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Cervical myofascial pain and headache

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Abstract

Myofascial pain is a common cause of regional chronic pain. Myofascial trigger points can refer pain to the head and face in the cervical region, thus contributing to cervicogenic headache. When identified properly, cervical myofascial pain is a treatable component of headache management. This article reviews current literature on the pathophysiology, diagnosis, and management of cervical myofascial pain.

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References and Recommended Reading

  1. Simons DG, Travell JG, Simons LS: Myofascial pain and dysfunction: the trigger point manual. In Upper Half of Body vol 1, edn 2. Baltimore: Williams and Wilkins; 1999.Is very helpful in the diagnosis of myofascial pain.

    Google Scholar 

  2. Kaergaard A, Anderson JH: Musculoskeletal disorders of the neck and shoulders in female sewing machine operators: prevalence, incidence, and prognosis. Occup Envir Med 2000, 57:528–534.

    Article  CAS  Google Scholar 

  3. Jensen R: Pathophysiologica; mechanisms of tension-type headache: a review of epidemiological and experimental studies. Cephalalgia 1999, 19:602–621.

    Article  PubMed  CAS  Google Scholar 

  4. Drewes AM, Jennum P: Epidemiology of myofascial pain, low back pain, morning stiffness and sleep related complaints in the general population [abstract]. J Musculoskeletal Pain 1995, 3(suppl 1):68.

    Google Scholar 

  5. Sola AE, Bonica JJ: Myofascial pain syndromes. In The management of pain. edn 2. Edited by Bonica JJ. Philadelphia:Lea & Feiberger; 1990:352–367.

    Google Scholar 

  6. Fields HL: Pain. New York: McGraw-Hill; 1987:210.

    Google Scholar 

  7. Travell J, Simons DG: Myofascial pain and dysfunction: the trigger point manual. Vol. 2, the lower extremities. Baltimore: Williams & Wilkins; 1992.

    Google Scholar 

  8. Fricton JR, Kroening R, Haley D, Siegert R: Myofascial pain syndrome of the head and neck: a review of clinical characteristics of 164 patients. Oral Surg Oral Med Oral Pathol 1985, 60:615–623.

    Article  PubMed  CAS  Google Scholar 

  9. Dohrenwend BP, Raphael KG, Marbach JJ, Gallagher RM: Why is depression comorbid with chronic myofascial face pain? A family study test of alternative hypotheses. Pain 1999, 83:183–192.

    Article  PubMed  CAS  Google Scholar 

  10. Schwartz RA, Greene CS, Laskin DM: Personality characteristics of patients with myofascial pain-dysfunction (MPD) syndrome unresponsive to conventional therapy. J Dent Res 1979, 58:1435–1439.

    PubMed  CAS  Google Scholar 

  11. Mense S, Simons DG, Russell IJ: Muscle Pain: Understanding its Nature, Diagnosis, and Treatment. Philadelphia: Lippincott Williams & Wilkins; 2001.Is very helpful in the diagnosis of muscle pain.

    Google Scholar 

  12. Simons DG: Myofascial pain syndrome due to trigger points. In Medical Rehabilitation. Edited by Basmajian JV and KirbyRL.Baltimore:Williams & Wilkins;1984.

    Google Scholar 

  13. Gerwin RD: A study of 96 subjects examined both for fibromylagia and myofascial pain. J Musculoskeletal Pain 1995, 3(Suppl 1):121.

    Google Scholar 

  14. Graff-Radford SB: Regional myofascial pain syndrome and headache: principles of diagnosis and management. Curr Pain Headache Rep 2001, 5(4):376–381.

    Article  PubMed  CAS  Google Scholar 

  15. Borg-Stein J, Simons DG: Myofascial pain: focused review. Arch Phys Med Rehabil 2002, 83(Suppl 1):S40-S49.

    Article  PubMed  Google Scholar 

  16. Mense S: Pathophysiologic basis of muscle pain syndromes. Phys Med Rehabil Clin North Am 1997, 8:23–53.

    Google Scholar 

  17. McNulty WH, Gervitz RN, Hubbard DR, Berkoff GM: Needle electomyographic evaluation of trigger point response to a psychological stressor. Psychophysiology 1994, 31:313–316.

