How Do Trigger Point Injections Help in Migraine?

A migraine is a type of headache that is associated with excruciating pain, usually on one side of the head. In some people, this pain can be debilitating enough to interfere with their everyday life. Many people who experience migraine also get other symptoms like nausea, vomiting, and sensitivity to sound, light, and smells before and during their headaches. There are several treatment options for migraine and relieving the symptoms, including over-the-counter and prescription medications, lifestyle and dietary changes, and even acupuncture. Another treatment option for migraine are trigger point injections, which target the muscles that are believed to have a role in causing the migraine episodes. Trigger point injection for migraine may work for some people but not for others. Read to find out if trigger point injections for treating migraine could be a potential treatment option for you.

It is estimated that nearly 14 percent of Americans, including children, suffer from migraine, which is a neurological condition that causes the following symptoms:^{(1, 2, 3, 4, 5)}

• Moderate to severe headache that is usually pulsing or throbbing in nature
• Headache might be on one side of the head.
• Nausea
• Vomiting
• Increased sensitivity to sound, light, and smells
• Dizziness
• Feeling faint

There are many treatment options available for migraine, including over-the-counter and prescription medications that also include preventive medicines, changes in diet and lifestyle, and even acupuncture or acupressure. One such option for treating migraines is known as trigger point injections.

Trigger points are specific points in the muscles that get irritated and display a band of tightness in that place of the muscle itself, producing pain. When these trigger points are pressed, they produce a twitch within the affected muscle. This pressure on the trigger point may not only cause pain in that affected muscle but also in the nearby area, especially locations in the head and neck, which is known as referred pain. Trigger points usually develop due to injury, trauma, inflammation, or any other factors.^{(6, 7, 8)}

Meanwhile, trigger point injections target these muscles that are believed to play a role in causing migraine episodes. These injections may work quickly and show great results in some people, but they might not work for others.

The exact cause of migraines remains unknown. There are several known triggers for migraine episodes, and one of them is believed to be the stimulation of certain areas of the muscle, known as trigger points. Trigger points have often been associated with musculoskeletal and myofascial pain when they are stimulated. These trigger points typically develop in the tight and sensitive bands of skeletal muscles.^{(9, 10)}

There are several therapies that target these trigger points through massage or other forms of manipulation, but these points can be a cause of irritation. Trigger points located in the muscles of the neck, shoulders, and head are known to be the cause of headaches. They are especially common in migraine and tension headaches. Studies have found that people with migraine have more trigger points than those who do not suffer from migraine. Furthermore, the number of trigger points a person has is related to how frequently they get migraine attacks and how severe these episodes are.⁽⁸⁾

Since trigger points have been identified as a potential cause of migraine episodes, it is also believed that targeting these points can give a possible solution to relieving migraine.

Trigger point injections have been used for the treatment of various types of chronic musculoskeletal pain. When it comes to headaches, the trigger points located in the neck and head are targeted. It is expected that about 94 percent of people with migraine report pain in these trigger points, primarily in the sub-occipital and temporal regions of the brain. More than 75 percent of specialists who work with the American Headache Society report success while working with trigger point injections as a form of migraine treatment.⁽¹¹⁾

Trained professionals administer these trigger point injections with tiny needles that inject a combination of medications used to treat both inflammation and pain. There is a variety of drugs that are used, with the most common ones being:^{(12, 13, 14)}

• Corticosteroids
• Local anesthetics
• Neurotoxins
• Alpha-adrenergic antagonists
• Non-steroidal anti-inflammatory agents (NSAIDs)

While there is little evidence to show that any one of these medications works better than the other, but usually local anesthetics are chosen as the preferred choice. These medications help numb the area that is being treated and help stop inflammation, thus reducing the pain signals that are sent to the brain to cause pain.

To begin treatment with trigger point injections, you will be asked to sit down comfortably. Your doctor will palpate or touch the muscles where your trigger points are located. Some of the most common muscles that are targeted for administering these injections include:

• Cervical paraspinal
• Frontalis
• Levator scapulae
• Masseter
• Occipitalis
• Sternocleidomastoid
• Temporalis
• Trapezius

Once the doctor locates the muscle where the injection has to be given, they will pinch a little bit of tissue and administer it. You may need to come back to get additional injections, and you may also have to stay in the office or hospital for some time, during which the healthcare team will observe you for any adverse reactions to the injection.

There is a lack of too many extensive studies to show how effective these injections are in treating migraine, but whatever evidence is there to date is quite promising. A study done in 2015 found that the use of such injections was more effective at controlling and treating migraine as compared to medications alone.⁽¹⁵⁾ Other studies have found that trigger point injections combined with other migraine treatments work best to relieve migraine. These studies have also shown that trigger point injections can help alleviate excruciating migraine pain in just under two hours.⁽⁸⁾

Evidence shows that severe side effects are very rare with trigger point injections.⁽¹⁶⁾ However, there can be some side effects, such as:

• Muscle injury
• Nerve damage
• Bleeding
• Infection
• Allergic reactions or anaphylaxis
• Dizziness

Most side effects are usually pretty mild and can be reduced by using smaller needles and lower medication doses, along with careful cleaning of the injection site before administering the injection.

Once the injection has been given, you can return home without any restrictions. In some cases, the administering of the trigger point injections and manipulation of the muscle can cause some referred pain, which means pain in another part of the body instead of the one that was treated with the injection.

When it comes to migraine pain, some people report experiencing relief within hours itself, while others do not experience any relief. If the treatment works, you will experience relief from migraine pain, and the effect of the injection can last for several weeks before you need another one.⁽¹⁷⁾

The cost of trigger point injections varies depending on the place where you live, but it can cost around $200 per site. Additional fees might be charged for administering the injection and any other services that were performed. Depending on the facility where you take the injection, you may avail some discounts for signing up for taking multiple injections at once, or you can choose to have them administered in more than one area at the same time.

Like any other medical treatment, what is found to be medically necessary for you by your doctor is usually covered by insurance. However, the specific coverage does depend on why the doctor has specified the treatment and also on the kind of insurance plan you have.

Trigger point injections are used to treat the following types of headaches and migraine attack types:⁽¹⁸⁾

• Chronic migraine
• Chronic tension headache
• Status migrainosus
• New daily persistent headache
• Episodic tension-type headache
• Chronic cluster headache
• Migraine without aura
• Migraine with aura
• Episodic cluster headache
• Hemicrania continua

Your doctor may also recommend trigger point injections with other forms of headache, but there are a couple of things that could prevent you from availing this treatment. Contraindications for this treatment are conditions that make this injection inadvisable, including:

• Any ongoing infection
• Injuries under the injection site
• Open skull defects
• Allergies to anesthetics

Some people may also need to take special precautions, including those who are pregnant or taking blood thinners.

Trigger point injections can help relieve migraine pain by decreasing the sensitivity of the muscle fibers around the neck and head. However, these injections don’t work for everyone, and they can be quite expensive if your insurance does not cover them. You can speak with your doctor to find out whether there is an option to go in for these injections. Also, discuss the potential risks and costs associated with the procedure before you make a decision.

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