Effects of MTRPs Therapy in Migraine.

Migraine Clinical Trial

— MTRPs  

Official title:

Effects of Myofascial Trigger Points Therapy in Migraine.

Clinical Trial Details — Status: Recruiting

Administrative data

• NCT number: NCT05646160
• Other study ID #: SKE 01-52 / 2017
• Secondary ID: 14/21//10/11/201
• Status: Recruiting
• Phase: N/A
• Start date: January 15, 2018
• Est. completion date: March 2, 2023

Study information

• Verified date: March 2023
• Source: Józef Pilsudski University of Physical Education
• Contact: Maciek Olesiejuk
• Phone: +48603125812
• Email: maciej.olesiejuk[@]awf.edu.pl
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

Case series, repeated-measures design, pilot study.

Adult, female, migraine patients underwent seven Ischemic Compression Myofascial Trigger Points (IC-MTrPs) therapy sessions.

The aim of the study is to investigate whether therapy of the shoulder girdle and neck muscles by deactivating MTrPs causes modification of biomechanical and biochemical variables in the blood and reduces headache in people with migraine, improving their quality of life by improving their health.

People qualified for the study were divided into 3 groups according to the type of migraine:

1. CM group - patients with chronic migraine

2. EMa group - patients with paroxysmal migraine with aura

3. EMb group - patients with paroxysmal migraine without an aura.

All patients underwent 7 interventions in the area of the muscles of the shoulder girdle and neck (by deactivating trigger points) performed every 2 or 3 days. They did not take any headache medications during the treatment period. However, during a migraine attack, they could undergo treatments and research measurements. Biomechanical measurements of the cervical spine, shoulder girdle muscles and blood chemistry were performed before, during and after the patients' therapy.

All treatments were performed on the following muscles:

• m. trapesius pars descendent (trapezius upper),

• m. sternocleidomastoideus (sternocleidomastoid),

• m. temporalis (temporal),

• m. legator scapulae (levator scapula),

• m. supraspinatus (supraspinatus),

• m. suboccipitales (suboccipital).

Description:

Detailed Description:

I. The specific objectives were to investigate whether the therapy of the shoulder girdle and neck had an effect on:

1. the range of mobility of the cervical spine

2. myometric variables (stiffness, flexibility and tension) of the muscle (trapezius upper part)

3. concentration of selected biochemical factors (S100 beta protein, substance P (SP), calcitonin gene-related peptide (CGRP), brain-derived neurotrophic factor (BDNF) in patients with migraine

4. feel headache

5. feel pain in the muscles of the shoulder girdle

6. feel the quality of life related to health.

II. Hypotheses

1. Inactivation of MTrPs by IC-MTRPs therapy improves biomechanical properties of the cervical spine (increases the range of mobility of the cervical spine - lateral inclination, rotation and forward inclination) in people with migraine.

2. Inactivation of MTrPs by IC-MTRPs therapy improves the resting biomechanical properties (reduction of tension, stiffness and increased flexibility) of the muscles of the shoulder girdle.

3. Inactivation of MTrPs by IC-MTRPs therapy reduces the concentration of biochemicals in the blood responsible for the aggravation of migraine pain.

4. TOBS therapy through IC-MTrPs therapy improves biomechanical and biochemical variables, reducing the sensations of headache and muscle pain, improving health-related quality of life in people with migraine.

III. The course of research. Before and during the intervention cycle, migraine patients were subjected to biomechanical and biochemical tests. In the morning, fasting blood was drawn on the first and last day of therapy, before and after the intervention, in order to determine the biochemical parameters. Before the start of therapy and one month after the last intervention, the patients completed the WHOQoL-BREF (WHO Quality of Life BREEF) and the VAS (visual analogue scale) for headache and muscle pain during therapy. Before and after the first, fourth and seventh interventions, and one month after the last treatment, myometric measurements of muscle tension, stiffness and flexibility were performed using the Myoton Pro 3 apparatus (Tallinn, Estonia), and biomechanical measurements of cervical spine mobility using the Myo Motion apparatus (Noraxon, Scottsdale, USA). Muscle pain and headache during the procedure were also assessed using the VAS scale.

The research was carried out during eight research sessions in the morning, which were carried out according to a strictly defined scheme (for all subjects in the same order and location)

IV. Research methods. IV (I) Anthropometric measurements. The subjects' height, weight and body composition were measured using the Tanita BC 418 ma electronic system (Tanita Corporation, Tokyo, Japan T174). Measurement of body mass composition was determined by the electrical bioimpedance (BIA) method. The obtained data were necessary to carry out myometric and accelerometric measurements (mobility of the cervical spine), where it was required to provide the current weight and height of the examined person.

IV (II) Biochemical determinations. Blood collection and serum collection. Peripheral blood from the ulnar vein was collected on an empty stomach between 6:00 am and 9:00 am before and after the treatment on the first day and 24 hours after the sixth treatment, into test tubes without serum anticoagulants. The sterile blood (8 ml) was left for 30 min at room temperature, then the blood was centrifuged at 1500 rpm / min x g for 10 min. Serum was transferred to new 300 µl tubes and stored at -70 ° C until biochemical determinations were made.

Determination of the concentration of SP and S100B, CGRP, BNDF with the immunochemical method of ELISA The concentration of substance P, protein S100beta, calcitonin gene-related peptide (CGRP), BNDF (brain-derived neurotrophic factor) was determined using the immunochemical ELISA method in accordance with the instructions of the kit manufacturers (R&D systems, Londyn UK).

