The effect of simultaneous administration of occipital nerve block and cervical myofascial trigger point injection (MTrPI) on headache parameters in chronic migraine patients.

BACKGROUND AND AIM: Peripheral myofascial mechanisms have been identified as contributors to migraine pathophysiology. The specific comorbid relationship between migraine and cervical trigger points may exacerbate the occurrence and severity of migraine attacks. Trigger point injections (TPIs) are frequently employed to address headaches and alleviate migraine symptoms. The current study explores the impact of concurrent myofascial trigger point injection (MTrPI) and occipital nerve block (greater occipital nerve block [GONB] + lesser occipital nerve block [LONB]) on the severity of headaches and the number of migraine attacks in individuals with chronic migraine (CM) and cervical myofascial trigger points (MTrPs), with a comparison of occipital nerve block alone (GONB + LONB). During trigger point examination and injection, trapezius, levator scapulae, splenius capitis, temporalis, and sternocleidomastoid muscles were targeted. We planned the treatment based on whether they were in the muscle groups we determined, rather than the number of trigger points. MATERIALS AND METHOD: This study enrolled 62 individuals experiencing CM with bilateral headache and cervical MTrP who sought care at the Algology Unit within the Departments of Neurology and Physical Therapy and Rehabilitation at Siirt Training and Research Hospital between 2020 and 2022. The CM cohort was stratified into two groups: group 1 received trigger point injections (TrPI), while group 2 underwent concurrent bilateral occipital nerve block (GONB + LONB) and TrPI. Both groups underwent three treatment sessions with bupivacaine 0.5% (1 ml = 5 mg) in weeks 1, 2, and 4. Visual analog scale (VAS) was used to measure the patients' pain intensity. The evaluation included the assessment of the monthly migraine frequency and visual analog scale (VAS) p score for pain before treatment (BT) and after treatment (AT), conducted at baseline and during follow-up visits. Analysis of the data was conducted utilizing IBM SPSS Statistics for Windows version 28.0 software. RESULTS: Among patients diagnosed with CM and MTrPs, 32 individuals (51.6%) underwent GONB and LONB, while 30 patients (48.4%) received simultaneous GONB, LONB, and cervical MTrPI. Within the entire sample, 51 participants (82.3%) were female, and 11 (17.7%) were male, with a mean age of 32.81 ± 10.75 years. With an average age of 32.81 ± 10.75 years, there was no statistically significant variance between the two groups (p = 0.516). Of the total cohort, 45 individuals (72.6%) reported experiencing headaches persisting for 12 months or longer. Among CM patients, 80% had active trigger points, while 20% had latent trigger points. No statistically significant difference was observed between the groups concerning TrPs (p = 0.158), and the distribution of TrPs was homogenous across the two groups. In group 1, the median (min-max) monthly frequency of migraines reduced from 18.5 days (range: 15.0 to 25.0 days) before treatment to 12.0 days (range: 7.0 to 17.0 days) after treatment (p = 0.000). In group 2, the median monthly frequency of migraines reduced from 16.5 days (range: 15.0 to 22.0 days) before treatment to 4.0 days (range: 2.0 to 8.0 days) after treatment (p = 0.000). The median (min-max) VAS score in group 1 was 8.0 (range: 5.0 to 9.0) before treatment, 4.0 (range: 2.0 to 6.0) at week 1, and 5.0 (range: 4.0 to 8.0) at week 4 (p = 0.000). In group 2, the median VAS score was 7.0 (range: 5.0 to 9.0) before treatment, 0.0 (range: 0.0 to 0.3) at week 1, and 2.0 (range: 0.0 to 0.3) at week 4 (p = 0.000). There were significant distinctions between the groups in terms of both the monthly count of migraine days and the severity of headaches (p = 0.000). CONCLUSION: The combination of repeated MTrPIs and ONB proves more effective than ONB alone in managing patients with CM and cervical MTrP. In patients with CM, performing TrPs examination and adding treatments for this may contribute to the treatment. In cases where patients endure prolonged episodes of headache associated with chronic migraine, the inclusion of trigger point injections alongside peripheral nerve blocks may offer enhanced therapeutic benefits.

The Role of Positional Release Therapy in Treating Recalcitrant Brachial Plexus Neuritis: A Case Report.

A 17-year-old female soccer player presented with severe right shoulder pain and scapular winging due to brachial plexus neuritis. The patient was diagnosed with Parsonage-Turner syndrome, a rare condition often resistant to traditional physical therapy, which typically persists for 6 months to years, at times requiring surgical intervention. Over the course of 6 weeks, the patient received positional release therapy once a week coupled with electrical modalities, massage, and a daily home exercise program. This case report is unique because we believe we were the first to use positional release therapy for treatment and the patient's condition resolved more quickly than is typically reported.

Chiropractic management of a geriatric patient with idiopathic neuralgic amyotrophy: a case report.

OBJECTIVE: The purpose of this paper is to describe chiropractic management of a patient with neuralgic amyotrophy (NA) and to provide discussion regarding presentation, differential diagnosis, management and prognosis of idiopathic NA. CASE PRESENTATION: An 85 year old Caucasian male presented to a chiropractic clinic with right periscapular and lateral rib cage pain. The patient had previously sought evaluation and treatment from multiple health care providers and underwent multiple interventions without relief. INTERVENTION AND OUTCOME: The patient was managed with a course of chiropractic care and an ongoing home exercise program was carried out. The patient reported spontaneous resolution of pain approximately 14 months post onset. SUMMARY: NA is a poorly known clinical entity amongst health care providers and poses challenges in timely and proper diagnosis. Recognition of NA is important for patients to be best managed and for more optimal patient outcomes to be achieved.

OBJECTIF: Ce document a pour objectif de décrire la prise en charge chiropratique d'un patient atteint d'amyotrophie névralgique (AN), ainsi que de discuter de la présentation, du diagnostic différentiel, de la prise en charge et du pronostic d'AN idiopathique. EXPOSÉ DE CAS: Un homme blanc de 85 ans se présente à une clinique de chiropratique en se plaignant de douleur périscapulaire droite et latérale à la cage thoracique. Le patient s'était déjà fait évalué et traité par nombre de fournisseurs de soins de santé et avait subi de nombreuses interventions, sans soulagement. INTERVENTION ET RÉSULTAT: Le patient a reçu des soins chiropratiques et on lui a créé un programme d'exercices à domicile. Le patient a déclaré une disparition spontanée de la douleur environ quatorze mois après l'apparition des symptômes. RÉSUMÉ: L'AN est une entité clinique mal connue des fournisseurs de soins de santé, ce qui complique le fait de parvenir à un diagnostic exact avec rapidité. Il est important de reconnaître l'AN pour assurer une prise en charge optimale des patients et obtenir des résultats optimaux.

Clinical Investigation and Nursing Care of Neuralgic Amyotrophy / 中国康复理论与实践

@#ObjectiveTo investigate the clinical features and nursing care of neuralgic amyotrophy.MethodsThe course of the treatment and nursing in a group of patients with idiopathic neuralgic amyotrophy was analyzed retrospectively.ResultsMyoatrophy was found in all patients, while 42% of patients were involved in both sides. Serious pain, as initial symptom, was found in 92% of patients. After medical and physical treatment, as well as holistic nursing care, the pain disappeared in 1～2 weeks in all patients but one. All patients had been followed up for 2～13 months, muscle power was recovered in 67% of all patients, partially recovered in 33% of patients.ConclusionThe careful nursing and observation is very helpful for recover of neuralgic amyotrophy and can decrease complications.