Prevalence and Significance of Muscle Tenderness During Common Migraine Attacks

SYNOPSIS To analyse from which extracranial tissues the pain of common migraine arises, 50 patients with typical common migraine were studied during the attack. Systematic recording of pain in 18 regions of the head and neck was followed by systematic palpation of 26 cranial and neck muscles and tendon insertions. All 50 patients were tender, and tenderness corresponded to pain in all but 2 cases. The most frequent sites of tenderness were: sternocleidomastoid, anterior temporal, neck and shoulder muscles, the coronoid process and occipital insertions. Referred pain was found in 73% of patients. Major pathways were sternocleidomastoid to temporofrontal area or occiput, occiput to vertex or temporofrontal area, neck to vertex or brow. The most tender spots were infiltrated with lidocaine 1.5% or saline double blindly. Results were judged clinically and by visual analog scales. 2648 patients were symptom free after 70 minutes which is significantly better than with medical treatment (p<0.01). There was no difference between lidocaine and saline. The study demonstrates that pericranial muscles and tendon insertions are important for common migraine pain.