IV (III) Biomechanical measurements of the cervical spine Determination of biomechanical parameters of the cervical spine. For mobility measurements, a set for recording and analyzing human movement in 3D with the use of Noraxon Myo Motion accelerometric sensors (Noraxon, Scottsdale, USA) was used. The measuring device allowed to assess the range of movement of the cervical spine with the motor control of the patient in the movement of the lateral to the right bend and left side, right and left rotations and forward bends. Automatic recording of motion parameters completely eliminated errors related to the subjective assessment of a diagnostician with the use of manual measuring tools. The ROM values will be expressed in degrees [°].

Sensors (sensor 1 was mounted at the height of the first spinous process of the thoracic spine (Th1), sensor 2 was mounted on the occiput (Co)) mounted on the patient's head, on an elastic band, have the function of automatic, wireless calibration, thanks to which the above-described data was collected before and after day 1, 4 and 7 of therapy for the muscles of the shoulder girdle and neck and for 1 month after the last intervention. Each of the examined women sat on a stiff armchair, fastened with belts preventing the movement of the torso in order to eliminate measurement errors resulting from the human factor. The examined person made a given neck movement at the clear command of the researcher. First left side bend, then right side bend, then left head rotation, then right side bend, last head tilt forward. The range of motion measured in the research was expressed in degrees. The examiner carried out the measurements without knowing about the study group (blinding) and did not participate in the analysis of the obtained data.

IV (IV) Myometric measurements of the muscle properties of the shoulder girdle (tension, stiffness and flexibility) of the muscles.

The muscle properties were tested using a Myoton Pro 3 miometer (Myoton, Tallinn, Estonia). The measurement is non-invasive and fast, it takes from 3 to 30 seconds depending on the selected option. In the presented work, the 10 measurement repetition mode was selected, from which the device software calculated the average for each of the three parameters (tension, stiffness and elasticity) and saved it in the device memory. The measurement consisted in placing the measuring tip of the myometer always perpendicular to the skin surface at a strictly defined point before and after the therapy. The researcher moved the device towards the examined tissue until the green light on the body of the device turned on. Such an operation activates the electromagnetic mechanism, which generated mechanical impulses with a constant force deforming the muscle at the measuring point through the moved measuring tip. The meter automatically performed a series of pulses (10), and the researcher held the device steadily in the selected position. The pressure of the tip (punch) is short (10 ms) and of low force (0.40 N), which does not cause a neurological reflex muscle contraction response. The impulse caused mechanical vibrations of the examined muscle, according to which the following parameters were calculated after automatic processing by the accelerometric recording processor:

• F (frequency) - it determines the muscle tension and is calculated as the maximum frequency from the power of the accelerometric signal spectrum and is expressed as in hertz [Hz].

• S (stiffness) - is calculated from the formula S-MYO = amax. mprobe / ^ l, where amax is the maximum acceleration of the striking measuring tip [kg], a ^ l is the maximum distance the stylus has moved [m]. This parameter is expressed in [N / m] and determines the force generated by the measuring tip of the myometer needed to deform the tested tissue to a specific depth.

• D (decrement) - free decrease of vibration calculated from the logarithm:

Patient seated steadily and relaxed in a chair with full body support, hands in lap, looking straight ahead. For all patients, six measurement points were carefully indicated on both sides of upper trapezius muscle, i.e. three points on the left upper trapezius (P1, P2, P3) and three on the right upper trapezius (P4, P5, P6). The three testing points were located on an horizontal line between the cervico-thoracic junction of the spine (C7 / Th1) and the shoulder process of scapula in a distance between these points similar for each patient. Going from medial to lateral side the testing points were as follows: (i) the most medial point as P1 on the left and P4 on the right trapezius, which was distant 3 cm laterally from the cervico-thoracic junction of the spine (C7 / Th1); (ii) the next P2 or P5 point (intermediate one) was distant 2 cm laterally from the P1 or P4; (iii) and the most laterally located the P3 or P6 point was distant 2 cm from the P2 or P5 (on the left or right trapezius, respectively)

Myometric measurements were performed on each patient before and after the first, fourth and seventh treatments and 1 month after the last intervention in accordance with the manufacturer's instructions. The examiner carried out the measurements without knowing about the study group (blinding) and did not participate in the analysis of the obtained data.

IV (V) Assessment of health-related quality of life and pain sensation.

1. Assessment of health-related quality of life using the WHOQoL-BREF scale In order to compare the health-related quality of life before and after therapy, and 1 month after its completion, the subject completed the WHOQoL-BREF questionnaire. All required licenses for the use of the survey in the described research have been obtained.

2. Assessment of pain perception using the VAS scale Pain was assessed with the VAS analog pain scale in graphic form. The subjects were assessed on a scale of 1 to 10, immediately after the therapy of the muscles of the neck and shoulder girdle on days 1, 4 and 7. Patients were asked to answer: "How much did you feel pain in your muscles during the treatment?" The VAS scale also determined the intensity of the perceived headache during the last migraine attack before taking part in the treatment cycle and 1 month after the end of treatment by answering the question: "What was the intensity of the last headache / migraine episode?"

V. Statistical analysis. The test results were presented as the arithmetic mean (X) ± standard deviation (SD). The statistical analysis was performed using the STATISTICA v. 10 program (StatSoft, Inc. 2001, Kraków Poland). The Shapiro-Wilk test was used to check the normality of the distribution of serum concentrations of biochemical factors, biomechanical parameters, parameters of muscle properties, myometric tests, tests related to pain and health-related quality of life. Significant deviations from the normal distribution were found, so further analyzes were performed using non-parametric tests. In the case of the analysis of comparisons of several measurements (more than two), the Friedman ANOVA was used and when there were differences between the variables, the Post Hoc For Friedman test. For the comparative analysis of the two measurements (as in the case of the pain analysis), a non-parametric test was used for two dependent samples: Wilcoxon pairwise order. The results were considered statistically significant at the significance level of p <0.05.

