Alleviation of migraine symptoms by application of repetitive peripheral magnetic stimulation to myofascial trigger points of neck and shoulder muscles – A randomized trial

DOI: https://doi.org/10.1038/s41598-020-62701-9

Abstract-Summary Thirty-seven subjects (age: 25.0 ±4.1 years; 36 females) diagnosed with high-fre- quency episodic migraine who presented at least one active myofascial trigger point (mTrP) in the trapezius muscles and at least one latent mTrP in the deltoid muscles bilaterally prospectively underwent six sessions of repetitive peripheral magnetic stimulation (rPMS) over two weeks.

Patients were randomly assigned to receive rPMS applied to the mTrPs of the

trapezius (n = 19) or deltoid muscles (n = 18).

Whereas the trapezius muscle is supposed to be part of the trigemino-cervical complex (TCC) and, thus, involved in the pathophysiology of migraine, the deltoid muscle was not expected to interfere with the TCC and was therefore chosen as a control stimulation site.

Frequency of headache days decreased significantly in both the trapezius and the deltoid group after six sessions of rPMS (trapezius group: p = 0.005; deltoid group: p = 0.003).

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The MIDAS score decreased significantly from 29 to 13 points (p = 0.0004) in

the trapezius and from 31 to 15 points (p = 0.002) in the deltoid group.

RPMS applied to mTrPs of neck and shoulder muscles offers a promising

approach to alleviate headache frequency and symptom burden.

Introduction Repetitive peripheral magnetic stimulation (rPMS) has been introduced recently as a novel method to stimulate the upper trapezius muscles in subjects with migraine, with its application being feasible, well-tolerated, and mostly free of any adverse effects among migraineurs [473].

The local pressure pain threshold (PPT) of the trapezius muscles was steadily increasing during the course of the six sessions of rPMS applied in this previous study, indicating local muscular effects besides alleviation of headache symp- toms [473].

These previous results imply that rPMS could alleviate muscular sensitivity at the stimulated area as well as headache symptoms within the context of the TCC, making rPMS a promising neuromodulatory technique [473].

We hypothesize a stronger alleviation of migraine symptoms when rPMS is

applied to the trapezius muscles when compared to the deltoid muscles.

Results No significant differences were found between subjects of the trapezius group com- pared to subjects of the deltoid group regarding demographics or items of the head- ache diary of the German Migraine andHeadache Society (DMKG) or the MIDAS questionnaire (p > 0.05).

The MIDAS score decreased from 29 to 13 points (p = 0.0004) in the trapezius

group and from 31 to 15 points in the deltoid group (p = 0.002).

After intervention, the productivity at school/work showed to be less affected by headache events (trapezius group: p = 0.001, relative reduction −40.0%; deltoid group: p = 0.005, relative reduction −53.3%) than prior to intervention.

Productivity in household improved significantly after rPMS in the trapezius

group (p = 0.002, relative reduction −60.0%), but not in the deltoid group. Discussion This study evaluated the central effects of rPMS applied to trapezius or deltoid muscles in young adults suffering from high- frequency episodic migraine with a focus on possible differences in stimulation effects between subjects stimulated on either of these muscles.

As the deltoid muscle is not expected to be part of the TCC, we initially hypoth- esized a less pronounced effect on migraine- related symptoms in the deltoid group—supported by the results of the previous publication, suggesting a more intense peripheral effect of rPMS on the trapezius muscles when compared to the deltoid muscles [474].

This study examined central effects of rPMS when applied to mTrPs of the tra- pezius muscles, considered part of the TCC, and of the deltoid muscles not being supposed to be part of the TCC in young adults with high-frequency episodic migraine.

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Materials and Methods The following criteria needed to be met for inclusion: (1) age between 18 and 35 years, (2) migraine (according to the German version of the headache questionnaire modified according to the International Classification of Headache Disorders [ICHD], 3rd edition [430, 475, 476]), (3) a frequency of 15 to 44 days of headache during the 90 days prior to the first rPMS intervention (verified by the headache diary of the DMKG), (4) at least one active mTrP in one of the upper trapezius muscles (identified by a physiotherapist specialized in manual palpation of mTrPs), (5) no metallic implants (e.g. pacemaker, cochlear implants), and (6) written informed consent.

All subjects had to fill in the German version of the headache questionnaire mod- ified according to the ICHD (3rd edition) to verify migraine diagnosis by the fol- lowing items: localization, duration and quality of pain, nausea, photophobia, phonophobia, and the influence of physical activity on the intensity of pain.

Acknowledgement A machine generated summary based on the work of Renner, Tabea; Sollmann, Nico; Heinen, Florian; Albers, Lucia; Trepte- Freisleder, Florian; Klose, Birgit; König, Helene; Krieg, Sandro M.; Bonfert, Michaela V.; Landgraf, Mirjam N. 2020 in Scientific Reports.

Neuronavigation based 10 sessions of repetitive transcranial magnetic stimulation therapy in chronic migraine: an exploratory study