Sunday, June 22, 2014

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.


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.


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 GMelotti RPattaro CProvini FCevoli SFacheris MFCortelli PPramstaller 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!

~ • ~ • ~ • ~ • ~ • ~

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


Unknown said...

Perhaps Melatonin could calm the body down.

The Pained Ink Slayer said...

Kirk, as you know, melatonin levels are what regulate our sleep, so while it seems more of it may help,that may not be the case. Since melatonin is a hormone, I would not suggest it without the supervision of a sleep specialist.

kim said...

I always enjoy reading your informative posts. I have RLS and headaches. I do not have migraines according to my neurologist, I have post-concussion headaches from a closed head injury. Would the information in this post also speak to these types of headaches? ~Kim

The Pained Ink Slayer said...

Hi Kim. Thank you so much. I cannot give medical advice, but I can tell you that any kind of pain can cause us to tense muscles and hold them in that position. That creates an environment rich for developing myofascial trigger points. Trigger points in the neck can sustain a headache beyond its normal course. As you know restless leg and periodic limb movement are thought to be due to a mix up in the brain, but this too can be aggravated or sustained by trigger points in our muscles, particularly the legs and feet. Here is an article I wrote on myofascial trigger points and chronic pain. It has several links, including some articles I wrote for Health Central. Wishing you the best.

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