The Harsh Reality of Migraine and Myofascial Trigger Points and Restless Leg Syndrome by Celeste Cooper

One thing of certainly is the uncertainly regarding migraine. Despite the fact that over 30 million Americans live with migraine, we don’t know what causes them. Because migraines originate within the central nervous system, they can be a great factor in decreasing our pain threshold making every nerve ending is fresh, raw and exposed. In this article we will discuss an often overlooked, yet harsh, reality to migraine: myofascial trigger points, and restless leg syndrome

*Warning. If it is a new symptom for you, have it checked out immediately as sudden onset, unusual headache can be an indication of an impending stroke.

The Myofascia and Migraine

It’s difficult to say which came first, the cart or the horse, but suffice it to say, if you have been a migraineur for most of your life, the aging process may contribute to your migraine. What was once a primary migraine, can become a secondary headache or migraine, or both!

As we age, or as an early disease process, our neck bones can develop arthritis and the discs between them can degenerate. For the migraineur, this can be a huge aggravating factor and can precipitate a migraine attack. You know it is a migraine because it has all the same hallmark symptoms. The difference is that the usual abortive medications (if they work for you) only work temporarily. In these instances, it is most important to know if you have myofascial trigger points, and if you do, it is important to address them. Degenerative neck disease can affect the muscles supporting the neck and head. 

From Summer Devotions 

If you have experienced a muscle that feels like a golf ball at the base of your skull, or if you find tiny strings of muscle fiber around your temple area (on the same side of your migraine), you have myofascial involvement. Neck and upper body muscles that are tight as banjo strings or hard as rocks that have pea sized knots that you can feel if the muscles isn't too tight can also contribute to, and/or sustain, your migraine. If you have neck disease, TMJ, or grind your teeth, you are at greater risk of developing these knots known as myofascial trigger points.

Migraine and restless leg syndrome (RLS)

Rest Leg Syndrome

Did you know different researchers have made a connection between migraine and restless leg syndrome?

This is not a new finding, but it is significant to note that research in this area continues. In a case-control study done by Fernández-Matarrubia, et. al, it was found that “RLS patients had higher lifetime prevalence of migraine than non-RLS controls, and active migraine without aura was significantly more prevalent in patients with RLS than in controls… Within the RLS group, patients with migraine had poorer sleep quality than those without migraine.”  Another study done in Italy by Zanigni, et al suggests “shared pathogenic pathway which would implicate new management strategies of these two disorders.”

So, why is this important? As discussed in our book, restless leg syndrome (and it’s cohort periodic limb movement during sleep) not only has a central nervous system component, it can also be affected by myofascial trigger points.

There Is Hope

According to the American Headache Society, there is a medication showing promise. “Developed by Alder Biopharmaceuticals, the drug is currently known by its experimental name: ALD403. It works on a small protein in the body thought to play an integral role in migraine headaches. The study involved patients with a history of 5-14 migraine days per month. They received a single dose of the new medicine by intravenous injection.”

Approved by the FDA is a new devise called Cefaly, a transcutaneous electrical nerve stimulation (TENS) unit. Because trigeminal nerve may be involved in migraine, this device may be helpful. It is available in the U.S. by prescription only. Keep in mind, “The proof is in the pudding” and just like medication, cautious optimism is prudent.

If you suspect there is a myofascial component to your headaches, seek the help of a specially trained myofascial therapist, chiropractor, physical therapist  or pain specialist that understands myofascial trigger points and the pain patterns specifically related to migraine. If you also have RLS, talk to your doctor about a sleep study. There are options. Education is power, so take up arms against the harsh realities of migraine.

Conclusion

Disrupted sleep can contribute to both migraine and restless leg syndrome. Periodic limb movement during sleep makes sleep quality insufficient. So if you have migraine and RLS, expect, or suggest that you have a sleep study. Treating RLS and sleep could help. It’s worth a try. As migraineurs, we have no problem reaching for answers. I know I have been through enough trials, and after attending the American Headache and Migraine Association (AHMA) conference in Scottsdale, AZ last year, I know one thing, not all neurologists understand migraine or all available treatments. I am still searching for a headache specialist, and if you don’t have one, I suggest the same for you.

You can read about my personal story with migraines in my blog “My story as a migraineur by Celeste Cooper,” here.

Other blogs on migraine

Migraine Awareness – An exercise that might help when all else fails and some recent research, here.

Scream “4,”Cervicogenic Migraine and Myofascial Trigger points: June Awareness, here.

About migraine from my website by Celeste Cooper, RN, here.

Understanding Migraine and the Role of Myofascial Trigger Points, here.

