Abstract：
OBJECTIVE: Peripheral myofascial mechanisms have been identified as contributors to migraine pathophysiology. The specific comorbid relationship between migraine and cervical trigger points may exacerbate the occurrence and severity of migraine attacks. Trigger point injections (TPIs) are frequently employed to address headaches and alleviate migraine symptoms. The current study explores the impact of concurrent myofascial trigger point injection (MTrPI) and occipital nerve block (greater occipital nerve block [GONB] + lesser occipital nerve block [LONB]) on the severity of headaches and the number of migraine attacks in individuals with chronic migraine (CM) and cervical myofascial trigger points (MTrPs), with a comparison of occipital nerve block alone (GONB + LONB). During trigger point examination and injection, trapezius, levator scapulae, splenius capitis, temporalis, and sternocleidomastoid muscles were targeted. We planned the treatment based on whether they were in the muscle groups we determined, rather than the number of trigger points.
METHODS: This study enrolled 62 individuals experiencing CM with bilateral headache and cervical MTrP who sought care at the Algology Unit within the Departments of Neurology and Physical Therapy and Rehabilitation at Siirt Training and Research Hospital between 2020 and 2022. The CM cohort was stratified into two groups: group 1 received trigger point injections (TrPI), while group 2 underwent concurrent bilateral occipital nerve block (GONB + LONB) and TrPI. Both groups underwent three treatment sessions with bupivacaine 0.5% (1 ml = 5 mg) in weeks 1, 2, and 4. Visual analog scale (VAS) was used to measure the patients\' pain intensity. The evaluation included the assessment of the monthly migraine frequency and visual analog scale (VAS) p score for pain before treatment (BT) and after treatment (AT), conducted at baseline and during follow-up visits. Analysis of the data was conducted utilizing IBM SPSS Statistics for Windows version 28.0 software.
RESULTS: Among patients diagnosed with CM and MTrPs, 32 individuals (51.6%) underwent GONB and LONB, while 30 patients (48.4%) received simultaneous GONB, LONB, and cervical MTrPI. Within the entire sample, 51 participants (82.3%) were female, and 11 (17.7%) were male, with a mean age of 32.81 ± 10.75 years. With an average age of 32.81 ± 10.75 years, there was no statistically significant variance between the two groups (p = 0.516). Of the total cohort, 45 individuals (72.6%) reported experiencing headaches persisting for 12 months or longer. Among CM patients, 80% had active trigger points, while 20% had latent trigger points. No statistically significant difference was observed between the groups concerning TrPs (p = 0.158), and the distribution of TrPs was homogenous across the two groups. In group 1, the median (min-max) monthly frequency of migraines reduced from 18.5 days (range: 15.0 to 25.0 days) before treatment to 12.0 days (range: 7.0 to 17.0 days) after treatment (p = 0.000). In group 2, the median monthly frequency of migraines reduced from 16.5 days (range: 15.0 to 22.0 days) before treatment to 4.0 days (range: 2.0 to 8.0 days) after treatment (p = 0.000). The median (min-max) VAS score in group 1 was 8.0 (range: 5.0 to 9.0) before treatment, 4.0 (range: 2.0 to 6.0) at week 1, and 5.0 (range: 4.0 to 8.0) at week 4 (p = 0.000). In group 2, the median VAS score was 7.0 (range: 5.0 to 9.0) before treatment, 0.0 (range: 0.0 to 0.3) at week 1, and 2.0 (range: 0.0 to 0.3) at week 4 (p = 0.000). There were significant distinctions between the groups in terms of both the monthly count of migraine days and the severity of headaches (p = 0.000).
CONCLUSIONS: The combination of repeated MTrPIs and ONB proves more effective than ONB alone in managing patients with CM and cervical MTrP. In patients with CM, performing TrPs examination and adding treatments for this may contribute to the treatment. In cases where patients endure prolonged episodes of headache associated with chronic migraine, the inclusion of trigger point injections alongside peripheral nerve blocks may offer enhanced therapeutic benefits.