Recruitment information / eligibility

• Status: Recruiting
• Enrollment: 100
• Est. completion date: March 2, 2023
• Est. primary completion date: March 1, 2023
• Accepts healthy volunteers: Accepts Healthy Volunteers
• Gender: Female
• Age group: 18 Years to 65 Years

Eligibility

Inclusion Criteria:

age: 18 to 65 years of age, female gender, migraine diagnosed by a specialist neurologist for at least 12 months, no metabolic, cardiological, neurological and orthopedic diseases within the shoulder girdle, and cervical spine, voluntary written consent for examination; criteria according to ICHD-3 allowing to classify the symptoms as migraines.

Exclusion Criteria:

minors or over 65 years of age, male gender, patients undergoing pharmacological treatment that cannot be discontinued; people with other headaches; past injuries of the musculoskeletal system in the cervical spine and shoulder girdle; skin diseases and other conditions such as deep vein thrombosis, osteoporosis; criteria for excluding migraine according to ICHD-3.

Related Conditions & MeSH terms

• Cervical Pain
• Migraine
• Migraine Disorders
• Muscle Pain
• Myalgia
• Myofascial Pain Syndromes
• Neck Pain
• Pain, Shoulder
• Shoulder Pain
• Sprains and Strains
• Trigger Point Pain, Myofascial

Intervention

Other:
• Ischemic Compression of Myofascial Trigger Points (IC-MTRPs)
IC-MTrPs intervention was made first on the right side and then on the left side and this order was the same in each patient. Before starting the therapeutic procedure, the MTrPs localizations were identified by palpation and pinch pressure in patients lying back on the couch. During the procedure, a qualified physiotherapist sat behind the subject's head. The pressure was sustained for about 5 seconds with a 2-3 seconds pause. In each subject, the intervention lasted 15 minutes on the same measurement day in the morning. The subjects underwent cycle of seven IC-MTrPs therapeutic sessions, with 3 days brakes between each session, that lasted in total about a 3-weeks (25 days).

Locations

Country	Name	City	State
Poland	Regional Research and Development Center	Biala Podlaska	Lubelskie

Sponsors (2)

Lead Sponsor	Collaborator
Józef Pilsudski University of Physical Education	University School of Physical Education in Wroclaw

Country where clinical trial is conducted

Poland, 

References & Publications (60)

21. Dejung B. Triggerpunkt-Therapie: Die Behandlungakuter Und chronischer Schmerzenim Bewegungsapparatmitmanueller Triggerpunkt-Therapie und Dry Needling. Berno, Hans Huber 2009; 13-37

Adstrum S, Hedley G, Schleip R, Stecco C, Yucesoy CA. Defining the fascial system. J Bodyw Mov Ther. 2017 Jan;21(1):173-177. doi: 10.1016/j.jbmt.2016.11.003. Epub 2016 Nov 16. — View Citation

Agostoni EC, Barbanti P, Calabresi P, Colombo B, Cortelli P, Frediani F, Geppetti P, Grazzi L, Leone M, Martelletti P, Pini LA, Prudenzano MP, Sarchielli P, Tedeschi G, Russo A; Italian chronic migraine group. Current and emerging evidence-based treatment options in chronic migraine: a narrative review. J Headache Pain. 2019 Aug 30;20(1):92. doi: 10.1186/s10194-019-1038-4. — View Citation

Aird L, Samuel D, Stokes M. Quadriceps muscle tone, elasticity and stiffness in older males: reliability and symmetry using the MyotonPRO. Arch Gerontol Geriatr. 2012 Sep-Oct;55(2):e31-9. doi: 10.1016/j.archger.2012.03.005. Epub 2012 Apr 13. — View Citation

Amin FM, Aristeidou S, Baraldi C, Czapinska-Ciepiela EK, Ariadni DD, Di Lenola D, Fenech C, Kampouris K, Karagiorgis G, Braschinsky M, Linde M; European Headache Federation School of Advanced Studies (EHF-SAS). The association between migraine and physical exercise. J Headache Pain. 2018 Sep 10;19(1):83. doi: 10.1186/s10194-018-0902-y. — View Citation

Bengtsson A, Henriksson KG, Larsson J. Reduced high-energy phosphate levels in the painful muscles of patients with primary fibromyalgia. Arthritis Rheum. 1986 Jul;29(7):817-21. doi: 10.1002/art.1780290701. — View Citation

Bizzini M, Mannion AF. Reliability of a new, hand-held device for assessing skeletal muscle stiffness. Clin Biomech (Bristol, Avon). 2003 Jun;18(5):459-61. doi: 10.1016/s0268-0033(03)00042-1. — View Citation

Boska MD, Welch KM, Barker PB, Nelson JA, Schultz L. Contrasts in cortical magnesium, phospholipid and energy metabolism between migraine syndromes. Neurology. 2002 Apr 23;58(8):1227-33. doi: 10.1212/wnl.58.8.1227. — View Citation

Bron C, Franssen J, Wensing M, Oostendorp RA. Interrater reliability of palpation of myofascial trigger points in three shoulder muscles. J Man Manip Ther. 2007;15(4):203-15. doi: 10.1179/106698107790819477. — View Citation

Calandre EP, Hidalgo J, Garcia-Leiva JM, Rico-Villademoros F, Delgado-Rodriguez A. Myofascial trigger points in cluster headache patients: a case series. Head Face Med. 2008 Dec 30;4:32. doi: 10.1186/1746-160X-4-32. — View Citation

