Neuropediatrics 2006; 37 - P94
DOI: 10.1055/s-2006-974105

Myofascial trigger points in children with tension-type headache: a new diagnostic and therapeutic option?

C von Stülpnagel 1, P Reilich 2, J Schäfer 1, A Blaschek 1, SH Lee 1, V Henschel 3, U Mansmann 3, F Heinen 1
  • 1Dr. von Haunersches Kinderspital, Ludwig-Maximilians-Universität, Abteilung für Neuropädiatrie und Entwicklungsneurologie, München, Germany
  • 2Friedrich-Baur-Institut, Abteilung für Neurologie, Campus Innenstadt, Ludwig-Maximilians-Universität, München, Germany
  • 3Institute für medizinische Informationsverarbeitung, Biometrie und Epidemiologie, Campus Großhadern, Ludwig-Maximilians-Universität, München, Germany

Objective: The goal of the presented pilot study (TRIKI-study) was to investigate the clinical significance of myofascial trigger points (MTrPs) in children with tension-type headache (TTH). We further investigated the therapeutic effect of the trigger point-specific physiotherapy on headache frequency, intensity and duration in these children.

Methods: Out of the group of our headache's outpatient clinic nine children (all girls, mean age 13.1; range 5–15 years) with the diagnosis of TTH and active myofascial trigger points (active TrP) participated in this pilot study from May to September 2006. Active TrP could be evaluated by two trained investigators blinded for each others examination in at least on of the following pericranial and cervical muscles: Sternocleidomastoid, Splenius capitis, Upper trapezius, Temporalis, Semispinales, Levator scapulae., Masseter and Frontalis muscles. Afterwards all nine patients attended trigger point-specific physiotherapy twice a week by an especially trained physiotherapist.

Results: Out of 88 patients (40 male), 39 (44.3%) had TTH, 32 (36.4%) had migraine, 11 (12.5%) patients showed a combination of TTH with migraine (comorbid headache), 1 patient (1.1%) had cluster headache and 5 (5.7%) had not further specified headaches. Out of the TTH and TTH+migraine subgroup, 15/50 patients had clinical evidence of active TrPs. Nine patients of this group attended trigger point-specific physiotherapy. After an average number of 6.5 therapeutic sessions the headache frequency had been reduced by 67.7% (from 3.1 to 1 days/week), intensity by 74.3% (from 6.5 VAS to 1.67 VAS) and headache duration by 77.3% (6 hours/day to 1.36 hours/day). Side-effects did not occur during treatment.

Conclusion: These preliminary findings suggest a role for active TrP also in children with TTH. Trigger point-specific physiotherapy seems to be an effective therapeutic option in this group of young patients with primary headache. Further prospective studies on a large patient group are warranted.