METHODS: This study enrolled 62 individuals experiencing CM with bilateral headache and cervical MTrP who sought care at the Algology Unit within the Departments of Neurology and Physical Therapy and Rehabilitation at Siirt Training and Research Hospital between 2020 and 2022. The CM cohort was stratified into two groups: group 1 received trigger point injections (TrPI), while group 2 underwent concurrent bilateral occipital nerve block (GONB + LONB) and TrPI. Both groups underwent three treatment sessions with bupivacaine 0.5% (1 ml = 5 mg) in weeks 1, 2, and 4. Visual analog scale (VAS) was used to measure the patients\' pain intensity. The evaluation included the assessment of the monthly migraine frequency and visual analog scale (VAS) p score for pain before treatment (BT) and after treatment (AT), conducted at baseline and during follow-up visits. Analysis of the data was conducted utilizing IBM SPSS Statistics for Windows version 28.0 software.
RESULTS: Among patients diagnosed with CM and MTrPs, 32 individuals (51.6%) underwent GONB and LONB, while 30 patients (48.4%) received simultaneous GONB, LONB, and cervical MTrPI. Within the entire sample, 51 participants (82.3%) were female, and 11 (17.7%) were male, with a mean age of 32.81 ± 10.75 years. With an average age of 32.81 ± 10.75 years, there was no statistically significant variance between the two groups (p = 0.516). Of the total cohort, 45 individuals (72.6%) reported experiencing headaches persisting for 12 months or longer. Among CM patients, 80% had active trigger points, while 20% had latent trigger points. No statistically significant difference was observed between the groups concerning TrPs (p = 0.158), and the distribution of TrPs was homogenous across the two groups. In group 1, the median (min-max) monthly frequency of migraines reduced from 18.5 days (range: 15.0 to 25.0 days) before treatment to 12.0 days (range: 7.0 to 17.0 days) after treatment (p = 0.000). In group 2, the median monthly frequency of migraines reduced from 16.5 days (range: 15.0 to 22.0 days) before treatment to 4.0 days (range: 2.0 to 8.0 days) after treatment (p = 0.000). The median (min-max) VAS score in group 1 was 8.0 (range: 5.0 to 9.0) before treatment, 4.0 (range: 2.0 to 6.0) at week 1, and 5.0 (range: 4.0 to 8.0) at week 4 (p = 0.000). In group 2, the median VAS score was 7.0 (range: 5.0 to 9.0) before treatment, 0.0 (range: 0.0 to 0.3) at week 1, and 2.0 (range: 0.0 to 0.3) at week 4 (p = 0.000). There were significant distinctions between the groups in terms of both the monthly count of migraine days and the severity of headaches (p = 0.000).
