The Effect of Methylprednisolone Acetate Injection at Cervical Trigger Points in Chronic as well as Drug Resistant Headache

  • Mohammadjavad Hadianfard Professor, Department of Physical Medicine and Rehabilitation, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran http://orcid.org/0000-0002-6273-2878
  • Abbas Rahimi-Jaberi Assistant Professor, Department of Neurology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
  • Shahrbanoo Kazemilar Physiatrist, Shiraz, Iran
Keywords: Headache; Methylprednisolone; Injection

Abstract

Background: Most adults have experienced a headache at least once. A high percentage of these headaches originate in cervical structures, such as neck muscles, known as cervicogenic headache (CGH). This study aimed to assess the efficacy of injection of methylprednisolone acetate at the Gallbladder 20 (GB-20) acupuncture points in muscle originated, chronic, and drug resistant headaches.

Methods: In this randomized clinical trial conducted at Shiraz University of Medical Sciences, Shiraz, Iran, in 2009-2010, 25 patients with both chronic and drug resistant CGH and cervical muscle tender points underwent methylprednisolone acetate injection. To evaluate the severity of these patients' headache, the visual analogue scale (VAS) was used. The collected data were analyzed using Wilcoxon test in SPSS software.

Results: The patients’ mean headache intensity on the VAS before the injection was 7.76 ± 2.30. This value was 2.60 ± 2.90, 30 days after the injection. The values at 1 and 3 months post-procedure were 3.52 ± 3.30 and 3.48 ± 3.50, respectively. In other words, a statistically significant reduction was observed in the pain score (P < 0.001). The frequency of headache attacks 1 and 3 months after the injection decreased 72% and 76% among patients, respectively. Average duration of headache attacks, 1 month and 3 months after the injection, decreased in 72% of patients.

Conclusion: Injection of methylprednisolone acetate at the GB-20 acupuncture points in muscle originated CGH could be used as an appropriate therapy with significant therapeutic efficacy only when injected once.

References

1. Sizer PS, Jr., Phelps V, Azevedo E, Haye A, Vaught M. Diagnosis and management of cervicogenic headache. Pain Pract 2005; 5(3): 255-74.
2. Narouze SN, Casanova J, Mekhail N. The longitudinal effectiveness of lateral atlantoaxial intra-articular steroid injection in the treatment of cervicogenic headache. Pain Med 2007; 8(2): 184-8.
3. Hecker HU, Steveling A, Peuker E, Kastner J, Liebchen K. Color atlas of acupuncture. 2nd ed. New York, NY: Thieme; 2009. p. 50.
4. Bogduk N. The neck and headaches. Neurol Clin 2004; 22(1): 151-71.
5. Maigne R. Diagnosis and treatment of pain of vertebral origin. Trans. Farjad M. 1st ed. Tehran, Iran: Sarmadi Publications; 2004. p. 100. [In Persian].
6. Sjaastad O, Fredriksen TA, Pfaffenrath V. Cervicogenic headache: Diagnostic criteria. The Cervicogenic Headache International Study Group. Headache 1998; 38(6): 442-5.
7. Borg-Stein J. Cervical myofascial pain and headache. Current Pain and Headache Reports 2002; 6(4): 324-30.
8. Barr KP, Concannon LG, Harrast MA. Low back pain. In: Gifu DX, editor. Braddom's Physical medicine and rehabilitation. 5th ed. Philadelphia, PA: Elsevier; p. 711-46.
9. Frontera WR, Silver JK, Rizzo TD. Essentials of physical medicine and rehabilitation. 2nd ed. Philadelphia, PA: Saunders; 2008.
10. Hong CZ, Simons DG. Pathophysiologic and electrophysiologic mechanisms of myofascial trigger points. Arch Phys Med Rehabil 1998; 79(7): 863-72.
11. Simons DG, Hong CZ, Simons LS. Endplate potentials are common to midfiber myofacial trigger points. Am J Phys Med Rehabil 2002; 81(3): 212-22.
12. Biondi DM, Bajwa ZH. Cervicogenic headache. UpTodate [Online]. [cited 2013 Mar 6]; Available from: URL:
https://www.uptodate.com/contents/cervicogenic-headache
13. Fernandez-de-las-Penas C, Fernandez-Mayoralas DM, Ortega-Santiago R, Ambite-Quesada S, Palacios-Cena D, Pareja JA. Referred pain from myofascial trigger points in head and neck-shoulder muscles reproduces head pain features in children with chronic tension type headache. J Headache Pain 2011; 12(1): 35-43.
14. Mikamo K, Takao Y, Wakutani Y, Nishikawa S. Effects of mecobalamin injection at acupoints on intractable headaches. Curr Ther Res Clin 1994; 55(12): 1477-85.
Published
2019-06-01
Section
Original Article(s)