The Journal Headache: Review of Trigger Point Injections in Headache Management. Implications to Neuromuscular Dentistry

A new review article “Peripheral Nerve Blocks and Trigger Point Injections in Headache Management – A Systematic Review and Suggestions for Future Research.” (PubMed abstract below) discusses the use of peripheral nerve blocks and trigger point injections in the treatment of headaches. While they are idely used there is no general agreement on what injections should be one or what regimen is most effective. They authors did note that results were generally successful. They found that the Greater Occipital nerve block was the most frequently discussed it the literature.

What is the role of these injections when Neuromuscular Dentistry is utilized to eliminate or prevent or trea migraines, chronic daily headaches, sinus headaches, tension-type headaches of facial pain. If a diagnostic orthotic is so effective in correcting the causes of these headaches why are injections ever necessary.

The answer is that during the diagnostic phase of treatment a host of chronic issues remain. Chronic Mofascial trigger points may need to be broken up with injections, massage accupresure or other manual medicine techniques. The neuromuscular position will help prevent new trigger points. Prolotherapy is also used to repair damaged tissues. I rarely use corticosterois in my treatment but as a short term treatment in disorders like coronoind teninitis. Long term correction is the result of a healthy physiologic position that allows healing of the tissues.

Patients seeking headache treatment thru neuromuscular dentistry are advise to look for experience practioners with multiple tools to address a multitude of specific problems. The underlying basis for physiologic health is the neuromuscular position and its positive effects on the Trigeminal Nervous system. The elimination of pathologic muscle accomadation may prevent the majority of future trigger point formation but will not necessarily eliminate all accumulated pathology.

Neuromuscular Dentistry can give remarkable relief but a comprehensive evaluation and treatment usually illuminates the presence of multiple related disorders that should also be addressed.

Sphenopalatine ganglion blocks and referral for Stellate Ganglion blocks should be considered if autonomic symptoms are present. Reflex Sympathetic Dystrophy (RSD) also called Complex Regional Pain Syndrome (CRPS) frequently are accompanied by hyperalgesia, allodynia or other problems reelated to central sensitization.

Headache. 2010 May 7. [Epub ahead of print]
Peripheral Nerve Blocks and Trigger Point Injections in Headache Management – A Systematic Review and Suggestions for Future Research.
Ashkenazi A, Blumenfeld A, Napchan U, Narouze S, Grosberg B, Nett R, Depalma T, Rosenthal B, Tepper S, Lipton RB.

From the Neurologic Group of Bucks/Montgomery County, Doylestown, PA, USA (A. Ashkenazi); The Headache Center of Southern CA – Headache Center, Encinitas, CA, USA (A. Blumenfeld); Albert Einstein College of Medicine – Neurology, Bronx, NY, USA (U. Napchan, B. Grosberg, and R.B. Lipton); Cleveland Clinic Foundation – Pain Management Department, Cleveland, OH, USA (S. Narouze); Texas Headache Associates, San Antonio, TX, USA (R. Nett); Harvard Beth Israel Deaconess Medical Center – Neurology, Waterville, ME, USA (T. DePalma); Ellis Hospital – Neurology, Schenectady, NY, USA (B. Rosenthal); Headache Center – Neurological Institute, Cleveland, OH, USA (S. Tepper).
(Headache 2010;**:**-**) Interventional procedures such as peripheral nerve blocks (PNBs) and trigger point injections (TPIs) have long been used in the treatment of various headache disorders. There are, however, little data on their efficacy for the treatment of specific headache syndromes. Moreover, there is no widely accepted agreement among headache specialists as to the optimal technique of injection, type, and doses of the local anesthetics used, and injection regimens. The role of corticosteroids in this setting is also debated. We performed a PubMed search of the literature to find studies on PNBs and TPIs for headache treatment. We classified the abstracted studies based on the procedure performed and the treated condition. We found few controlled studies on the efficacy of PNBs for headaches, and virtually none on the use of TPIs for this indication. The most widely examined procedure in this setting was greater occipital nerve block, with the majority of studies being small and non-controlled. The techniques, as well as the type and doses of local anesthetics used for nerve blockade, varied greatly among studies. The specific conditions treated also varied, and included both primary (eg, migraine, cluster headache) and secondary (eg, cervicogenic, posttraumatic) headache disorders. Trigeminal (eg, supraorbital) nerve blocks were used in few studies. Results were generally positive, but should be taken with reservation given the methodological limitations of the available studies. The procedures were generally well tolerated. Evidently, there is a need to perform more rigorous clinical trials to clarify the role of PNBs and TPIs in the management of various headache disorders, and to aim at standardizing the techniques used for the various procedures in this setting.

PMID: 20487039 [PubMed – as supplied by publisher]