    Article  PubMed  CAS  Google Scholar 

  18. Simons DG, Hong CZ, Simons LS: Endplate potentials are common to midfiber myofascial trigger points. Am J Phys Med Rehabil 2002, 81(3):212–222.

    Article  PubMed  Google Scholar 

  19. Couppe C, Midttun A, Hilden J, et al.: Spontaneous needle electromyographic activity in myofascial trigger points in the infraspinatus muscle: a blinded assessment. J Musculoskeletal Pain 2001, 9:7–17.

    Article  Google Scholar 

  20. Liley AW: An investigation of spontaneous activity at the neuromuscular junction of the rat. J Physiol 1956, 132:650–666.

    PubMed  CAS  Google Scholar 

  21. Simons DG, Stolov WC: Microscopic features and transient contraction of palpable bands in canine muscle. Am J Phys Med 1976, 55:66–68.

    Google Scholar 

  22. Reitinger A, Radner H, Tilscher H, et al.: Morphologic study of trigger points [in German]. Manuelle Med 1996, 34:256–262.

    Google Scholar 

  23. Bruckle W, Suckfull M, Felckenstein W, et al.: Tissue pO2 measurement in taut back musculature (m.erector spinae) [in German]. Z. Rheumatol 1990, 49:208–216.

    PubMed  CAS  Google Scholar 

  24. Vecchiet L, Vecchiet J, Giamberardino MA: Referred muscle pain: clinical and pathophysiologic aspects. Curr Rev Pain 1999, 3:489–498.

    PubMed  Google Scholar 

  25. Bahr R, Blumberg H, Janig W: Do dichotomizing afferent fibers exist which supply visceral organs as well as somatic structures? A contribution to the problem of referred pain. Neurosci Lett 1981, 24:25–28.

    Article  PubMed  CAS  Google Scholar 

  26. Baranauskas G, Nistri A: Sensitization of pain pathways in the spinal cord: cellular mechanisms. Prog Neurobiol 1998, 54:349–365.

    Article  PubMed  CAS  Google Scholar 

  27. Davidoff RA: Trigger points and myofascial pain: toward an understanding of how they affect headaches. Cephalalgia 1998, 18:436–448.

    Article  PubMed  CAS  Google Scholar 

  28. Hubbard DR: Chronic and recurrent muscle pain: pathophysiology and treatment and review of pharmacologic studies. J Musculoskeletal Pain 1996, 4:123–143.

    Article  Google Scholar 

  29. Chen JT, Chen SM, Kuan TS, et al.: Phentolamine effect on spontaneous electrical activity of active loci in a myofascial trigger spot of rabbit skeletal muscle. Arch Phys Med Rehabil 1998, 79:790–794.

    Article  PubMed  CAS  Google Scholar 

  30. Jay GW: Sympathetic aspects of myofascial pain. Pain Digest 1995, 5:192–194.

    Google Scholar 

  31. Browne PA, Clark GT, Kuboki T, Adachi NY: Concurrent cervical and craniofascial pain: a review of empiric and basic science evidence. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1998, 86(6):633–640.

    Article  PubMed  CAS  Google Scholar 

  32. Bogduk N: Cervicogenic headache: anatomic basis and pathophysiologic mechanisms. Curr Pain Headache Rep 2001, 5:382–386.

    Article  PubMed  CAS  Google Scholar 

  33. Goldenberg DL, Felson DT, Dinerman H: A randomized, controlled trial of amitriptyline and naproxen in the treatment of patients with fibromyalgia. Arthritis Rheum 1986, 29:1371–1377.

    Article  PubMed  CAS  Google Scholar 

  34. Russell IJ, Fletcher EM, Michalek JE, et al.: Treatment of primary fibrositis/fibromyalgia syndrome with ibuprofen and alpraxolam: a double-blind, placebo-controlled study. Arthritis Rheum 1991, 34:552–560.

    Article  PubMed  CAS  Google Scholar 

  35. Fossaluzza V, DeVita S: Combined therapy with cyclobenzaprine and ibuprofen in primary fibromyalgia syndrome. Int J Clin Pharmacol Res 1992, 12:99–102.

