Department of Paediatric Neurology and Developmental Medicine, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University, Munich, Germany.
German Vertigo and Balance Center (DSGZ), Ludwig-Maximilians-University, Munich, Germany.
Eur J Pain. 2018 Feb;22(2):385-392. doi: 10.1002/ejp.1127. Epub 2017 Sep 26.
The objective was to evaluate a supposed clinical interdependency of myofascial trigger points and migraine in children. Such interdependency would support an interaction of spinal and trigeminal afferences in the trigemino-cervical complex as a contributing factor in migraine.
Children ≤18 years with the confirmed diagnosis of migraine were prospectively investigated. Comprehensive data on medical history, clinical neurological and psychological status were gathered. Trigger points in the trapezius muscle were identified by palpation and the threshold of pressure pain at these points was measured. Manual pressure was applied to the trigger points, and the occurrence and duration of induced headache were recorded. At a second consultation (4 weeks after the first), manual pressure with the detected pressure threshold was applied to non-trigger points within the same trapezius muscle (control). Headache and related parameters were again recorded and compared to the results of the first consultation.
A total of 13 girls and 13 boys with migraine and a median age of 14.5 (Range 6.3-17.8) years took part in the study. Manual pressure to trigger points in the trapezius muscle led to lasting headache after termination of the manual pressure in 13 patients while no patient experienced headache when manual pressure was applied to non-trigger points at the control visit (p < 0.001). Headache was induced significantly more often in children ≥12 years and those with internalizing behavioural disorder.
We found an association between trapezius muscle myofascial trigger points and migraine, which might underline the concept of the trigemino-cervical complex, especially in adolescents.
In children with migraine headache can often be induced by pressure to myofascial trigger points, but not by pressure to non-trigger points in the trapezius muscle. This supports the hypothesis of a trigemino-cervical-complex in the pathophysiology of migraine, which might have implications for innovative therapies in children with migraine.
本研究旨在评估儿童肌筋膜触发点与偏头痛之间是否存在临床相关性。这种相关性支持脊柱和三叉神经传入在三叉颈复合体中的相互作用，这可能是偏头痛的一个致病因素。
本前瞻性研究纳入了确诊为偏头痛的≤18 岁儿童。收集了全面的病史、临床神经学和心理学数据。通过触诊确定斜方肌中的触发点，并测量这些点的压痛阈。在触发点上施加手动压力，并记录诱发头痛的发生和持续时间。在第二次就诊（第一次就诊后 4 周）时，在同一斜方肌内检测到的压痛阈下，对非触发点施加手动压力（对照）。再次记录头痛及相关参数，并与第一次就诊的结果进行比较。
共纳入 13 名女性和 13 名男性偏头痛患儿，年龄中位数为 14.5 岁（范围 6.3-17.8 岁）。在 13 名患者中，斜方肌触发点的手动压力会导致头痛持续，而在对照就诊时，手动压力施加于非触发点时，没有患者出现头痛（p<0.001）。在≥12 岁和有内化性行为障碍的儿童中，头痛的诱发更为常见。
我们发现斜方肌肌筋膜触发点与偏头痛之间存在关联，这可能强调了三叉颈复合体的概念，尤其是在青少年中。
在偏头痛患儿中，肌筋膜触发点的压力常可诱发头痛，但斜方肌的非触发点的压力则不会。这支持了三叉颈复合体在偏头痛病理生理学中的假说，这可能对偏头痛患儿的创新性治疗具有重要意义。
