The Basics of Trigger Point Injections for Headache and Migraine

 

What are trigger points?

Trigger points are areas in muscle that are very irritable, show a band of tightness in the area of muscle itself, and, when pressed, produce a twitch within the affected muscle. A trigger point may produce not only pain in the affected muscle, but in a distant area, including locations in the head and neck, called referred pain. Trigger points may develop because of trauma, injury, inflammation, or other factors.

Can trigger points cause headaches or trigger migraines?

Trigger points within muscles of the head, neck, and shoulders can cause headache by themselves, and this type of condition is often called myofascial pain. In addition, trigger points can be present in patients with migraine, tension-type, post-traumatic, and other headache disorders, and can be worsening or perpetuating factors for the underlying headache condition.

What are trigger point injections?

A trigger point injection is a procedure where a medication, usually a local anesthetic, is injected into the painful muscle to provide relief. The pain relief should be experienced not only in the affected muscle, but in the area of referred pain as well.

Who should receive trigger point injections?

Patients that have specific trigger points that can be elicited with palpation (a firm touch) may experience the most relief from injections. They may be very helpful for immediate relief for severe pain in patients with an individual headache or migraine attack, or can help treat an overall worsening of head pain in patients with chronic headache disorders who are having an exacerbation.

How are trigger point injections performed?

In the trigger point procedure, a health care provider inserts a small needle into the patient’s specific area of pain (trigger point) in a muscle. The injection usually contains only a local anesthetic, but occasionally may contain a steroid medication. This procedure can be performed in a doctor’s office, and does not require sedation. The patient is positioned sitting or lying down. Your doctor will first palpate and identify the painful areas within a muscle. After identifying such trigger points, your doctor will inject those areas. Depending on how many trigger points are identified, more than one injection may be required. Some headache specialists perform trigger point injections along with peripheral nerve blocks in the same treatment session.

How do trigger point injections work?

The anesthetic medication will be injected into the muscle and will block pain receptors within the nerves surrounding the muscle, and, in turn, reduce the pain signals sent to the brain. If steroid medication is used, it reduces the inflammation and swelling of tissue around the nerves, which may help reduce pain. The needle without medication may even provide independent benefits mechanically. The needle separates, relaxes and lengthens the muscle fiber to provide further pain relief. This approach is called “needling” and may be used in patients with allergies to anesthetic medication.

Are trigger point injections safe?

The most common side effects are temporary pain and numbness at the injection site. Infection and bleeding may occur at the injection site, but this can be avoided by cleaning the site before injection and applying pressure to the site after injection. Patients may also experience light-headedness after injections.
If steroid injections are used, repeated dosing may cause a loss of hair, fatty tissue accumulation, or loss of muscle thickness at the injection site.

What can I expect after receiving trigger point injections?

Immediately after the injection, you may feel that your pain has remitted or lessened significantly, in both the affected muscle as well as the area of the referred pain in the head or neck. Some patients may not benefit at all, while others may have significant pain remission lasting for weeks. You can return to your daily activities immediately after the injections. Health care providers may repeat the procedure as needed and customize how often it is performed.

Summary

Trigger point injection is a procedure which can be performed at a doctor’s office safely to treat headache and migraine in certain patients. Consult with your doctor as to whether or not this treatment is appropriate for you.

References

• Travell JG, S.D., Simons LS, Travell and Simons’ Myofacial pain and dysfunction: The trigger point manual. 2 ed. Vol. 1. 1999, Baltimore MD: Williams and Wilkens.
• Graff-Radford SB. Myofascial pain: diagnosis and management. Curr Pain Headache Rep. 2004;8:463-467.