trigger points

23 March 2024

Migraine Surgery: Why does it fail?

A recent review at Cureus Journal of Medical Science took a look at the success and failure of a certain type of surgery for migraine. One of the key questions was – why does migraine surgery fail?

At first, the statistics in the report look pretty good. Up to 80% of patients experienced “complete elimination of headaches”. Naturally, we should be suspicious of that “up to”. But also, remember that this is going to be a very specific group of migraine sufferers, those who were already likely to benefit from this type of surgery.

This type of surgery for chronic migraine sufferers focuses on trigger points, which may be different for each patient. The surgery works by relieving irritation to certain nerves, or by blocking pain signals from certain locations.

These are patients who have also tried other treatments, because surgery comes with its own risks and downsides.

But back to the study. The researchers also found that “up to” 35% of patients had no relief. So let’s say about 30% of surgeries failed. That’s a lot of time, trouble, and money for no result – especially considering that these patients have (hopefully) tried several other treatments already.

Why did the surgeries fail? It’s hard to tell from this review alone, but researchers found some common reasons:

The trigger points were not all dealt with. This could mean that the surgeon simply hadn’t detected all the problem areas, or that the surgery did not successfully relieve them.
Migraine headache was triggered from new trigger points after the surgery, or it was triggered again from the old trigger points (the success of the surgery was temporary?).
For an unknown reason, the surgery simply did not relieve the migraine attacks.

There is only so much you can do about #3, because it’s unknown. The second point is tricky as well, because we may not know ahead of time how the body will respond to the surgery.

To a certain extent, the first point can be addressed by finding a specialist with considerable experience in migraine surgery – a specialist who will take the time that is needed to get the surgery right.

But all that being said, it still seems to be common wisdom to find a good specialist and investigate other treatments before trying surgery. The search for a good treatment will likely take time – don’t expect a “cure” in two months. Being patient and going to an experienced headache specialist in the first place will greatly increase your chances of success.

9 March 2009

Trigger Points: Identification, Myths, and Preparing to Fight them

James Information, Treatments 1

This is the third in our series on mayofascial trigger points, headache, and migraine. We started with Trigger Points and headache – Fakery or Fact? Then we tried to figure out if they’re a factor when it comes to headaches and migraine with Trigger points – do they trigger headaches? (I know, I’m taking a long time to get through the series. But a significant amount of research is going in to this one!)

So what’s next? Well, we’re going to find out how to treat them, of course. But before we get into specifics (in the next post in the series), we’re going to get some background on trigger point treatment – things you need to know before you’ll see it really work for you.

Blasting Myths about Trigger Points

Trigger Points - causing you a headache?

First, let’s clear up some common myths about mayofascial trigger points (MTPs):

Trigger points are not consistent. Some people think they always get them in the same pattern causing the same pain – sometimes there can be consistency, and there are patterns, but you can’t rely on them. Just when you think you have it figured out, something changes.
MTPs are not always in the same location as your other symptoms. In other words, just because you have a headache in your temples, that doesn’t mean that the MTP is in your temple.
You can’t necessarily feel a trigger point. Some people associate MTPs with muscles that feel "tight", or little "lumps" or "knobs" in muscle tissue. That could be a MTP, but some are small enough (or hidden enough) that you can’t feel them, but big enough to cause problems.

Are Trigger Points causing YOU problems?

Sometimes it’s very hard to tell. I’m willing to bet, however, that if you’re having any kind of consistent headache, or migraine attacks, or cluster headaches, that MTPs are a factor. Sometimes they’re a hidden factor, but other times they’re quite obvious. When they are more obvious:

Part of your muscle is intensely sensitive when moderate pressure is applied
Pressing on some MTPs make the muscle twitch
You might feel muscle "tightness"
The pain you feel when applying pressure on the trigger point may be "good pain" – in other words, it hurts, but feels like something that is "needed"
Your body often makes more "noise" where trigger points are – such as popping, crunching noises
Your muscles feel tired and heavy, or stiff, or there is a dull, nagging pain
Heat makes it feel better

On the other hand, if the pain is due to a recent injury, or it comes on suddenly, it’s extremely sensitive to light pressure, the muscle is sore all over, or you have consistent sharp pain – that’s probably not a trigger point (and may be a reason to see your doctor!).

You should especially see your doctor if you have pain that is consistently getting worse and worse. Trigger points tend to come and go, or stay the same.