Calandre EP, Hidalgo J, Garcia-Leiva JM, Rico-Villademoros F. Trigger point evaluation in migraine patients: an indication of peripheral sensitization linked to migraine predisposition? Eur J Neurol. 2006 Mar;13(3):244-9. doi: 10.1111/j.1468-1331.2006.01181.x. — View Citation

Cernuda-Morollon E, Larrosa D, Ramon C, Vega J, Martinez-Camblor P, Pascual J. Interictal increase of CGRP levels in peripheral blood as a biomarker for chronic migraine. Neurology. 2013 Oct 1;81(14):1191-6. doi: 10.1212/WNL.0b013e3182a6cb72. Epub 2013 Aug 23. — View Citation

Chaitow L, Fritz L. A Massage Therapist's Guide to Understanding, Locating and Treating Myofascial Trigger Points. Churchill Livingstone, Edinburgh 2006

Chen Q, Basford J, An KN. Ability of magnetic resonance elastography to assess taut bands. Clin Biomech (Bristol, Avon). 2008 Jun;23(5):623-9. doi: 10.1016/j.clinbiomech.2007.12.002. Epub 2008 Feb 21. Erratum In: Clin Biomech (Bristol, Avon). 2009 Mar;24(3):314. — View Citation

Crooks DI, Newington K, Pilling L, Todd M. Assessing the feasibility of mobilisation of C0-C3 cervical segments to reduce headache in migraineurs. Int J Ther Reh 2018; 25(8): 382-394

Dahlof C, Linde M. One-year prevalence of migraine in Sweden: a population-based study in adults. Cephalalgia. 2001 Jul;21(6):664-71. doi: 10.1046/j.1468-2982.2001.00218.x. — View Citation

Dahlof CG, Dimenas E. Migraine patients experience poorer subjective well-being/quality of life even between attacks. Cephalalgia. 1995 Feb;15(1):31-6. doi: 10.1046/j.1468-2982.1995.1501031.x. — View Citation

Diener HC, Bussone G, de Liano H, Eikermann A, Englert R, Floeter T, Gallai V, Gobel H, Hartung E, Jimenez MD, Lange R, Manzoni GC, Mueller-Schwefe G, Nappi G, Pinessi L, Prat J, Puca FM, Titus F, Voelker M; EMSASI Study Group. Placebo-controlled comparison of effervescent acetylsalicylic acid, sumatriptan and ibuprofen in the treatment of migraine attacks. Cephalalgia. 2004 Nov;24(11):947-54. doi: 10.1111/j.1468-2982.2004.00783.x. — View Citation

Diener HC, Holle D, Dodick D. Treatment of chronic migraine. Curr Pain Headache Rep. 2011 Feb;15(1):64-9. doi: 10.1007/s11916-010-0159-x. — View Citation

Edvinsson L. Calcitonin gene-related peptide (CGRP) and the pathophysiology of headache: therapeutic implications. CNS Drugs. 2001;15(10):745-53. doi: 10.2165/00023210-200115100-00001. — View Citation

Espi-Lopez GV, Ruescas-Nicolau MA, Nova-Redondo C, Benitez-Martinez JC, Dugailly PM, Falla D. Effect of Soft Tissue Techniques on Headache Impact, Disability, and Quality of Life in Migraine Sufferers: A Pilot Study. J Altern Complement Med. 2018 Nov;24(11):1099-1107. doi: 10.1089/acm.2018.0048. Epub 2018 Apr 30. — View Citation

Evans RW. Sports and Headaches. Headache. 2018 Mar;58(3):426-437. doi: 10.1111/head.13263. Epub 2018 Feb 5. — View Citation

Evers S, Afra J, Frese A, Goadsby PJ, Linde M, May A, Sandor PS; European Federation of Neurological Societies. EFNS guideline on the drug treatment of migraine--revised report of an EFNS task force. Eur J Neurol. 2009 Sep;16(9):968-81. doi: 10.1111/j.1468-1331.2009.02748.x. — View Citation

Farkkila M, Diener HC, Geraud G, Lainez M, Schoenen J, Harner N, Pilgrim A, Reuter U; COL MIG-202 study group. Efficacy and tolerability of lasmiditan, an oral 5-HT(1F) receptor agonist, for the acute treatment of migraine: a phase 2 randomised, placebo-controlled, parallel-group, dose-ranging study. Lancet Neurol. 2012 May;11(5):405-13. doi: 10.1016/S1474-4422(12)70047-9. Epub 2012 Mar 28. — View Citation

Fernandez-de-Las-Penas C, Simons D, Cuadrado ML, Pareja J. The role of myofascial trigger points in musculoskeletal pain syndromes of the head and neck. Curr Pain Headache Rep. 2007 Oct;11(5):365-72. doi: 10.1007/s11916-007-0219-z. — View Citation

Ferracini GN, Florencio LL, Dach F, Bevilaqua Grossi D, Palacios-Cena M, Ordas-Bandera C, Chaves TC, Speciali JG, Fernandez-de-Las-Penas C. Musculoskeletal disorders of the upper cervical spine in women with episodic or chronic migraine. Eur J Phys Rehabil Med. 2017 Jun;53(3):342-350. doi: 10.23736/S1973-9087.17.04393-3. Epub 2017 Jan 24. — View Citation

Ferrari MD, Roon KI, Lipton RB, Goadsby PJ. Oral triptans (serotonin 5-HT(1B/1D) agonists) in acute migraine treatment: a meta-analysis of 53 trials. Lancet. 2001 Nov 17;358(9294):1668-75. doi: 10.1016/S0140-6736(01)06711-3. — View Citation

