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.
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!
~ • ~ • ~ • ~ • ~ • ~
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All blogs and comments are based on the author's opinions and are
not meant to replace medical advice.
4 comments:
Perhaps Melatonin could calm the body down.
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.
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
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. http://www.celestecooper.com/2015/07/myofascial-trigger-points-and-chronic.html#.Wvm8qogvzIW
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