How to make Trigger Points worse

We’ll talk more about the practical side of treating trigger points in the next article. But today, let’s see a few things that can make the problem worse, and stop treatment from being as effective as it could be.

Not dealing with stress. If you’re letting yourself get stressed-out, this could make MTPs flare up
Shallow breathing. Deep breathing from time to time can help keep MTPs away.
Awkward positions. Especially those you stay in for a long time. Weird sleeping positions, sitting standing…
Actually, staying in one position for a long time, even if it’s not awkward.
Muscle relaxants. Actually, they don’t make the situation worse so much, they just don’t help.
Over exertion. Over exercising, or trying to do something that’s just over the top.
Not treating another problem. Yes, treating trigger points may help cut down your migraine attacks. However, you will likely still need to treat migraine itself, especially if you’re in a bad cycle. You may need to break the cycle first, then in the future trigger point therapy may be all you need. This goes for any headache or condition that may cause a pain cycle, or make your MTPs worse.
One more great way to make MTPs worse. Don’t be flexible in your treatment. Learn one way from Uncle Joe, then stick to it forever, no matter what your body is telling you.

Coming up…

What if I told you that trigger point therapy is better than Botox? Many of you know that Botox has become a treatment for more than wrinkles. Some migraine patients have found that it helps (more on Botox for migraine).

The amazing thing about Botox is that it kills MTPs – temporarily. Sounds great, right?

Well, it’s pretty good for that one trigger point. But MTPs that are setting off your headaches or migraine attacks could be almost anywhere on your body – and it’s different for everyone! An invasive procedure, such as a Botox treatment, is still a lot of guesswork when it comes to an individual. You’re only treating a few specific locations.

Mayofascial Trigger Point therapy has some advantages. You can treat more areas with a less invasive treatment. You can learn over time where the offending MTPs are.

And best of all, it’s usually a lot cheaper. Very often you can do trigger point therapy all by yourself!

And that’s what we’re going to look at in the next article – how to start knocking out those trigger points on your own, to cut back on those headaches and migraine attacks.

Once again, this information comes from a variety of sources, but I’m especially indebted to Trigger Point Therapy for Headaches & Migraines: Your Self-Treatment Workbook for Pain Relief by Valerie Delaune and Save Yourself from Trigger Points and Myofascial Pain Syndrome! by Paul Ingraham.

30 August 2008

Trigger Points and headache – Fakery or Fact?

James Discoveries & Stats, Treatments 14

Has this happened to you? You have a headache, and a friend says,"Here, just press your finger there and it will help you feel better". They explain to you that it’s a trigger point, and that they learned all about it from their Mom/massage therapist/Uncle Frank. So what is all this Trigger Point Therapy stuff? Is it just folk remedy mumbo-jumbo, or does Uncle Frank know what he’s talking about?

I’ll tell you right up front – Frank is not completely out to lunch. Still, he may be confused about exactly what trigger points are. But trigger point therapy is a real and well researched treatment, with great potential to keep the pain in your head away.

Muscles

To understand what trigger points are, you need to understand how muscles work. A muscle’s job is to contract. So how does it do that?

Your muscle is made up of bundles of cells called fibres (fibers), smaller around than one of your hairs. A fibre contains myofibrils, which are made up of protein filaments. These proteins slide past each other, which causes the "contraction" or movement of your muscle. This complex system in the myofibril is called a sarcomere. (we’re focusing on skeletal muscles here – other types are arranged differently)

We could get a lot more complicated, but I just want you to remember these tiny sarcomeres are contracting, and that means the muscle is contracting.

When trigger points appear

So when we’re talking about trigger points, (more properly mayofascial trigger points or MTPs) what do we mean? Once in a while, these sarcomeres go crazy. A bunch of them all contract together – a part of the muscle contracts, as opposed to a full muscle cramp. The muscle actually ends up in a tug-of-war with itself, meaning that some of it is pulled together, and some is stretched tight. The patch of clenched muscle actually gets very sick, actually cutting off its own blood supply.

Now the problem is you can’t really use the part of the muscle that’s "stuck" like this. You can’t strengthen it, you can’t stretch it – it just stubbornly folds its hands and refuses to do anything.

Where do they come from?

