Presented at the 2013 AAPM Annual Meeting « Back

Masseter Muscle Trigger Point Injections for Differential Diagnosis of Head Pain

Toni J. Hanson, MD, hanson.toni@mayo.edu¹, Rand L. Redfern, DDS², (1) Mayo Clinic, Rochester, Minnesota, (2) Maxillofacial Radiology Associates, Colorado Springs, Colorado

Introduction: Differential diagnosis of head and facial pain is a challenge encountered by medical specialties and dentists. Etiologies can include the muscles of mastication. The masseter muscle is a powerful, well vascularized muscle which can develop trigger points. Masseter trigger points can be present in head pain patients. Practitioners need to consider the importance of the role of the muscles of mastication in the production of head pain. Materials and Method: Five patients are presented. Physical examination revealed trigger points in the masseter muscles. Trigger point injections were administered into the masseter muscles and the posterior fibers of the temporalis muscles in the mandible, consisting of 1.8cc of 2% Lidocaine. Results: Five of five patients who demonstrated trigger points in the masseter muscle experienced from 60-80% relief within a few minutes of the injections. In the context of the successful masseter trigger point injections, further treatment was directed toward decreasing the activity of the masseter and temporalis muscles. Further management techniques included physical therapy and maxillary orthotics to enhance muscle relaxation. Conclusion: Trigger point injections in the muscles of mastication can be helpful in the diagnosis and management of patients with suboptimally managed head pain, including those with chronic pain.

Funding: None