A small prospective cohort study conducted by Nico Sollmann, MD, at the University Hospital Ulm in Germany, revealed a potential link between inflammation and edema of the trapezius muscles and tension and migraine headaches. The study, presented at the Radiological Society of North America’s annual meeting and published in the Journal of Headache and Pain, included 50 participants aged 20 to 31, with 82% being women.
Patients experiencing mixed-type tension and migraine headaches exhibited the highest muscle T2 MRI values (31.4 ms on both sides), significantly surpassing those with tension headaches alone (30.8-30.9 ms) and healthy controls (30.0-30.2 ms; P<0.001 for each). Higher T2 signals in the trapezius muscles were associated with more frequent headache days and double the likelihood of neck pain. Trapezius muscle T2 demonstrated a promising ability to differentiate between mixed-type tension and migraine headaches and individuals with no history of regular headaches (area under the curve of 0.82).
“With this preliminary data,” Sollmann said 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.”
“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 stated. “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.”
Tension-type headaches, affecting two-thirds of U.S. adults, are commonly linked to stress and muscle tension, though their exact origin remains unclear. Migraines, affecting around 37 million Americans, pose a significant health concern. The researchers at the University of Ulm are currently conducting a controlled clinical trial to investigate whether treating inflammation and edematous changes in the trapezius muscles can lead to observable improvements in individuals with tension and migraine headaches.
“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 stated.
The study sheds light on the potential connection between trapezius muscle changes and tension and migraine headaches. The ongoing clinical trial may provide further insights into the impact of addressing muscle inflammation on headache symptoms, offering potential implications for how clinicians screen and treat headaches.
“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 stated “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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