CONCLUSIONS: The combination of repeated MTrPIs and ONB proves more effective than ONB alone in managing patients with CM and cervical MTrP. In patients with CM, performing TrPs examination and adding treatments for this may contribute to the treatment. In cases where patients endure prolonged episodes of headache associated with chronic migraine, the inclusion of trigger point injections alongside peripheral nerve blocks may offer enhanced therapeutic benefits.
摘要：
目的：外周肌筋膜机制已被确定为偏头痛病理生理学的贡献者。偏头痛和宫颈触发点之间的特定共病关系可能会加剧偏头痛发作的发生和严重程度。触发点注射(TPI)经常用于解决头痛和缓解偏头痛症状。本研究探讨了同时进行肌筋膜触发点注射（MTrPI）和枕神经阻滞（枕神经大阻滞[GONB]+枕神经小阻滞[LONB]）对头痛严重程度和偏头痛发作次数的影响慢性偏头痛（CM）和颈肌筋膜触发点（MTrP），与单纯枕骨神经阻滞(GONB+LONB)比较。在触发点检查和注射期间，斜方肌,肩胛骨提肌,脾炎,颞叶，并瞄准胸锁乳突肌。我们根据他们是否在我们确定的肌肉群中计划治疗，而不是触发点的数量。
方法：这项研究招募了62名患有双侧头痛和宫颈MTrP的CM患者，他们在2020年至2022年之间在Siirt培训与研究医院神经内科和物理治疗与康复科的Algology部门寻求护理。将CM队列分为两组：第1组接受触发点注射（TrPI），而第2组同时进行双侧枕神经阻滞（GONBLONB）和TrPI。两组均在第1、2和4周接受三次布比卡因0.5％（1ml=5mg）治疗。视觉模拟量表（VAS）用于测量患者的疼痛强度。评估包括治疗前（BT）和治疗后（AT）的每月偏头痛频率和疼痛视觉模拟量表（VAS）p评分。在基线和随访期间进行。利用IBMSPSSStatisticsforWindows28.0版软件进行数据分析。
结果：在被诊断为CM和MTrPs的患者中，32人(51.6%)接受了GONB和LONB，而30例患者（48.4％）同时接受GONB，LONB,和宫颈MTrPI。在整个样本中，51名参与者（82.3%）为女性，11人(17.7%)为男性，平均年龄32.81±10.75岁。平均年龄32.81±10.75岁,两组间差异无统计学意义(p=0.516).在整个队列中，45人（72.6%）报告头痛持续12个月或更长时间。在CM患者中，80%有活跃的触发点,而20%有潜在的触发点。两组之间关于TrP的差异无统计学意义（p=0.158），两组的TrP分布均匀。在第1组中，偏头痛的中位数（最小-最大）每月频率从治疗前的18.5天（范围：15.0至25.0天）降低到治疗后的12.0天（范围：7.0至17.0天）（p=0.000）。在第2组中，偏头痛的中位每月频率从治疗前的16.5天（范围：15.0至22.0天）减少到治疗后的4.0天（范围：2.0至8.0天）（p=0.000）。第1组治疗前VAS评分中位数(min-max)为8.0(范围:5.0~9.0),第1周为4.0（范围：2.0至6.0），第4周为5.0（范围：4.0至8.0）（p=0.000）。在第2组中，治疗前VAS评分中位数为7.0（范围：5.0至9.0），第1周为0.0（范围：0.0至0.3），第4周为2.0（范围：0.0至0.3）（p=0.000）。两组之间在每月偏头痛天数和头痛严重程度方面存在显着差异（p=0.000）。
结论：在治疗CM和宫颈MTrP患者方面，重复MTrPIs和ONB的组合证明比单独ONB更有效。在CM患者中，进行TrP检查并为此增加治疗可能有助于治疗。在患者忍受与慢性偏头痛相关的长期头痛发作的情况下，在外周神经阻滞的同时包括触发点注射可能会提高治疗效果.
方法：这项研究招募了62名患有双侧头痛和宫颈MTrP的CM患者，他们在2020年至2022年之间在Siirt培训与研究医院神经内科和物理治疗与康复科的Algology部门寻求护理。将CM队列分为两组：第1组接受触发点注射（TrPI），而第2组同时进行双侧枕神经阻滞（GONBLONB）和TrPI。两组均在第1、2和4周接受三次布比卡因0.5％（1ml=5mg）治疗。视觉模拟量表（VAS）用于测量患者的疼痛强度。评估包括治疗前（BT）和治疗后（AT）的每月偏头痛频率和疼痛视觉模拟量表（VAS）p评分。在基线和随访期间进行。利用IBMSPSSStatisticsforWindows28.0版软件进行数据分析。
结果：在被诊断为CM和MTrPs的患者中，32人(51.6%)接受了GONB和LONB，而30例患者（48.4％）同时接受GONB，LONB,和宫颈MTrPI。在整个样本中，51名参与者（82.3%）为女性，11人(17.7%)为男性，平均年龄32.81±10.75岁。平均年龄32.81±10.75岁,两组间差异无统计学意义(p=0.516).在整个队列中，45人（72.6%）报告头痛持续12个月或更长时间。在CM患者中，80%有活跃的触发点,而20%有潜在的触发点。两组之间关于TrP的差异无统计学意义（p=0.158），两组的TrP分布均匀。在第1组中，偏头痛的中位数（最小-最大）每月频率从治疗前的18.5天（范围：15.0至25.0天）降低到治疗后的12.0天（范围：7.0至17.0天）（p=0.000）。在第2组中，偏头痛的中位每月频率从治疗前的16.5天（范围：15.0至22.0天）减少到治疗后的4.0天（范围：2.0至8.0天）（p=0.000）。第1组治疗前VAS评分中位数(min-max)为8.0(范围:5.0~9.0),第1周为4.0（范围：2.0至6.0），第4周为5.0（范围：4.0至8.0）（p=0.000）。在第2组中，治疗前VAS评分中位数为7.0（范围：5.0至9.0），第1周为0.0（范围：0.0至0.3），第4周为2.0（范围：0.0至0.3）（p=0.000）。两组之间在每月偏头痛天数和头痛严重程度方面存在显着差异（p=0.000）。
结论：在治疗CM和宫颈MTrP患者方面，重复MTrPIs和ONB的组合证明比单独ONB更有效。在CM患者中，进行TrP检查并为此增加治疗可能有助于治疗。在患者忍受与慢性偏头痛相关的长期头痛发作的情况下，在外周神经阻滞的同时包括触发点注射可能会提高治疗效果.