Neck Pain, Migraines, and Myofascial Trigger Points, here.

Resources:

Ashkenazi A, Blumenfeld A, Napchan U, Narouze S, Grosberg B, Nett R, DePalma T, Rosenthal B, Tepper S, Lipton RB. Peripheral nerve blocks and trigger point injections in headache management - a systematic review and suggestions for future research. Headache. 2010 Jun;50(6):943-52. Epub 2010 May 7.

Bodes-Pardo G, Pecos-Martin D, Gallego-Izquierdo T et al. 2013. Manual treatment for cervicogenic headache and active trigger point in the sternocleidomastoid muscle: A pilot randomized clinical trial. J Manipulative Physiol Ther. [July 8 Epub ahead of print]. 

Boyer N, Dallel R, Artola A et al. General trigeminospinal central sensitization and impaired descending pain inhibitory controls contribute to migraine progression. Pain. 2014. [Mar 12 Epub ahead of print.] 

Fernández-Matarrubia M, Cuadrado ML, Sánchez-Barros CM, Martínez-Orozco FJ, Fernández-Pérez C, Villalibre I, Ramírez-Nicolás B, Porta-Etessam J. Prevalence of Migraine in Patients With Restless Legs Syndrome: A Case-Control Study. Headache. 2014 May 20. doi: 10.1111/head.12382. [Epub ahead of print]

Pinto Fiamengui LM, Freitas de Carvalho JJ, Cunha CO et al. 2013. The influence of myofascial temporomandibular disorder pain on the pressure pain threshold of women during a migraine attack. J Orofac Pain. 27(4):343-349.

Thomas K, Shankar H. 2013. Targeting myofascial taut bands by ultrasound. Curr Pain Headache Rep. 17(7):349.

Watson DH, Drummond PD. Cervical Referral of Head Pain in Migraineurs: Effects on the Nociceptive Blink Reflex. Headache, 2014

Zanigni S1, Giannini G, Melotti R, Pattaro C, Provini F, Cevoli S, Facheris MF, Cortelli P, Pramstaller PP. Association between restless legs syndrome and migraine: a population-based study. Eur J Neurol. 2014 May 20. doi: 10.1111/ene.12462. [Epub ahead of print]

(Signature line appended, March 2018)

In healing,

Celeste Cooper, RN / Author, Freelancer, Advocate

Think adversity?-See opportunity!

http://www.CelesteCooper.com

~ • ~ • ~ • ~ • ~ • ~

Learn more about Celeste’s books here. Subscribe to posts by using the information in the upper right hand corner or use the share buttons to share with others.

All blogs and comments are based on the author's opinions and are not meant to replace medical advice.  

Countdown Book Promotion - Broken Body, Wounded Spirit: Balancing the See-Saw of Chronic Pain, SUMMER DEVOTIONS, Revised 2014.

The "Kindle Discount Countdown" for Broken Body, Wounded Spirit: Balancing the See-Saw of Chronic Pain SUMMER DEVOTIONS runs for one week.

It works like this:

                                    % Discount

1            June 17, 2014 at 8:00 AM (PST)        48h      $0.99  (84% Discount)

2            June 19, 2014 at 8:00 AM (PST)        48h      $1.99  (67% Discount)

3            June 21, 2014 at 8:00 AM (PST)        48h      $2.99  (51% Discount)

End        June 23, 2014 at 8:00 AM (PST)                    Original list price $5.99         

It is available in the US here 

It is available in the UK here 

~ • ~ • ~ • ~ • ~ • ~

"Adversity is only an obstacle if we fail to see opportunity."  Celeste Cooper, RN

Author, patient/ advocate, fibromyalgia health expert 

Books:

Read about Celeste and access to her books at Author Central here

Broken Body, Wounded Spirit: Balancing the See Saw of Chronic Pain [Four book series]

Integrative Therapies for Fibromyalgia, Chronic Fatigue Syndrome, and Myofascial Pain 

Website: http://www.TheseThree.com

My story as a migraineur Updated 2016 by Celeste Cooper

Updated June, 2016

I have suffered with migraines for fifty years. I always lived with the hope that my migraines would ease with age as did my paternal grandmother, but quite the contrary has happened. They have become more frequent and now I have not only classic migraine, I also have cervicogenic migraine. You can read more on the chronic migraine, migraine with aura, occipital neuralgia, and some weird type of migraine that is only treatable with lidocaine up my nose.

My life has consisted of unpredictable severe and incapacitating pain, vomiting until breaking all the blood vessels in my face, accompanied by irritable bowel attacks as my body revolts against the enemy within. My blood pressure has dropped out of sight, literally. 