Florencio LL, Ferracini GN, Chaves TC, Palacios-Cena M, Ordas-Bandera C, Speciali JG, Falla D, Grossi DB, Fernandez-de-Las-Penas C. Active Trigger Points in the Cervical Musculature Determine the Altered Activation of Superficial Neck and Extensor Muscles in Women With Migraine. Clin J Pain. 2017 Mar;33(3):238-245. doi: 10.1097/AJP.0000000000000390. — View Citation

Gandolfi M, Geroin C, Vale N, Marchioretto F, Turrina A, Dimitrova E, Tamburin S, Serina A, Castellazzi P, Meschieri A, Ricard F, Saltuari L, Picelli A, Smania N. Does myofascial and trigger point treatment reduce pain and analgesic intake in patients undergoing onabotulinumtoxinA injection due to chronic intractable migraine? Eur J Phys Rehabil Med. 2018 Feb;54(1):1-12. doi: 10.23736/S1973-9087.17.04568-3. Epub 2017 Jul 27. — View Citation

Ge HY, Fernandez-de-Las-Penas C, Yue SW. Myofascial trigger points: spontaneous electrical activity and its consequences for pain induction and propagation. Chin Med. 2011 Mar 25;6:13. doi: 10.1186/1749-8546-6-13. — View Citation

Gerwin RD, Dommerholt J, Shah JP. An expansion of Simons' integrated hypothesis of trigger point formation. Curr Pain Headache Rep. 2004 Dec;8(6):468-75. doi: 10.1007/s11916-004-0069-x. — View Citation

Glemser PA, Jaeger H, Nagel AM, Ziegler AE, Simons D, Schlemmer HP, Lehmann-Horn F, Jurkat-Rott K, Weber MA. 23Na MRI and myometry to compare eplerenone vs. glucocorticoid treatment in Duchenne dystrophy. Acta Myol. 2017 Mar;36(1):2-13. — View Citation

Gozalov A, Jansen-Olesen I, Klaerke D, Olesen J. Role of BK(Ca) channels in cephalic vasodilation induced by CGRP, NO and transcranial electrical stimulation in the rat. Cephalalgia. 2007 Oct;27(10):1120-7. doi: 10.1111/j.1468-2982.2007.01409.x. Epub 2007 Aug 21. — View Citation

Headache Classification Committee of the International Headache Society (IHS) The International Classification of Headache Disorders, 3rd edition. Cephalalgia. 2018 Jan;38(1):1-211. doi: 10.1177/0333102417738202. No abstract available. — View Citation

Horwitz S, Stewart A. An Exploratory Study to Determine the Relationship between Cervical Dysfunction and Perimenstrual Migraines. Physiother Can. 2015 Winter;67(1):30-8. doi: 10.3138/ptc.2012-47. — View Citation

Katsarava Z, Buse DC, Manack AN, Lipton RB. Defining the differences between episodic migraine and chronic migraine. Curr Pain Headache Rep. 2012 Feb;16(1):86-92. doi: 10.1007/s11916-011-0233-z. — View Citation

Kollewe K, Escher CM, Wulff DU, Fathi D, Paracka L, Mohammadi B, Karst M, Dressler D. Long-term treatment of chronic migraine with OnabotulinumtoxinA: efficacy, quality of life and tolerability in a real-life setting. J Neural Transm (Vienna). 2016 May;123(5):533-40. doi: 10.1007/s00702-016-1539-0. Epub 2016 Mar 31. — View Citation

Koppen H, van Veldhoven PL. Migraineurs with exercise-triggered attacks have a distinct migraine. J Headache Pain. 2013 Dec 21;14(1):99. doi: 10.1186/1129-2377-14-99. — View Citation

Linde M. Migraine: a review and future directions for treatment. Acta Neurol Scand. 2006 Aug;114(2):71-83. doi: 10.1111/j.1600-0404.2006.00670.x. — View Citation

Linton-Dahlof P, Linde M, Dahlof C. Withdrawal therapy improves chronic daily headache associated with long-term misuse of headache medication: a retrospective study. Cephalalgia. 2000 Sep;20(7):658-62. doi: 10.1111/j.1468-2982.2000.00099.x. — View Citation

Lionetto L, Cipolla F, Guglielmetti M, Martelletti P. Fremanezumab for the prevention of chronic and episodic migraine. Drugs Today (Barc). 2019 Apr;55(4):265-276. doi: 10.1358/dot.2019.55.4.2970909. — View Citation

Lipton RB. Chronic migraine, classification, differential diagnosis, and epidemiology. Headache. 2011 Jul-Aug;51 Suppl 2:77-83. doi: 10.1111/j.1526-4610.2011.01954.x. — View Citation

Marusiak J, Jaskolska A, Koszewicz M, Budrewicz S, Jaskolski A. Myometry revealed medication-induced decrease in resting skeletal muscle stiffness in Parkinson's disease patients. Clin Biomech (Bristol, Avon). 2012 Jul;27(6):632-5. doi: 10.1016/j.clinbiomech.2012.02.001. Epub 2012 Feb 25. — View Citation

Mualla B, Dilek B, Murat C, Nilgün I, Asuman G, Arsida B, Ilknur A. The clinical efficiency of acupuncture in preventing migraine attacks and its effect on serotonin levels Turk J Phys Med Rehabil 2017; 63 (1): 59, 7

Mueller-Wohlfahrt HW, Haensel L, Mithoefer K, Ekstrand J, English B, McNally S, Orchard J, van Dijk CN, Kerkhoffs GM, Schamasch P, Blottner D, Swaerd L, Goedhart E, Ueblacker P. Terminology and classification of muscle injuries in sport: the Munich consensus statement. Br J Sports Med. 2013 Apr;47(6):342-50. doi: 10.1136/bjsports-2012-091448. Epub 2012 Oct 18. — View Citation

Myoton PRO For research use only: not for use in clinical, diagnostic or therapeutic procedures USER MANUAL, Londyn 2013; 25-26, 102-103.

