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.  

The Mystery of Sleep in Fibromyalgia and Chronic Fatigue Syndrome by Celeste Cooper

We talk about sleep a great deal. We don’t seem to get enough and when we do, we still don’t feel rested.  But what really is dysfunctional sleep?

Dysfunctional sleep is loss of sleep and ineffective sleep patterns. This problem can cause agitation, phobia, sleep deprivation psychosis, headaches, cognitive deficit, problems with gait, weight problems, and it can affect our mental, physical, emotional, and spiritual health and weaken our immune response.  Though sleep dysfunction can be part of any chronic pain condition, its effects are prevalent fibromyalgia (FM), and myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS).  Both disorders affect multiple body systems and have particular overlapping conditions of bruxism, severe headaches, and restless leg syndrome accompanied by periodic limb movement during sleep. 

Dysfunctional sleep can be caused by some type of airway obstruction causing sleep apnea where the person stops breathing several times a night, and it can be due to abnormal cycles of sleep, where certain cycles are not present or brain activity, measured by brain waves, is abnormal. These abnormalities have an effect on maintaining sleep or sleep quality. Insomnia, which is not being able to get to sleep, is also considered dysfunctional. Many of us seldom, if ever, enter deep stages of sleep

In sleep apnea or other obstructions to air flow, a person is deprived of oxygen needed for cellular metabolism and energy resulting in many of the symptoms listed in the introduction, and it can cause problems with the cardiovascular system. Obstructive sleep can also create disrupted sleep cycles and in a recent review, it was found that as many as one third of patients diagnosed with ME/CFS actually had primary sleep problem and not ME/CFS at all.  For certain other patients, dysfunctional sleep is comorbid to FM and CFS/ME.

Symptoms of bruxism, teeth grinding, are unusual wear and tear on your teeth, continued breakdown of dental restorations, teeth breaking, and tooth sensitivity. Though the exact cause is unknown, it could be mediated in the central nervous system creating an unconscious response to pain or stress. While it is usually your dentist who notices the wear pattern on your teeth, it can also be identified in sleep studies. Teeth grinding can also increase the incidence of myofascial trigger points, TMJ, and migraine. You can read more on this connection here. 

In a small study done at Johns Hopkins University, Richard Allen, PhD, using an MRI, found glutamate, a chemical messenger in the central nervous system associated with arousal, to be abnormally high in patients with RLS and the quantity was associated with sleep quality. Maybe not so coincidentally, glutamate levels were also found to be elevated in the muscle of FM patients.

Restless leg syndrome is often misused interchangeably with periodic limb movement. Periodic limb movement (PLM) is repeated movement of legs, and sometimes arms, during sleep. While RLS and PLM often occur together, they are not the same. Restless leg occurs during wakefulness and PLM occurs during sleep.

In summary, could disrupted sleep patterns, obstructive sleep function, bruxism, and periodic limb movement, be major contributing factors to our sleep quality? The answer is yes. And, should all fibromyalgia and chronic fatigue syndrome (ME/CFS) patients have their sleep evaluated with a sleep study, not only considering sleep wave progression and presence of obstructive sleep function, but also a specific assessment for bruxism and PLM?  

Sleep deprivation can impede healing, foster agitation, and when severe, cause psychosis. This might explain why so many of us have difficulty fighting off viruses and recovering from injury, which is normally repaired during sleep.  The prevalence of bruxism, RLS and PLM in fibromyalgia is significant and can be factors in sleep quality which is a primary symptom of fibromyalgia. I felt it so important that I wrote a couple of letters and advocated with one of the authors of the diagnostic criteria for an automatic referral for a sleep study.

In light of the significance of sleep in both FM and ME/CFS, I feel it important to discuss your symptoms with your doctor.  They may or may not know the many factors associated, but most important is to get a sleep study. You could have a treatable condition that might improve your symptoms overall.

You can learn more about sleep, sleep hygiene, bruxism, restless leg syndrome and periodic limb movement, the involvement of myofascial trigger points and possible other causes and disruption of the central nervous system in Integrative Therapies for Fibromyalgia Chronic Fatigue Syndrome and Myofascial Pain: The Mind Body Connection, available here. 

Resources:

Allen RP, Barker PB, Horská A, Earley CJ. Thalamic glutamate/glutamine in restless legs syndrome: increased and related to disturbed sleep. Neurology. 2013 May 28;80(22):2028-34. doi: 10.1212/WNL.0b013e318294b3f6. Epub 2013 Apr 26.

