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CHICAGO -- Inflammation and edema of the trapezius muscles appeared linked to tension and migraine headaches, a small prospective cohort study found.

Patients with mixed-type tension and migraine headaches demonstrated the highest muscle T2 MRI values (31.4 ms on the right and left sides), and the average value was significantly higher compared to those with tension headaches only (30.8-30.9 ms) and healthy controls (30.0-30.2 ms; P<0.001 for each comparison), reported Nico Sollmann, MD, of University Hospital Ulm in Germany, in his presentation at the annual meeting of the Radiological Society of North America.

Higher T2 signals in the trapezius muscles were associated with more headache days (β coefficient=2.04, 95% CI 0.05-4.03, P=0.04) and with twice the likelihood of neck pain (OR 2.26, 95% CI 1.04-4.90, P=0.04). Results of the study were also earlier this year in the Journal of Headache and Pain.

"With this preliminary data," Sollmann told MedPage Today, "we are seeing an association; but it may be that the head and neck muscles may be a contributor to headache or the other way around. There is this interconnection between the brain and the neck muscles."

"Our findings support the role of neck muscles in the pathophysiology of primary headaches," Sollmann said. "Therefore, treatments that target the neck muscles could lead to a simultaneous relief of neck pain, as well as headache."

Muscle T2 mapping could be used to stratify patients with primary headaches and to track potential treatment effects for monitoring, he suggested.

"The quantified inflammatory changes of neck muscles significantly correlate with the number of days lived with headache and the presence of subjectively perceived neck pain," he said. "Those changes allow us to differentiate between healthy individuals and patients suffering from primary headaches."

Trapezius muscle T2 had an area under the curve of 0.82 for differentiating between mixed-type tension and migraine headaches and no history of regular headaches.

Tension-type headaches affect two out of every three adults in the U.S., the researchers noted. While these headaches are typically associated with stress and muscle tension, their exact origin is not fully understood. Migraines affect as many as 37 million Americans.

"At this stage, this is a diagnostic study, and we are trying to establish an objective biomarker based on imaging to differentiate between tension-type headaches and migraine in healthy subjects," Sollmann said. "In the long run, we are going to apply magnetic stimulation to neck muscles, which can be an effective treatment to relieve pain both at the neck level and at the brain level."

"We will see if we can capture MRI changes in order to monitor treatment effects," he added. "This approach is non-invasive and doesn't require medications, so it could be a useful approach for some people."

The Ulm researchers are in the midst of a controlled clinical trial to determine if treatment of the inflammation and edematous changes results in an observable difference in these individuals, he said.

The research team enrolled 50 individuals into their preliminary study. The participants ranged in age from 20 to 31 years, and 82% were women.

A total of 32% had tension-type headaches, 24% had mixed-type tension and migraine headaches, and 44% were healthy controls who did not report regular headache issues. Average headache days per month were significantly higher in the headache groups compared to controls, at 10.1, 10.3, and 1.9, respectively. Neck pain was also significantly more common in the headache groups: 63% of the tension-type headache-alone group, 83% of the group with mixed-type headaches, versus none of the healthy controls.

All the subjects underwent fat-suppressed T2‐prepared three-dimensional turbo spin-echo MRI.

The bilateral trapezius muscles were manually segmented, followed by muscle T2 extraction. "The participants filled out a 30-day headache diary before they underwent the MRI, and we saw a significant difference in the number of days with headache and the T2 changes observed in the MRI T2 mapping sequence," Sollmann said.

No association was seen between T2 values and myofascial trigger points as determined by manual palpation of the trapezius muscles.

In commenting on the study, Joshua Wibecan, MD, a resident in radiology at Boston Medical Center and Boston University, noted potential implications of this work for how clinicians screen for headache.

"For example, currently we don't often look at the trapezius muscles, so it is possible that this could change the diagnostic workup for these patients," he told MedPage Today.

Sollmann suggested that might be a possibility. "We could give someone with headache and neck pain a quick T2 examination and we could determine if there were neck abnormalities. And from that we could say that the patients would be a good candidate for the magnetic stimulation therapy," he said. "My personal feeling is that there is a connection between neck inflammation -- and that it is mainly manifested in the T2 increases, which reflect edematous changes."

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