I have always needed accommodations. I was the kid embarrassed by having to raise my hand to go to the nurse's office, stopping by the bathroom to vomit then laying on the cot waiting until I could get home, hoping I didn't lose my lunch or my bowels on the bus. I was the young adult who had to retreat to a dark room while in college and miss classes that I should not miss. I remember my first REAL job as a young adult and working with a very kind woman, who always made sure I had a dark place to go.

No difference came with age other than the advent of Imitrex, which has made my life more bearable, though it does not work as well as it once did. I have been made to feel that I created this problem. I have lived long enough to be judged as a neurotic middle aged woman who couldn't deal with life, and I have lived knowing the statistics of having a stroke as I age into later life, because I am a migraineur.

My brain has felt ready to explode, I have prayed for a hot poker to relieve the pressure behind my right eye. If you are a migraineur reading this, you know exactly the other things I have prayed for too. I know what transitioning is. I have lost my vision; have prodromal (early symptoms) of eye lid dropping and my right eye crossing. Sometimes after vomiting, it will move to the left, that is when I know my nightmare will soon lessen. I have tried every drug known to man to prevent them; nothing works. 

I have been poked and prodded, promised miracle injections that didn't work. I have had Botox(T)  in my neck, which rendered me in so much pain I cried every day until it wore off, that was several months. (I will clarify that the Botox was to treat my cervical degeneration, not the migraine protocol.)

Yes, I have lived the migraine life. There is no other pain like it, and I have plenty of other pain conditions to boot. We all know that even after an attack leaves, we do not feel like tripping through a field of flowers as pharmaceutical ads imply—If only. We have come a long way in understanding them, but we have miles to go before we sleep.

Help change the world. Raise awareness for migraine treatment and prevention. Join a group like the AHMA, follow AmericanHeadache Society. Even if you don't have them often, you know you never want them again.

My first blog of the month is here. 

~ • ~ • ~ • ~ • ~ • ~

"Adversity is only an obstacle if we fail to see opportunity."  

Learn more about what you can do to help your body function to its potential in the books you can find here on Celeste's  blog. Subscribe to posts by using the information in the upper right hand corner or use the share buttons to share with others.

All answers and blogs are based on the author's opinions and writing and are not meant to replace medical advice.  

Sneak Peek – Revised edition of Broken Body, Wounded Spirit: Balancing the See-Saw of Chronic Pain, SUMMER DEVOTIONS

Inside the Cover:

“Broken Body – Wounded Spirit is a movable feast of poetry, reflections, coping strategies, educational tidbits, enchanting imagery, and more. For anyone in persistent pain holding a desire to restore physical, mental, emotional, and spiritual balance, Celeste and Jeff offer help, hope, and a path to self-empowerment.” Myra J. Christopher, Kathleen M. Foley Chair in Pain and Palliative Care at the Center for Practical Bioethics, and Principal Investigator of the Pain Action Alliance to Implement a NationalStrategy.

Summer 

Day One

The Power of Summer

               

Today is the day to begin our summer growth, a time to mature into a different way of thinking about how we can use and improve on what we learned from the Spring Devotions in this series. As we embrace the summer season and feel the warmth of the sun, we learn to rise up in the face of summer power and empowerment despite our personal adversities. The benefits of the season are bountiful...

Spending 20 minutes in the sun can:

• Boost vitamin D levels (having many health benefits).
• Provide an opportunity to get up and get going.
• Improve our mood...

and more.

Things we can do while we are enjoying the outdoors: 

• Appreciate the detail of a flower by looking at it closely with a camera or magnifying glass.
• Smell new mown grass and feel it under our feet.
• Spend time visiting with a friend...

 and more.

What are some other things I could add to these lists?

About the Book 
Review the Table of Contents 
What others have to say, Inside the Cover 

Available:

Amazon (Also available in Kindle)
Barnes and Noble 
Amazon UK
Amazon Canada 

Migraine Awareness – An exercise that might help when all else fails. Followed by some recent research. by Celeste Cooper

Because migraine occurs in many patients with fibromyalgia, chronic fatigue syndrome, and chronic myofascial pain and this is migraine awareness month, I felt you might find the following excerpt from our book Fibromyalgia, Chronic Fatigue Syndrome and Myofascial Pain helpful. Following the excerpt are some more recent research citations on migraine if you are so inclined to share with your healthcare provider.

Before the advent of medications to treat migraine, I had to find ways of working through them in other ways. Some not so pleasant, but I learned early in my life how to meditate through pain.

Excerpt:
From Integrative Therapies for Fibromyalgia, Chronic FatigueSyndrome and Myofascial Pain: The Mind Body Connection, pgs. 285-286.

