Effectiveness of ropivacaine trigger points inactivation in the prophylactic management of patients with severe migraine.

OBJECTIVE

Tenderness and referred pain have been described in migraine and involved in its pathogenesis. The present study was performed to evaluate the prophylactic effectiveness of ropivacaine injections during a 12-week period.

INTERVENTIONS

A total of 52 patients agreed to participate in the study. Trigger points were explored by manual palpation and injected weekly with 10 mg ropivacaine. The frequencies of migraine attacks were recorded from 4 weeks before the beginning of injections until 4 weeks after the last one, and a Clinical Global Impression improvement scale was completed in the final visit.

RESULTS

All of the subjects had one or more trigger points, located in temporal and/or suboccipital areas in most of the cases. In nine (17.3%) patients the frequency of attacks was reduced >or=50%, and in 19 (36.5%) cases the reduction was comprised between 11% and 49%. A total of 31 (59.6%) patients reported to be much or very much improved after finishing the injection period. In 11 cases rescue medication intake was reduced >or=50% in comparison with baseline period, and the attacks of severe intensity decreased significantly. Eight (26.6%) out of 30 patients suffering chronic migraine reverted to episodic migraine. Local pain in injection sites was reported by 14 patients, and 13 subjects (25.5%) experienced postinjection soreness.

CONCLUSIONS

Trigger points inactivation can be an effective palliative measure in the prophylactic management of severe refractory migraine.