名偏头痛参与者中，肌肉的主动收缩和拉伸均增加了牵涉痛，这与明确的肌筋膜触发点一致。所有明确的触发点均与头痛侧同侧。相反，只有5名对照者（20%）有牵涉痛。他们均无明确的肌筋膜触发点，因为肌肉拉伸并未增加疼痛强度。偏头痛患者在滑车检查各阶段的牵涉痛强度均高于对照者（P<0.001）。
单侧偏头痛患者通常会感觉到来自滑车区域的牵涉痛，这可能源于肌筋膜触发点。滑车区域的肌筋膜紊乱可能导致伴发偏头痛的持续存在。