I combine body scanning with progressive muscle relaxation for dealing with migraine, chronic pain, and tension...I lie down on my back in a comfortable, quiet place, usually my bed.

• I allow my eyelids to gently close while feeling the softness of their flowing movement across my eyes.

• I practice diaphragmatic breathing, focusing on the sound of each breath as the air moves in and out of my nose or mouth.

• I begin progressive relaxation by starting at the top of my head and proceeding down my body to the tips of my toes, paying close attention to each individual segment.

• I contract the muscles around the area I am concentrating on, and allow the tension to release as I relax the muscles.

• If I have a hard time releasing the tension, or find my mind keeps drifting back to this area after I have left it, I go back to it.

• For resistant areas, I visualize something comforting as I release the tightened muscles. I might imagine my head full of gelatin that starts to melt as I release the tension in my head. I imagine multiple colors blending into one, full of the strength needed to push out the resistant toxins.

• As I leave each area, I take a deep breath and blow off the cellular waste that had been allowed to accumulate there.

• I allow myself to recognize different sensations, like pain, numbness, tightness, or coldness.

• I move along my body parts, from eyebrows to nose, to mouth, to neck, to shoulders, to arms, to fingers, and so on.

• If the soreness or sensation is deeper, perhaps lodged in my organs where I cannot intentionally contract and release, I visualize something internally soothing, like warm herbal tea or chicken broth flowing from my mouth down my throat, then coating my stomach and comforting me.

 If I’m still awake by the time I get to my toes, I take a deep breath and allow my body to cleanse itself as a whole.

Some recent research from the NIH, Pub Med. 

Bashir A, Lipton RB, Ashina S et al. 2013.  Migraine and structural changes in the brain: A systematic review and meta-analysis. Neurology. 81(14):1260-1268. “This review and meta-analysis was conducted: “To evaluate the association between migraine without aura (MO) and migraine with aura (MA) and 3 types of structural brain abnormalities detected by MRI: white matter abnormalities (WMAs), infarct-like lesions (ILLs), and volumetric changes in gray and white matter (GM, WM) regions….These data suggest that migraine may be a risk factor for structural changes in the brain. Additional longitudinal studies are needed to determine the differential influence of migraine without and with aura, to better characterize the effects of attack frequency, and to assess longitudinal changes in brain structure and function.”

Bodes-Pardo G, Pecos-Martin D, Gallego-Izquierdo T et al. 2013. Manual treatment for cervicogenic headache and active trigger point in the sternocleidomastoid muscle: A pilot randomized clinical trial. J Manipulative Physiol Ther. [July 8 Epub ahead of print].  Twenty patients. “The preliminary findings show that manual therapy targeted to active TrPs in the sternocleidomastoid muscle may be effective for reducing headache and neck pain intensity and increasing motor performance of the deep cervical flexors, PPT (pressure-pain threshold), and active CROM (cervical range of motion) in individuals with CeH (cervicogenic headache) showing active TrPs in this muscle. Studies including greater sample sizes and examining long-term effects are needed. “

Boldingh MI, Ljostad U, Mygland A et al. 2013. Comparison of interictal vestibular function in vestibular migraine vs. migraine without vertigo. Headache. [May 15 Epub ahead of print]. This study found vestibular abnormalities in all migraine patients tested. 

Boyer N, Dallel R, Artola A et al. General trigeminospinal central sensitization and impaired descending pain inhibitory controls contribute to migraine progression. Pain. 2014. [Mar 12 Epub ahead of print.] 

Castaldo M, Ge HY, Chiarotto A et al. Myofascial trigger points in patients with whiplash-associated disorders and mechanical neck pain. Pain Med. 2014. [Mar 18 Epub ahead of print.]  “Active MTPs are more prominent in WAD (whiplash associated disorders) than MNP and related to current pain intensity and size of the spontaneous pain distribution in whiplash patients..." 

Cvetković VV, Strineka M, Knezević-Pavlić M, Tumpić-Jaković J, Lovrencić-Huzjan A. Analysis of headache management in emergency room. Acta Clin Croat. 2013 Sep;52(3):281-8.

Evans RW, de Tommaso M. 2011. Migraine and fibromyalgia. Headache. 51(2):295-299

Gerwig M1, Rauschen L, Gaul C, Katsarava Z, Timmann D. Subclinical cerebellar dysfunction in patients with migraine: Evidence from eyeblink conditioning.Cephalalgia. 2014 Feb 24. [Epub ahead of print]

CONCLUSIONS: Reduced acquisition of CRs in the cohort of female patients studied here supports findings of a cerebellar dysfunction in migraine.