Carra MC, Huynh N, Lavigne G. Sleep bruxism: a comprehensive overview for the dental clinician interested in sleep medicine. Dent Clin North Am. 2012 Apr;56(2):387-413. doi: 10.1016/j.cden.2012.01.003.

Fernandes G, Franco AL, Gonçalves DA, Speciali JG, Bigal ME, Camparis CM. Temporomandibular disorders, sleep bruxism, and primary headaches are mutually associated. J Orofac Pain. 2013 Winter;27(1):14-20. doi: 10.11607/jop.921.

Gerdle B, Larsson B, Forsberg F, Ghafouri N, Karlsson L, Stensson N, Ghafouri B. Chronic Widespread Pain: Increased Glutamate and Lactate Concentrations in the Trapezius Muscle and Plasma. Clin J Pain. 2013 Jul 24. [Epub ahead of print]

Jackson ML, and Bruck D. Sleep Abnormalities in Chronic Fatigue Syndrome/Myalgic Encephalomyelitis: A Review. J Clin Sleep Med. 2012 December 15; 8(6): 719–728.

doi:  10.5664/jcsm.2276 PMCID: PMC3501671

van der Zaag J, Naeije M, Wicks DJ, Hamburger HL, Lobbezoo F. Time-linked concurrence of sleep bruxism, periodic limb movements, and EEG arousals in sleep bruxers and healthy controls. Clin Oral Investig. 2013 May 9. [Epub ahead of print]

(Signature line appended, April 2018)

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. 

Legs come to me, be still: Fibromyalgia and Restless Leg Syndrome are they Bed Buddies?

If you have restless leg syndrome (RLS) you understand the creepy crawly sensation, the inability to keep your legs still, the nocturnal interrupter of peace and sleep, the unwanted bed buddy.

Restless leg syndrome, like fibromyalgia is believed to be caused by a disruption in the central nervous system. It frequently occurs with FM and is considered in the preliminary proposed criteria for diagnosing FM. Though not generally considered painful, it is quit annoying and rears its ugly head in the evening and bedtime hours.

Like many centralization disorders, RLS most likely has a myofascial component which initiates the event and disturbs the normal nighttime neurotransmitters (messengers to and from the brain), interrupting our normal stages of sleep. You know, the ones we don’t get, the ones that keep us from feeling refreshed even if we do sleep eight or nine hours.

Check it out:

Massage your legs; see if you feel any bumps that hurt when you press on them. If you do feel a trigger point, massage it with short strokes in one direction, holding about 80%pressure as you do. Because of the central nervous system component, the presence of trigger points may be an aggravating factor not only to FM, but to RLS also.

Periodic Limb movement (PLM) is its cohort. You may wake yourself in the night because of it, and these jerking, kicking, tear up the sheets movements are looked for in a sleep study. Periodic limb movement interferes with sleep quality and disrupts the sleep cycle, or it could be the other way around, the out of balance brain chemicals makes us move our legs in sleep 100's of times. Either way, if you have RLS you should have a sleep study done to “check for PLM.” You can have PLM without RLS, but frequently they are in cohabitation.

There are medications to treat RLS/PLM, some are affective, some not. We are all different, and just as a patient with hypertension, you might have to try several different ones, from several different classes of drugs before you find one that helps you. Paradoxically, some medications can cause RLS, and medications used to treat RLS may interfere with other medications you are taking . Be sure to talk this over with your doctor and pharmacist.


Harmony and Hope, Celeste

This blog is based on my original answer as fibromyalgia expert at ShareCare to the question, "Is Fibromyalgia Related to Restless Leg Syndrome?” View other answered questions on my profile at http://sharecare.com/user/celeste-Cooper


Resources:

Viola-Saltzman M, et al High prevalence of restless legs syndrome among patients with fibromyalgia: A controlled cross-sectional study. Journal of Clinical Sleep Medicine ,2010; 6: 423-427.

Wolfe F, Clauw DJ, Fitzcharles MA, Goldenberg DL, Häuser W, Katz RS, Mease P, Russell AS, Russell IJ, Winfield JB. Fibromyalgia Criteria and Severity Scales for Clinical and Epidemiological Studies: A Modification of the ACR Preliminary Diagnostic Criteria for Fibromyalgia. Rheumatol. 2011 Feb 1. [Epub ahead of print]

All blogs, posts and answers are based on the work in Integrative Therapies for Fibromyalgia, Chronic Fatigue Syndrome, and Myofascial Pain: The Mind-Body Connection by Celeste Cooper, RN, and Jeff Miller, PhD. 2010, Vermont: Healing Arts press and are not meant to replace medical advice. www.thesethree.com