Ranoux D, Martine G, Espagne-Dubreuilh G, Amilhaud-Bordier M, Caire F, Magy L. OnabotulinumtoxinA injections in chronic migraine, targeted to sites of pericranial myofascial pain: an observational, open label, real-life cohort study. J Headache Pain. 2017 Dec;18(1):75. doi: 10.1186/s10194-017-0781-7. Epub 2017 Jul 21. — View Citation

Schroeter ML, Sacher J, Steiner J, Schoenknecht P, Mueller K. Serum S100B represents a new biomarker for mood disorders. Curr Drug Targets. 2013 Oct;14(11):1237-48. doi: 10.2174/13894501113149990014. — View Citation

Shah JP, Danoff JV, Desai MJ, Parikh S, Nakamura LY, Phillips TM, Gerber LH. Biochemicals associated with pain and inflammation are elevated in sites near to and remote from active myofascial trigger points. Arch Phys Med Rehabil. 2008 Jan;89(1):16-23. doi: 10.1016/j.apmr.2007.10.018. — View Citation

Shah JP, Thaker N, Heimur J, Aredo JV, Sikdar S, Gerber L. Myofascial Trigger Points Then and Now: A Historical and Scientific Perspective. PM R. 2015 Jul;7(7):746-761. doi: 10.1016/j.pmrj.2015.01.024. Epub 2015 Feb 24. — View Citation

Simons D, Travell J. Myofascial Pain and Dysfunction The Trigger Point Manual - Vol. 1 - Upper Half of Body 1998

Song TJ, Cho SJ, Kim WJ, Yang KI, Yun CH, Chu MK. Sex Differences in Prevalence, Symptoms, Impact, and Psychiatric Comorbidities in Migraine and Probable Migraine: A Population-Based Study. Headache. 2019 Feb;59(2):215-223. doi: 10.1111/head.13470. Epub 2019 Jan 9. — View Citation

Starling AJ, Vargas BB. A Narrative Review of Evidence-Based Preventive Options for Chronic Migraine. Curr Pain Headache Rep. 2015 Oct;19(10):49. doi: 10.1007/s11916-015-0521-0. — View Citation

Stepien A. Treatment of primary headaches. Pain 2011; 12 (4): 7-10

Sufrinko A, McAllister-Deitrick J, Elbin RJ, Collins MW, Kontos AP. Family History of Migraine Associated With Posttraumatic Migraine Symptoms Following Sport-Related Concussion. J Head Trauma Rehabil. 2018 Jan/Feb;33(1):7-14. doi: 10.1097/HTR.0000000000000315. — View Citation

Tali D, Menahem I, Vered E, Kalichman L. Upper cervical mobility, posture and myofascial trigger points in subjects with episodic migraine: Case-control study. J Bodyw Mov Ther. 2014 Oct;18(4):569-75. doi: 10.1016/j.jbmt.2014.01.006. Epub 2014 Feb 6. — View Citation

Terry DP, Huebschmann NA, Maxwell BA, Cook NE, Mannix R, Zafonte R, Seifert T, Berkner PD, Iverson GL. Preinjury Migraine History as a Risk Factor for Prolonged Return to School and Sports following Concussion. J Neurotrauma. 2018 Aug 2. doi: 10.1089/neu.2017.5443. Online ahead of print. — View Citation

Viir R, Laiho K, Kramarenko J, Mikkelsson M. Repeatability of trapezius muscle tone assessment by a myometric method. J Mech Med Biol 2006; 6: 215-228.

Wells RE, Beuthin J, Granetzke L. Complementary and Integrative Medicine for Episodic Migraine: an Update of Evidence from the Last 3 Years. Curr Pain Headache Rep. 2019 Feb 21;23(2):10. doi: 10.1007/s11916-019-0750-8. — View Citation

Zhang LM, Dong Z, Yu SY. Migraine in the era of precision medicine. Ann Transl Med. 2016 Mar;4(6):105. doi: 10.21037/atm.2016.03.13. — View Citation