Kashikar-Zuck S, Zafar M, Barnett KA et al. 2013. Quality of life and emotional functioning in youth with chronic migraine and juvenile fibromyalgia. Clin J Pain. [Feb 26 Epub ahead of print]. “Chronic pain in children is associated with significant negative impact on social, emotional and school functioning.” …“Youth with JFM (juvenile fibromyalgia) had significantly higher anxiety and depressive symptoms, and lower quality of life in all domains. Among children with CM (chronic migraine), overall functioning was higher but school functioning was a specific area of concern….Results indicate important differences in subgroups of pediatric pain patients and point to the need for more intensive multidisciplinary intervention for JFM patients.”

Küçükşen S, Genç E, Yılmaz H, Sallı A, Gezer IA, Karahan AY, Salbaş E, Cingöz HT, Nas O, Uğurlu H. The prevalence of fibromyalgia and its relation with headache characteristics in episodic migraine. Clin Rheumatol. 2013 Feb 27. [Epub ahead of print] “This study indicates that the assessment and management of coexisting FM should be taken into account in the assessment and management of migraine, particularly when headache is severe or patients suffer from widespread musculoskeletal pain.”

Laursen JC, Cairns BE, Kumar U et al. Nitric oxide release from trigeminal satellite glial cells is attenuated by glial modulators and glutamate. Int J Physiol Pathophysiol Pharmacol. 2013. 5(4):228-238. “…these findings suggest that targeting SGCs (satellite glial cells) may provide a novel therapeutic approach for management of craniofacial pain conditions such as migraine in the future.”

Lovati C, Mariotti C, Giani L et al. 2013. Central sensitization in photophobic and non-photophobic migraineurs: possible role of retino nuclear way in the central sensitization process. Neurol Sci. 34 Suppl 1:133-135. “Overall, these findings suggest that light stimulation may contribute to central sensitization of pain pathways in migraineurs, possibly contributing to progression into chronic forms. The possible connections underlying this type of sensitization are offered by the recently published data on a non-image-forming visual retino-thalamo-cortical pathway which may allow photic signals to converge on a thalamic region which is selectively activated during migraine headache.”

Pérez C, Villalibre I, Ramírez-Nicolás B, Porta-Etessam J. Prevalence of Migraine in Patients With Restless Legs Syndrome: A Case-Control Study. Headache. 2014 May 20. doi: 10.1111/head.12382. [Epub ahead of print]

Pinto Fiamengui LM, Freitas de Carvalho JJ, Cunha CO et al. 2013. The influence of myofascial temporomandibular disorder pain on the pressure pain threshold of women during a migraine attack.  J Orofac Pain. 27(4):343-349. Conclusion: Migraine attack is associated with a significant reduction in PPT [pressure pain threshold ] values of masticatory muscles, which appears to be influenced by the presence of myofascial TMD pain.”  [This was a very small sample size. While TMJ can have an MPS component, it is not synonymous, and I suspect the migraine with TMJ group would also have had MTrPs located in pain referral patterns. This very likely contributes to the reduction of PPT as well. Cc]

Silva-Néto RP, Peres MF, Valença MM. Accuracy of osmophobia in the differential diagnosis between migraine and tension-type headache.  J Neurol Sci. 2014 Feb 6. pii: S0022-510X(14)00064-1. doi: 10.1016/j.jns.2014.01.040. [Epub ahead of print]

Watson DH, Drummond PD. Cervical Referral of Head Pain in Migraineurs: Effects on the Nociceptive Blink Reflex. Headache, 2014... [Mar 25 Epub ahead of print.] “Our findings corroborate previous results related to anatomical and functional convergence of trigeminal and cervical afferent pathways in animals and humans, and suggest that manual cervical modulation of this pathway is of potential benefit in migraine.”

Yun DJ, Choi HN, Oh GS. 2013. A case of postural orthostatic tachycardia syndrome associated with migraine and fibromyalgia. Korean J Pain. 26(3):303-306. “Postural orthostatic tachycardia syndrome (POTS) refers to the presence of orthostatic intolerance with a heart rate (HR) increment of 30 beats per minute (bpm) or an absolute HR of 120 bpm or more. There are sporadic reports of the autonomic nervous system dysfunction in migraine and fibromyalgia. We report a case of POTS associated with migraine and fibromyalgia. The patient was managed with multidisciplinary therapies involving medication, education, and exercise which resulted in symptomatic improvement. We also review the literature on the association between POTS, migraine, and fibromyalgia.”

(Signature line appended, March 2018)

In healing,

Celeste Cooper, RN / Author, Freelancer, Advocate

Think adversity?-See opportunity!

http://www.CelesteCooper.com