    PubMed  CAS  Google Scholar 

  36. Wilder-Smith CH, Hill L, Spargo K, Kalla A: Treatment of severe pain from osteoarthritis with slow-release tramadol or dihydrocodone in combination with NSAIDs: a randomized study comparing analgesia, antinociception and gastrointestinal effects. Pain 2001, 91:23–31.

    Article  PubMed  CAS  Google Scholar 

  37. Roth SH: Efficacy and safety of tramadol HCl in breakthrough musculoskeletal pain attributed to osteoarthritis. J Rheumatol 1998, 25:1358–1363.

    PubMed  CAS  Google Scholar 

  38. Katz WA: Pharmacology and clinical experience with tramadol in osteoarthritis. Drugs 1996, 52(Suppl 3):39–47.

    Article  PubMed  CAS  Google Scholar 

  39. Biasi G, Manca S, Manganelli S, Marcolongo R: Tramadol in the fibromyalgia syndrome: a controlled clinical trial versus placebo. Int J Clin Pharmacol Res 1998, 18(1):13–19.

    PubMed  CAS  Google Scholar 

  40. Schnitzer RJ, Gray WL, Paster RZ, Kamin M: Efficacy of tramadol in treatment of chronic low back pain. J Rheumatol 2000, 27:772–778.

    PubMed  CAS  Google Scholar 

  41. Goldenberg D, Mayskiy M, Mossey C, et al.: A randomized, double-blind crossover trial of fluoxetine and itriptyline in the treatment of fibromyalgia. Arthritis Rheum 1996, 39:1852–1859.

    Article  PubMed  CAS  Google Scholar 

  42. Bendtsen L, Jensen R: Amitriptyline reduces myofascial tenderness in patients with chronic tension-type headache. Cephalalgia 2000, 20:603–610.

    Article  PubMed  CAS  Google Scholar 

  43. Brown BRJr, Womble J: Cyclobenzaprine in intractable pain syndromes with muscle spasm. JAMA 1978, 240(11):1151–1152.

    Article  PubMed  Google Scholar 

  44. O’Malley PG, Balden E, Tomkins G, et al.: Treatment of fibromyalgia with antidepressant: a meta analysis. J Gen Intern Med 2000, 15:659–666.

    Article  PubMed  CAS  Google Scholar 

  45. Bennett R: Fibromyalgia, chronic fatigue syndrome, and myofascial pain. Curr Opin Rheumatol 1998, 19:95–103.

    Article  Google Scholar 

  46. Davies J: Selective depression of synaptic transmission of spinal neurons in the cat by a new centrally acting muscle relaxant, 5-chloro-4-(2-imidazolin-2-yl-amino)-2, 1, 3-bensothiodazole(DS 103-282). Br J Pharmacol 1982, 76:473–81.

    PubMed  CAS  Google Scholar 

  47. Ono H, Mishima A, Ono S, et al.: Inhibitory effects of clonidine and tizandine on release of substance P from slices of rat spinal cord and antagonism by alpha-adrenergic receptor antagonists. Neuropharmacology 1991, 30:585–589.

    Article  PubMed  CAS  Google Scholar 

  48. Ono H, Satoh M, Fukada H: Alpha-2 agonist-induced reduction of noradrenaline release from descending noradrenergic terminals in rat spinal cord: functional relation to spinal motor system. Biomed Res 1988, 9:169–176.

    CAS  Google Scholar 

  49. Longmire DR: The relationship between the sympathetic nervous system and chronic myofascial pain has led to the use of the term chronic neuromuscular pain (CNMP). In: American Academy of Pain Management Annual Meeting: Pain Management: A Decade of Intergrating Clinical Services; Las Vegas.1999 Set 24;

  50. Fragoso YD, Carrazana EJ: Low doses of gabapentin may be helpful in the management of chronic daily headache. Med Gen Med 2000, E52.

  51. Chesire WP, Abashian SW, Mann JD: Botulinum toxin in the treatment of myofascial pain syndrome. Pain 1994, 59:65–69.

    Article  Google Scholar 

  52. Porta M: A comparative trial of botulinum toxin type A and methylprednisolone for the treatment of myofascial pain syndrome and pain from chronic muscle spasm. Pain 2000, 85:101–105.

