MRI in migraineurs: are there abnormalities in the area where the myofascial trigger points are palpable and in volume measurements?

INTRODUCTION: Patients with migraine may present a higher quantity of myofascial trigger points (MTrP) and alterations in the cervical muscles when compared to non-migraineurs. The magnetic resonance imaging (MRI) is a robust method for the study of human soft tissues and could be useful to investigate these points. OBJECTIVES: To identify the presence of MTrP in the descending fibers of the trapezius muscle in women with migraine and to quantify the muscle volume by MRI, correlating it with the headache characteristics. METHODS: A cross-sectional analytic study was conducted among 14 women, eight in migraine group, and six in without migraine group. The presence of MTrP was evaluated using Simons' criteria, and linolenic acid capsules subsequently marked the areas. MRI was performed with 1.5T, T1-weighted sequence, and T2 in the axial, sagittal, and coronal planes. The T1-weighted sequences were performed with and without gadolinium contrast. RESULTS: The T1-weighted image analysis with and without gadolinium did not show any signal alteration in the MTrP areas in both groups. The migraine group presented more MTrP in the trapezius muscle (MD [95%CI] = 1[1; 3]; MD [95%CI] = 1[0; 2] right and left side, respectively), and a smaller muscle volume (MD [95%CI] = -198.1[-338.7;-25.6], MD [95%CI] = -149.9[-325.05;-0.13] right and left side, respectively) than non-migraineurs. The migraine frequency presented a negative strong correlation with the trapezius volumes (r = -0.812; p = 0.014). CONCLUSION: Migraineurs present more MTrP and a smaller muscle volume than non-migraineurs. The trapezius volume is negatively correlated with migraine frequency. MRI is not a suitable outcome measure for assessing MTrP.

Contract-relax technique compared to static stretching in treating migraine in women: A randomized pilot trial.

INTRODUCTION: Physical therapy is often used by patients with headache, including modalities such as muscle stretching exercises. OBJECTIVES: To evaluate the feasibility of a pilot trial aimed at determining the efficacy of the proprioceptive neuromuscular facilitation (PNF) contract-relax technique compared to static stretching for treating migraineurs. METHODS: This pilot trial allocated 30 migraineur women (23 ±â€¯4 years) into PNF (n = 15) and static stretching groups (n = 15). The interventions were performed twice a week (16 sessions, 8 weeks). The feasibility outcomes included successful random allocation of 30 patients during a 12-month period, the proportion of eligible patients randomly assigned to each group, and the proportion of those who completed the 30-day follow-up. The outcomes of headache characteristics; medication intake; severity of migraine-related disability; neck disability; cervical mobility; pressure pain threshold; adverse effects and global perception of change were evaluated at baseline, after the end of treatment and after 30-day follow-up. RESULTS: The recruitment rate was 4.66% participants/month. The proportion of eligible patients randomly assigned to each group and for those who completed the 30-day follow-up was 88.23% and 100%, respectively. Both groups improved in headache-related outcomes. The perception of change was important for 67% of the PNF group and 47% of the static stretching group. No differences were found between groups regarding the studied outcomes. CONCLUSION: This is a feasible pilot trial. The PNF contract-relax technique was no more effective than static stretching for treating migraine, but both techniques improved the headache, the severity of migraine-related disability and the satisfaction after treatment.

Intra and inter-rater reliability of ultrasonographic evaluation of longus colli muscle in women with migraine / Confiabilidade intra e interexaminadores da avaliação ultrassonográfica do músculo longo do pescoço em mulheres com migrânea

Objetivo: Determinar a confiabilidade intra e interexaminadores das medidas ultrassonográficas do músculo longo do pescoço em mulheres com e sem migrânea. Métodos: Trata-se de um estudo transversal, avaliando 20 mulheres com idade entre 20 e 24 anos (22 ± 2). Foram realizadas duas avaliações ultrassonográficas da área de secção transversa (cm2) do músculo longo do pescoço, em repouso e em contração com intervalo de uma semana entre elas, por dois examinadores cegos. Para análise estatística, foram utilizados o coeficiente de correlação intraclasse (ICC) e os limites de concordância. Resultados: A confiabilidade intraexaminador do grupo com migrânea, em repouso e contração, foi excelente à direita e moderada à esquerda; no grupo sem migrânea variou de excelente (0,93) no repouso, à pobre (0,35) na contração. A confiabilidade interexaminadores foi excelente (ICC > 0,75) à direita e à esquerda, no repouso, em ambos os grupos. Na contração, variou de moderada (ICC = 0,71), no lado esquerdo no grupo sem migrânea, à excelente (ICC > 0,75) nas demais mensurações. Foram observados baixos limites de concordância dos intervalos de confiança em todas as medidas. Conclusão: Foram observados baixos limites de concordância, de acordo com o intervalo de confiança, na confiabilidade das medidas ultrassonográficas do músculo longo do pescoço em mulheres com migrânea. (AU)