* Note: There are 60 references in all — Click here to view all references

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	ROM cervical spine	The measuring device allowed to assess the range of movement of the cervical spine with the motor control of the patient in the movement of the lateral to the right bend and left side, right and left rotations and forward bends. The ROM values will be expressed in degrees [°].	Before the first treatment.
Primary	ROM cervical spine	The measuring device allowed to assess the range of movement of the cervical spine with the motor control of the patient in the movement of the lateral to the right bend and left side, right and left rotations and forward bends. The ROM values will be expressed in degrees [°].	After the first treatment.
Primary	ROM cervical spine	The measuring device allowed to assess the range of movement of the cervical spine with the motor control of the patient in the movement of the lateral to the right bend and left side, right and left rotations and forward bends. The ROM values will be expressed in degrees [°].	Before the fourth treatment.
Primary	ROM cervical spine	The measuring device allowed to assess the range of movement of the cervical spine with the motor control of the patient in the movement of the lateral to the right bend and left side, right and left rotations and forward bends. The ROM values will be expressed in degrees [°].	After the fourth treatment.
Primary	ROM cervical spine	The measuring device allowed to assess the range of movement of the cervical spine with the motor control of the patient in the movement of the lateral to the right bend and left side, right and left rotations and forward bends. The ROM values will be expressed in degrees [°].	Before the seventh treatment.
Primary	ROM cervical spine	The measuring device allowed to assess the range of movement of the cervical spine with the motor control of the patient in the movement of the lateral to the right bend and left side, right and left rotations and forward bends. The ROM values will be expressed in degrees [°].	After the seventh treatment.
Primary	ROM cervical spine	The measuring device allowed to assess the range of movement of the cervical spine with the motor control of the patient in the movement of the lateral to the right bend and left side, right and left rotations and forward bends. The ROM values will be expressed in degrees [°].	Described data was collected for 1 month after the last intervention.
Primary	Health-related quality of life	Health-related quality of life will be expressed as points of the WHOQoL-BREF scale [point]. The subject completed the WHOQoL-BREF questionnaire.	Before the first therapy.
Primary	Health-related quality of life	Health-related quality of life will be expressed as points of the WHOQoL-BREF scale [point]. The subject completed the WHOQoL-BREF questionnaire.	After the first therapy.
Primary	Health-related quality of life	Health-related quality of life will be expressed as points of the WHOQoL-BREF scale [point]. The subject completed the WHOQoL-BREF questionnaire.	1 month after intervention completion, the subject completed the WHOQoL-BREF questionnaire again.
Primary	Muscle pain perception	The subjects were assessed on a scale of 1 to 10 (VAS scale), immediately after the therapy of the muscles of the neck and shoulder girdle. Muscle pain perception will be expressed in [cm] as the distance between the two end points (between value 1 and 10) of visual analog scale.	Day 1
Primary	Muscle pain perception	The subjects were assessed on a scale of 1 to 10 (VAS scale), immediately after the therapy of the muscles of the neck and shoulder girdle. Muscle pain perception will be expressed in [cm] as the distance between the two end points (between value 1 and 10) of visual analog scale.	Day 4
Primary	Muscle pain perception	The subjects were assessed on a scale of 1 to 10 (VAS scale), immediately after the therapy of the muscles of the neck and shoulder girdle. Muscle pain perception will be expressed in [cm] as the distance between the two end points (between value 1 and 10) of visual analog scale.	Day 7
Primary	Headache pain perception	The VAS scale also determined the intensity of the perceived headache during the last migraine attack. Headache pain perception will be expressed in [cm] as the distance between the two end points (between value 1 and 10) of visual analog scale (VAS).	Before the treatment cycle.
Primary	Headache pain perception	The VAS scale also determined the intensity of the perceived headache during the last migraine attack. Headache pain perception will be expressed in [cm] as the distance between the two end points (between value 1 and 10) of visual analog scale (VAS).	1 month after the end of treatment.
Secondary	Myomentric parameter - Frequency	Frequency. Myotonometric frequency of natural oscillations (F-MYO) expressed in [Hz].	Before the first treatment.
Secondary	Myomentric parameter - Frequency	Frequency. Myotonometric frequency of natural oscillations (F-MYO) expressed in [Hz].	After the first treatment.
Secondary	Myomentric parameter - Frequency	Frequency. Myotonometric frequency of natural oscillations (F-MYO) expressed in [Hz].	Before the fourth treatment.
Secondary	Myomentric parameter - Frequency	Frequency. Myotonometric frequency of natural oscillations (F-MYO) expressed in [Hz].	After the fourth treatment.
Secondary	Myomentric parameter - Frequency	Frequency. Myotonometric frequency of natural oscillations (F-MYO) expressed in [Hz].	Before the seventh treatment.
Secondary	Myomentric parameter - Frequency	Frequency. Myotonometric frequency of natural oscillations (F-MYO) expressed in [Hz].	After the seventh treatment.
Secondary	Myomentric parameter - Frequency	Frequency. Myotonometric frequency of natural oscillations (F-MYO) expressed in [Hz].	1 month after the last intervention.
Secondary	Myomentric parameter - Stiffness	Stiffness. Myotonometric stiffnes (S-MYO) expressed in [N/m].	Before the first treatment.
Secondary	Myomentric parameter - Stiffness	Stiffness. Myotonometric stiffnes (S-MYO) expressed in [N/m].	After the first treatment.
Secondary	Myomentric parameter - Stiffness	Stiffness. Myotonometric stiffnes (S-MYO) expressed in [N/m].	Before the fourth treatment.
Secondary	Myomentric parameter - Stiffness	Stiffness. Myotonometric stiffnes (S-MYO) expressed in [N/m].	After the fourth treatment.
Secondary	Myomentric parameter - Stiffness	Stiffness. Myotonometric stiffnes (S-MYO) expressed in [N/m].	Before the seventh treatment.
Secondary	Myomentric parameter - Stiffness	Stiffness. Myotonometric stiffnes (S-MYO) expressed in [N/m].	After the seventh treatment.
