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.

Figure 1

Number of days with headache. The box plots depict the number of days with headache according to evaluation by the headache diary of the German Migraine and Headache Society (DMKG), which was carried out before and after the two-week interval of repetitive peripheral magnetic stimulation (rPMS). Median values with 25% and 75% percentiles and minimum and maximum whiskers are shown separately for the trapezius group and deltoid group. There was a statistically significant difference between the pre and post-interventional assessments in both groups (trapezius group: p = 0.005, deltoid group: p = 0.003).

Figure 2

Study design and enrollment. This flow chart provides an overview of the study design, its inclusion and exclusion criteria, and group assignments. Overall, 199 subjects were screened, with a final sample size of 37 participants undergoing repetitive peripheral magnetic stimulation (rPMS) after consideration of the study’s inclusion and exclusion criteria. No dropouts were registered.

Figure 3

Timeline of study participation. This flow chart depicts the steps of the study in a chronological order, consisting of pre- and post-interventional assessments using the headache diary of the German Migraine and Headache Society (DMKG) and Migraine Disability Assessment (MIDAS) questionnaire. These assessments were grouped around a two-week interval of repetitive peripheral magnetic stimulation (rPMS) that was subdivided into six single sessions. Stimulation by rPMS was applied to either myofascial trigger points (mTrPs) of the trapezius muscles (trapezius group) or deltoid muscles (deltoid group). Determination of the presence and location of mTrPs was done by a physiotherapist.

Figure 4

Setup of stimulation. This figure depicts the setup of stimulation by repetitive peripheral magnetic stimulation (rPMS). During pulse application to either myofascial trigger points (mTrPs) in the trapezius or deltoid muscles, the subject sat on a comfortable chair with armrests, headrest, and footplate in a relaxing position. After careful positioning of the stimulation coil over the individually defined mTrPs, a static coil holder was used to fix the correct position. Written informed consent was obtained from the subject of this figure to use this photo for publication.