Objective: To determine intra and inter-rater reliability of ultrasonographic measures of the longus colli muscle in women with and without migraine. Methods: This is a cross-sectional study involving 20 women aged between 20 and 24 years (22 ± 2). Two ultrasonographic assessments, conducted one week apart by two blind examiners, were made of the crosssectional area (cm2) of the longus colli muscle, at rest and in contraction. Statistical analysis used the intraclass correlation coefficient (ICC) and limits of agreement. Results: Intra-rater reliability in the group with migraine, at rest and in contraction, was excellent on the right and moderate on the left; in the group without migraine it ranged from excellent (0.93) at rest to poor (0.35) in contraction. Inter-rater reliability was excellent (ICC > 0.75) at rest on the right and left, in both groups. In contraction, it ranged from moderate (ICC = 0.71) on the left in the group without migraine to excellent (ICC > 0.75) in the other measurements. Low limits of agreement were observed for the confidence intervals in all the measures. Conclusion: According to the confidence interval, low limits of agreement were observed, regarding the reliability of ultrasonographic measures of the longus colli muscle in women with migraine.(AU)

Analysis of dimensions, activation and median frequency of cervical flexor muscles in young women with migraine or tension-type headache.

BACKGROUND: Central and peripheral mechanisms may be involved in migraine and tension-type headache pathogenesis, however the role of muscle disorders in their pathophysiological mechanisms remains unclear. OBJECTIVES: To assess the association between the presence of migraine or tension-type headache and changes in longus colli muscle dimensions and sternocleidomastoid muscle activity. METHOD: An observational study with 48 women comparing the following groups: migraine (n=21), tension-type headache (n=16), and control (n=11). The cross-sectional area, lateral and anteroposterior dimensions, and shape ratio of the longus colli muscle were measured using ultrasound. The activation of the sternocleidomastoid muscle was assessed by signal amplitude and the decline in median frequency using surface electromyographic analysis. RESULTS: The dimensions of the longus colli muscle did not differ between groups (p>0.05). Post-test analysis showed lower sternocleidomastoid muscle activation on both sides, at the onset of contraction, in the group with tension-type headache when compared to the control group {right sternocleidomastoid [tension-type headache: 0.39 (0.30-0.49); control: 0.58 (0.42-0.76); p=0.026] and left sternocleidomastoid [tension-type headache: 0.39 (0.31-0.48); control: 0.60 (0.42-0.79); p=0.039], Tukey's post hoc test}. There was no difference between the three groups in sternocleidomastoid muscle activation, on both sides, at the end of contraction (p>0.05). Intergroup analysis showed no difference in the rate of decline in median frequency (p>0.05). CONCLUSION: The group with tension-type headache exhibited less activation at the onset of sternocleidomastoid muscle contraction. No association was observed between the presence of headache and alterations in longus colli muscle dimensions, median frequency, and sternocleidomastoid muscle activation at the end of contraction.

Analysis of dimensions, activation and median frequency of cervical flexor muscles in young women with migraine or tension-type headache

Background: Central and peripheral mechanisms may be involved in migraine and tension-type headache pathogenesis, however the role of muscle disorders in their pathophysiological mechanisms remains unclear. Objectives: To assess the association between the presence of migraine or tension-type headache and changes in longus colli muscle dimensions and sternocleidomastoid muscle activity. Method: An observational study with 48 women comparing the following groups: migraine (n=21), tension-type headache (n=16), and control (n=11). The cross-sectional area, lateral and anteroposterior dimensions, and shape ratio of the longus colli muscle were measured using ultrasound. The activation of the sternocleidomastoid muscle was assessed by signal amplitude and the decline in median frequency using surface electromyographic analysis. Results: The dimensions of the longus colli muscle did not differ between groups (p>0.05). Post-test analysis showed lower sternocleidomastoid muscle activation on both sides, at the onset of contraction, in the group with tension-type headache when compared to the control group {right sternocleidomastoid [tension-type headache: 0.39 (0.30-0.49); control: 0.58 (0.42-0.76); p=0.026] and left sternocleidomastoid [tension-type headache: 0.39 (0.31-0.48); control: 0.60 (0.42-0.79); p=0.039], Tukey's post hoc test}. There was no difference between the three groups in sternocleidomastoid muscle activation, on both sides, at the end of contraction (p>0.05). Intergroup analysis showed no difference in the rate of decline in median frequency (p>0.05). Conclusion: The group with tension-type headache exhibited less activation at the onset of sternocleidomastoid muscle contraction. No association was observed between the presence of headache and alterations in longus colli muscle dimensions, median frequency, and sternocleidomastoid muscle activation at the end of contraction. .

Application of the biosphere reserve concept to urban areas: the case of São Paulo City Green Belt Biosphere Reserve, Brazil--São Paulo Forest Institute: a case study for UNESCO.

This report attempts to bring together contributions from technicians and scientists studying and dealing with the manifold aspects of the São Paulo City Green Belt Biosphere Reserve. It will highlight the understanding by UNESCO of the important role that biosphere reserves can play in the urban setting.