Secondary	Myomentric parameter - Stiffness	Stiffness. Myotonometric stiffnes (S-MYO) expressed in [N/m].	1 month after the last intervention.
Secondary	Myomentric parameter - Decrement	Decrement. Myotonometric decrement of natural oscillations (D-MYO) expressed in logarithm of damping oscillations [log].	Before the first treatment.
Secondary	Myomentric parameter - Decrement	Decrement. Myotonometric decrement of natural oscillations (D-MYO) expressed in logarithm of damping oscillations [log].	After the first treatment.
Secondary	Myomentric parameter - Decrement	Decrement. Myotonometric decrement of natural oscillations (D-MYO) expressed in logarithm of damping oscillations [log].	Before the fourth treatment.
Secondary	Myomentric parameter - Decrement	Decrement. Myotonometric decrement of natural oscillations (D-MYO) expressed in logarithm of damping oscillations [log].	After the fourth treatment.
Secondary	Myomentric parameter - Decrement	Decrement. Myotonometric decrement of natural oscillations (D-MYO) expressed in logarithm of damping oscillations [log].	Before the seventh treatment.
Secondary	Myomentric parameter - Decrement	Decrement. Myotonometric decrement of natural oscillations (D-MYO) expressed in logarithm of damping oscillations [log].	After the seventh treatment.
Secondary	Myomentric parameter - Decrement	Decrement. Myotonometric decrement of natural oscillations (D-MYO) expressed in logarithm of damping oscillations [log].	1 month after the last intervention.
Secondary	Blood parameter - SP	The concentration of substance P was determined by immunochemical ELISA method according to the kit manufacturers' instructions (R&D systems, London UK). The concentration of substance P expressed in [ng/ml]. Peripheral blood from the ulnar vein was collected on an empty stomach between 6:00 am and 9:00 am into test tubes without serum anticoagulants.	Before the treatment on the first day.
Secondary	Blood parameter - SP	The concentration of substance P was determined by immunochemical ELISA method according to the kit manufacturers' instructions (R&D systems, London UK). The concentration of substance P expressed in [ng/ml]. Peripheral blood from the ulnar vein was collected on an empty stomach between 6:00 am and 9:00 am into test tubes without serum anticoagulants.	After the treatment on the first day.
Secondary	Blood parameter - SP	The concentration of substance P was determined by immunochemical ELISA method according to the kit manufacturers' instructions (R&D systems, London UK). The concentration of substance P expressed in [ng/ml]. Peripheral blood from the ulnar vein was collected on an empty stomach between 6:00 am and 9:00 am into test tubes without serum anticoagulants.	24 hours after the sixth treatment.
Secondary	Blood parameter S100beta	The concentration of protein S100beta was determined by immunochemical ELISA method according to the kit manufacturers' instructions (R&D systems, London UK). The concentration of protein S100beta expressed in [ng/ml]. Peripheral blood from the ulnar vein was collected on an empty stomach between 6:00 am and 9:00 am into test tubes without serum anticoagulants.	Before the treatment on the first day.
Secondary	Blood parameter S100beta	The concentration of protein S100beta was determined by immunochemical ELISA method according to the kit manufacturers' instructions (R&D systems, London UK). The concentration of protein S100beta expressed in [ng/ml]. Peripheral blood from the ulnar vein was collected on an empty stomach between 6:00 am and 9:00 am into test tubes without serum anticoagulants.	After the treatment on the first day.
Secondary	Blood parameter S100beta	The concentration of protein S100beta was determined by immunochemical ELISA method according to the kit manufacturers' instructions (R&D systems, London UK). The concentration of protein S100beta expressed in [ng/ml]. Peripheral blood from the ulnar vein was collected on an empty stomach between 6:00 am and 9:00 am into test tubes without serum anticoagulants.	24 hours after the sixth treatment.
Secondary	Blood parameter CGRP	The concentration of calcitonin gene-related peptide (CGRP) was determined by immunochemical ELISA method according to the kit manufacturers' instructions (R&D systems, London UK). The concentration of calcitonin gene-related peptide (CGRP) expressed in [ng/ml]. Peripheral blood from the ulnar vein was collected on an empty stomach between 6:00 am and 9:00 am into test tubes without serum anticoagulants.	Before the treatment on the first day.
Secondary	Blood parameter CGRP	The concentration of calcitonin gene-related peptide (CGRP) was determined by immunochemical ELISA method according to the kit manufacturers' instructions (R&D systems, London UK). The concentration of calcitonin gene-related peptide (CGRP) expressed in [ng/ml]. Peripheral blood from the ulnar vein was collected on an empty stomach between 6:00 am and 9:00 am into test tubes without serum anticoagulants.	After the treatment on the first day.
Secondary	Blood parameter CGRP	The concentration of calcitonin gene-related peptide (CGRP) was determined by immunochemical ELISA method according to the kit manufacturers' instructions (R&D systems, London UK). The concentration of calcitonin gene-related peptide (CGRP) expressed in [ng/ml]. Peripheral blood from the ulnar vein was collected on an empty stomach between 6:00 am and 9:00 am into test tubes without serum anticoagulants.	24 hours after the sixth treatment.
Secondary	Blood parameter BNDF	The concentration of BNDF (brain-derived neurotrophic factor) was determied by immunochemical ELISA method according to the kit manufacturers' instructions (R&D systems, London UK). The concentration of BNDF expressed in [ng/ml]. Peripheral blood from the ulnar vein was collected on an empty stomach between 6:00 am and 9:00 am into test tubes without serum anticoagulants.	Before the treatment on the first day.
Secondary	Blood parameter BNDF	The concentration of BNDF (brain-derived neurotrophic factor) was determied by immunochemical ELISA method according to the kit manufacturers' instructions (R&D systems, London UK). The concentration of BNDF expressed in [ng/ml]. Peripheral blood from the ulnar vein was collected on an empty stomach between 6:00 am and 9:00 am into test tubes without serum anticoagulants.	After the treatment on the first day.
Secondary	Blood parameter BNDF	The concentration of BNDF (brain-derived neurotrophic factor) was determied by immunochemical ELISA method according to the kit manufacturers' instructions (R&D systems, London UK). The concentration of BNDF expressed in [ng/ml]. Peripheral blood from the ulnar vein was collected on an empty stomach between 6:00 am and 9:00 am into test tubes without serum anticoagulants.	24 hours after the sixth treatment.