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

Abstract

Migraine is a burdensome disease with an especially high prevalence in women between the age of 15 and 49 years. Non-pharmacological, non-invasive therapeutic methods to control symptoms are increasingly in demand to complement a multimodal intervention approach in migraine. Thirty-seven subjects (age: 25.0 ± 4.1 years; 36 females) diagnosed with high-frequency 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. The headache calendar of the German Migraine and Headache Society (DMKG) as well as the Migraine Disability Assessment (MIDAS) questionnaire were used to evaluate stimulation-related effects. 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). 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. Thus, rPMS applied to mTrPs of neck and shoulder muscles offers a promising approach to alleviate headache frequency and symptom burden. Future clinical trials are needed to examine more profoundly these effects, preferably using a sham-controlled setting. According to the Global Burden of Disease Study more than one billion people were suffering from migraine in 2016, making migraine one of the most prevalent neurological disorders worldwide 1. Especially women between the age of 15 and 49 years are concerned-in this group migraine is also the first cause of disability worldwide 1-4. Further, migraineurs show a considerably reduced health-related quality of life (QoL) and considerable loss in work productivity 5-7. The high impact of migraine on QoL is reflected by percentages as high as 85%

Neuromodulation techniques for acute and preventive migraine treatment: a systematic review and meta-analysis of randomized controlled trials

“…One study tested repetitive peripheral magnetic stimulation to myofascial trigger points of the neck compared to shoulder-muscle stimulation [ 37 ]. As such peripheral magnetic stimulation has an impact on peripheral nerves, it was included in this systematic review.…”

Non-Invasive Neurostimulation Methods for Acute and Preventive Migraine Treatment—A Narrative Review

“…One study used peripheral pulsed electromagnetic fields applied to the wrist and was negative [ 45 ]. Another study tested repetitive magnetic stimulation to myofascial trigger points of the neck compared to shoulder muscle stimulation [ 46 ]. There was no difference between the two stimulation sites, although a reduction relative to baseline was seen in both groups.…”

Patients with episodic migraine show increased T2 values of the trapezius muscles – an investigation by quantitative high-resolution magnetic resonance imaging

“…Further, elevated T2 values may serve as future response predictors for such therapies on the long run. Vice versa, CGRP levels may serve as markers for prediction or assessment of treatment responses of approaches focusing on the neck and shoulder muscles, such as repetitive peripheral magnetic stimulation (rPMS) ( 37 – 39 ). Yet, another interesting perspective may be to assess the effects of CGRP-targeting medications applied subcutaneously in the neck and shoulder region.…”