People who have regular headache or migraine attacks will appreciate this one – we have an idea what gets them going, but in the end they’re very unpredictable. Certainly an injury or poor posture can aggravate a muscle. But there are also major trigger points that seem to appear out of nowhere. Or, pain itself could actually trigger them – chronic headache, anyone?

Tracking down trigger points

So is that what we call a knot, or a tight band? Well, it could be. But the truth is, you can’t always feel trigger points, and sometimes something that feels like one isn’t. A trigger point could actually be tiny – even microscopic – making it very tricky to find!

The most common way to identify trigger points is how they feel to the patient – they’re often sensitive and painful – but strangely it’s a "good pain" – there’s a feeling like release when the trigger point is worked on.

Trigger points and your head

There are a lot of things going on in a trigger point. Not only is the muscle tissue unnaturally contracted, there is also a soup of metabolic waste around the area. These acidic chemicals could have a lot to do with the pain – and may show why the problem of trigger points goes beyond the exact area.

MTPs not only cause pain where they are, they can mysteriously cause pain in other parts of the body. Just because you have pain in the back of your head doesn’t mean the MTP is there – it could be in your lower trapezius muscle – in the middle of your back!

What kinds of signals are these chemicals sending to the rest of your body? We don’t understand everything that’s going on, but we do know that migraine, for example, is tightly connected to the pain signals and sensitivity of your body. Recent studies have shown that a) migraine patients very often have trigger points related to their areas of pain (Calandre et al. 2006) and b) working on trigger points can improve quality of life for those with chronic migraine, especially helping with the headache pain people often get between the major attacks (Jensen et al. 1988).

Ignoring mayofascial trigger points

Ignoring these problems is not a good idea. In fact, if left long enough, serious MTPs may cause permanent damage.

The researchers in the study mentioned above discovered that people who had had migraine symptoms longer also had more trigger points. That’s right, it looks like there is a cumulative effect! The pain of a headache may bring on MTPs which can trigger more headaches… More evidence that you should not just "hope the problem goes away" – whether it be chronic headache, migraine, or the trigger points themselves!

Coming up

This is the first post in a series on mayofascial trigger points and headache. Later on, we’ll go more in-depth on how trigger points may be involved in the cluster headache, migraine or tension type headache scenerio, how they can be treated, and what you can do on your own to fight back. Stay tuned!

Fakery or fact?

Fact, but regularly misunderstood or ignored. To quote Paul Ingraham, Registered Massage Therapist and trigger point researcher/writer:

Trigger points are not a flaky diagnosis.

You can take photomicrographs of them, measure their electrical activity, take samples of their acidic and toxic tissue chemistry, and a new MRI-like technology can now show them as well. They rest on a bedrock of thousands of scientific papers published in mainstream, peer-reviewed medical scientific journals. Detailed charts of the patterns of pain that they cause, as seen at the right, are widely available.

The pioneers of trigger point research still are and always have been medical doctors like Janet Travell1, David Simons, Siegfried Mense, and Chan Gunn.

You can take pictures of trigger points, and take samples of their toxic tissue chemistry.

So, I repeat, the existence and importance of trigger points is not scientifically controversial. The problem is educating health care professionals and getting the word out.

Paul Ingraham from his article Save Yourself from Trigger Points and Myofascial Pain Syndrome!

Credits/To find out more

Some of the sources I consulted for this article: An overview of how muscles work here. Study New Views of Myofascial Trigger Points: Etiology and Diagnosis, and definitive manual (for professionals) Travell & Simons’ Myofascial Pain and Dysfunction: The Trigger Point Manual, materials from Paul Ingraham including this article on the physiology of sarcomeres, and Trigger Point Therapy for Headaches & Migraines: Your Self-Treatment Workbook for Pain Relief by Valerie Delaune.

6 October 2005

Trigger points

James Resources, Treatments 1

Most people with chronic pain have had someone mention to them the concept of "trigger points". A lot of us have had a friend tell us that this or that trigger point will relieve our pain.

On my lookout for helpful books, I came across this one, the latest edition published last summer. It has gotten excellent reviews. Some people have found that it is a little bit difficult for the novice, and that the illustrations could be clearer. At the same time, lots of people have tried it and have found a great deal of relief from pain that has been plaguing them for a long time. It is intended to be a self-help book.

I would be interested to hear from anyone who has tried The Trigger Point Therapy Workbook. If you have another resource that has been a help, share that with us too.