Can Trigger Point Injections Treat Migraine?

There are lots of triggers for migraine attacks, but one specific cause can be the stimulation of certain areas of muscle called trigger points. Trigger points have been connected to musculoskeletal and myofascial pain when they are stimulated. These points develop in the tight, sensitive bands of skeletal muscles.

While some therapies target trigger points through massage or other types of manipulation, they can also be a cause of irritation. Trigger points in the muscles of the head, neck, and shoulders may cause headaches, and are common in tension headaches and migraine. In fact, studies have found that people with migraine may have more trigger points than people who don’t, and that the number of trigger points someone has is connected to how often they get migraine attacks and how severe they are.

Since trigger points have been identified as a possible cause of migraine attacks, they’ve also been targeted as a possible solution.

Trigger point injections can be used to treat several kinds of chronic musculoskeletal pain. With headaches, trigger points in the head and neck are targeted most often. About 94 percent of people with migraine report trigger point pain, mainly in the temporal and sub-occipital areas of the brain, and more than 75 percent of specialists with the American Headache Society report using trigger point injections as migraine treatment.

These injections are done by trained professionals who use tiny needles to inject a combination of medications to treat pain and inflammation. A number of medications can be used, but the most common include:

• local anesthetics
• corticosteroids
• alpha-adrenergic antagonists
• neurotoxins
• non-steroidal anti-inflammatory agents

There is little research to show that any of these medications are better than another, although local anesthetics are often the preferred choice. These medications numb the area being treated or stop inflammation, reducing pain signals that are sent to the brain to cause attacks.

To start the treatment, you will be seated and your doctor will touch, or palpate, the muscles where your trigger points are located. Common muscles targeted for these injections include:

• trapezius
• sternocleidomastoid
• cervical paraspinal
• levator scapulae
• temporalis
• masseter
• frontalis
• occipitalis

Once the area for the injection has been located, your doctor will pinch a small bit of tissue and perform the injection. You may have to return for additional injections, and you will usually be observed in the office for any reactions before you can go home.

There haven’t been many large studies on the effectiveness of these injections, but the research that has been done is promising. A study in 2015 found that the use of trigger point injections worked better at controlling and treating migraine than medication alone. Other reports suggest using these injections alongside other migraine treatments for the best effect.

One report showed that trigger point injections can reduce severe migraine pain in as little as 2 hours.

Serious side effects are rare with trigger point injections. When they do occur, the most common are:

• nerve damage
• muscle injury
• dizziness
• allergic reactions or anaphylaxis
• bleeding
• infection

These risks can be reduced by using smaller needles and medication doses, as well as careful cleaning of the injection site before treatment.

After your injection, you should be able to return home without restrictions. In some cases, trigger point injections and manipulation can cause referred pain, which is pain in another area of the body other than the one that was treated.

In terms of migraine pain, some people have relief within hours, while others have none at all. If the treatment works to relieve migraine pain, it can last for several weeks before another injection is needed.

Prices can vary. Injections alone can cost around $200 per site, with additional fees charged for administration and other services performed. Depending on the facility, you may also be able to get discounts for signing up for multiple injections at once, or by having more than one area at a time treated.

Like most medical treatments, what’s deemed medically necessary by your doctor is typically covered by Medicare, Medicaid, and private insurance providers. Specific coverage will depend on why your doctor orders the treatment and on the type of insurance plan you have.

Trigger point injections are typically used to treat the following headaches and migraine attack types:

• chronic tension headache
• chronic migraine
• new daily persistent headache
• status migrainosus
• episodic tension-type headache
• chronic cluster headache
• migraine without aura
• hemicrania continua
• migraine with aura
• episodic cluster headache

Your doctor may also consider this treatment with other headache types, but there are a few specific things that could prevent you from using this treatment.

Contraindications are conditions that make treatment or procedure inadvisable. Contraindications — conditions that make the procedure inadvisable — include:

• current infection
• open skull defects or injuries under the injection site
• allergies to anesthetics

There may also be special precautions taken for people who are taking blood thinners or are pregnant.

To find someone in your area that performs trigger point injections, start by asking your doctor for a referral. In many cases, these procedures are performed by nerve and spine — or pain — specialists.

Trigger point injections may help relieve migraine pain by reducing the sensitivity of muscle fibers around your head and neck. These injections don’t work for everyone, and they can be expensive if your insurance doesn’t cover the service. Speak with your doctor about your treatment options, and whether injections could work for you. Discuss the risks and costs of the procedure with a specialist before making a decision.