    Article  PubMed  CAS  Google Scholar 

  53. Wheeler AH, Goolkasian P, Gretz SS: A randomized, doubleblind, prospective pilot study of botulinum toxin injection for refractory, unilateral, cervicothoracic, paraspinal, myofascial pain syndrome. Spine 1998, 23:1662–1666.

    Article  PubMed  CAS  Google Scholar 

  54. Gobel H, Heinze A, Henize-Kuhn K, Austermann K: Botulinum toxin A for the treatment of headache disorders and pericranial pain syndromes [in German]. Nervenarzt 2001, 72:261–274.

    Article  PubMed  CAS  Google Scholar 

  55. Khalil TM, Abdel-Moty E, Steele-Rosomoff R, Rosmoff HL: The role of ergonomics in the prevention and treatment of myofascial pain. In Myofascial Pain and Fibromyalgia: Trigger Point Management. Edited by Rachlin ES. St. Louis: Mosby; 1994:487–523.

    Google Scholar 

  56. Roberts AH, Sternback RA, Polich J: Behavioral management of chronic pain and excess disability: long term follow-up of an outpatient program. Clin J Pain 1993, 9:41–48.

    Article  PubMed  CAS  Google Scholar 

  57. Ferraccioli G, Ghirelli L, Scita F, et al.: EMG-biofeedback training in fibromyalgia syndrome. J Rheumatol 1987, 14:820–825.

    PubMed  CAS  Google Scholar 

  58. Kaplan KH, Goldenberg DL, Galvin-Nadeau M: The impact of a meditation based stress reduction program on fibromyalgia. Gen Hosp Psychiatry 1993, 15:284–289.

    Article  PubMed  CAS  Google Scholar 

  59. Berman BM, Ezzo J, Hadhazy V, Swyers JP: Is acupuncture effective in the treatment of fibromyalgia? J Fam Pract 1999, 48:213–218.

    PubMed  CAS  Google Scholar 

  60. NIH Consens Statement: Acupuncture. 1997 November 3–5, 15(5):1–34.

  61. Birch S, Jamison RN: Controlled trial of Japanese acupuncture for chronic myofascial neck pain: assessment of specific and nonspecific effects of treatment. Clin J Pain 1998, 77:73–79.

    Google Scholar 

  62. Gam AN, Warming S, Larsen LH, et al.: Treatment of myofascial trigger-points with ultrasound combined with massage and exercise: a randomized controlled trial. Pain 1998, 77:73–79.

    Article  PubMed  CAS  Google Scholar 

  63. Kruger LR, van der Linden WJ, Cleaton-Jones PE: Transcutaneous electrical nerve stimulation in the treatment of myofascial pain dysfunction. S Afr J Surg 1998, 36:35–38.

    PubMed  CAS  Google Scholar 

  64. Graff-Radford SB, Reeves JL, Baker RL, Chiu D: Effects of transcutaneous electrical nerve stimulation on myofascial pain and trigger point sensitivity. Pain 1989, 37:1–5.

    Article  PubMed  CAS  Google Scholar 

  65. Graff-Radford SB, Reeves JL, Jaeger B: Management of chronic headache and neck pain: effectiveness of altering factors perpetuating myofascial pain. Headache 1987, 27:186–190.

    Article  PubMed  CAS  Google Scholar 

  66. Cummings TM, White AR: Needling therapies in the management of myofascial trigger point pain: a systematic review. Arch Phys Med Rehabil 2001, 82:986–992.

    Article  PubMed  CAS  Google Scholar 

  67. Hong CZ: Lidocaine injection versus dry needling of myofascial trigger point: the importance of the local twitch response. Am J Phys Med Rehabil 1994, 73:256–263.

    Article  PubMed  CAS  Google Scholar 

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  1. Spaulding-Wellesley Rehabilitation Center, 65Walnut Street, 02481, Wellesley, MA, USA

    Joanne Borg-Stein MD

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  1. Joanne Borg-Stein MD
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Borg-Stein, J. Cervical myofascial pain and headache. Current Science Inc 6, 324–330 (2002). https://doi.org/10.1007/s11916-002-0055-0

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