Now, are they saying one round of injections for the whole cycle?  Or injections for each attack?  ICKY ICKY ICKY.....(I HAAAAAATE needles... )

UnderTheRadar wrote on Jan 5^th, 2009 at 2:32pm:

Since "ABORTIVE INFILTRATIONS" are mentioned ...

Oliver

This fits in with the idea that anything that is injured or aggravated anywhere near the trigeminal can feed into the CH process.  Sinus inflammation is another big one IMO, and for some, TMJ.  Nerves talk to nearby nerves, and when one is stressed, the others get jumpy and more likely to fire.  I think deactivating trigger points is similar to a nerve block in many ways.

A good thing about trigger points is that they can also be deactivated by pressure or massage - lidocaine injections are good, but not the only way. The trick is to identify them and give them some attention.  Trigger points are defined as a point that is tender when pressed, and which typically refers pain to another spot - for example, a trigger point in one part of the upper neck may cause pain around the jaw and ear, while a nearby point will refer pain to the temple.

One of the better books for dealing with them is The Trigger Point Therapy Workbook: Your Self-Treatment Guide for Pain Relief. (currently about $15 on Amazon).  I have aborted occular migraines in minute or two by identifying and massaging trigger points (have been in CH remission since before learning about trigger points, so couldn't experiment on that).

George wrote on Jan 19^th, 2009 at 6:39pm:


Not necessarily - when using massage to deactivate trigger points, specific techniques are needed ... merely rubbing the area as one would do in a casual massage will not do much for trigger points. Likewise, aggressively manipulating a muscle in a manly way (pulping and pounding)  without concern for trigger points will probably make the trigger point problems worse. Althoug I used the term massage, maybe 'physiotherapy' would have been better.  

The trigger points could be in places on the neck, shoulders, or face in places where most people would never think to associate with the pain. For TMJ and tinnitus (and some types of headaches), one muscle that commonly adds to the pain is located inside the mouth at the back of the jaw!  I tend to get them in the soft sides of the neck - a place I never massaged much, from fear of messing with the carotid artery.  Someone who is clueless can do damage to the sides and front of the neck; someone who understands the anatomy and treats specfic muscles can do a lot of good.

Injecting lidocaine into the trigger points is usually very quick acting if the right spot is hit - it can be thought of similar to a nerve block, althought the target is obviously not directly the nerve, but a lesion in the muscle that is pulling on a nerve.  Many myofascial therapists prefer this method (if allowed to by law - oftn, massage/physical therapists are not trained or allowed to inject anthing, and most MDs that can do injections have no understanding of trigger points or myofascial activation).  Another effective technique is 'freeze and release' - using a very cold spray followed by manipulation. Massage is usually not so quick, although it is obviously more appropriate for the DIY person.  In the Trigger Point Therapy Manual, Davies talks about particular types of massage that are applied briefly 5 times or more a day (only a few seconds for each round).

When my shoulder locked up, the obvious pain was in the deltoid of the upper arm.  I found spots around the collar bone and base of the neck that fit all the characteristics of trigger points.  I started to see results around the second day of 6 specific treatments per day, and got normal function by about a week.  

That books takes more of an anatomical approach - it has a chapter on head and neck, and shows different areas of pain, and where the typical trigger points are that can refer pain to those areas. It does mention migraine.  

Here's an abstract on a study on trigger points and migraine:

Quote:


comments:

The fact that simply detecting/pressing on the trigger points can trigger a migraine attack is both good and bad ... myofascial theory says that this should happen - pressing on trigger points typically causes a flare in the symptoms because that 'knot' is sending pain or other types of nerve signals to the affected area.  But that once the point is deactivated, things get better.  This also reminds me of the recent post here that someone had a cluster triggered by massage.

The most common trigger points for migraine were temporal and suboccipital = temples and back of head/top of neck. The fact that some people with clusters and bad jaws have improved after TMJ treatment, or that some people with clusters and sinus issues (especially endonasal contact points) have improved after treating that are consistent with the idea that peripheral activation of the nerves around the trigeminal can make it more irritable and likely to be set off.

They mention trigger point therapy, acupuncture, needling and botox ... I would add 'nerve block' to that list.  All of these different approaches may have an underlying common mechanism, one of reducing angry nerve communication ('nociception') that sensitizes a nerve.  

Overall, I don't think that this approach will come close to 100%, but I think that for some people, it could be a safe, inexpensive approach that might lead to a big reduction of pain.  I am prone to getting trigger points, and for me, it has been really beneficial for a variety of non-cluster conditions (I've been in remission since learning about this).

For more information about trigger points and Myofascial pain syndrome have a look at the following wiki article and references:

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I don't have any experience with this and don't necessarily endorse or condem this therapy.  I would like to learn more with a greater number of test subjects.

Ray

I would very much like to see your doctor's protocol for trigger point injections to pass it along to my doc.