Russian Military Medical Academy ReportsRussian Military Medical Academy Reports2713-23152713-2323Eco-Vector11188310.17816/rmmar111883Review ArticleThe place of myofascial syndrome in the genesis of headaches and facial painsTardovMikhail V.<p>M.D., D.Sc. (Medicine), Professor of the General Medical Practice Department</p>mvtardov@rambler.ruhttps://orcid.org/0000-0002-6673-5961BoldinAlexey V.<p>M.D., D.Sc. (Medicine)</p>drboldin@rambler.ruhttps://orcid.org/0000-0001-9319-2061SturovNikolay V.<p>M.D., Ph.D. (Medicine)</p>sturov-nv@rudn.ruhttps://orcid.org/0000-0002-3138-8410KobylyanuGeorgiy N.<p>M.D., Ph.D. (Medicine)</p>kobylyanu-gn@rudn.ruhttps://orcid.org/0000-0002-8303-514XThiagoFreire Da Silvafreyre-da-silva-ts@rudn.ruhttps://orcid.org/0000-0001-8763-947XPeoples' Friendship University of RussiaThe First Sechenov Moscow State Medical University under Ministry of Health of the Russian Federation171120224144294371310202220102022Copyright © 2022, Eco-Vector2022<p>The article discusses the patterns of development and the main features of myofascial syndrome. Emphasis is placed on the myofascial syndrome involving head and face muscles with characterization of masks of the syndrome: irradiation zones of trigger point pain in the skeletal muscles of the cervical region are described (important role of the sternocleidomastoid muscle is emphasized), in the facial muscles and masticatory muscles. Trigger point properties are covered in detail, including painful and non-painful manifestations, such as tinnitus and congestion in the ear, dizziness, vertigo and hearing loss; as well as local vegetative symptoms. When diagnosing myofascial syndrome, it is necessary to specify in detail the anamnestic data (the time and conditions for the onset of the first manifestations), as well as to specify as many characteristics of pain as possible (the circumstances of its provocation and relief, the duration of the attack, the pain modality). The most important role belongs to palpation of the muscles with the definition of trigger points and muscle cords. The basic principles of therapy for myofascial syndrome are given: anesthesia, relaxation and stretching. Further, specific methods of drug, physiotherapeutic and manual procedures on the affected muscles are analyzed in detail. Two clinical cases from our own practice are presented, demonstrating the features of the myofascial syndrome clinical picture formation in the face area and the possibility of interrupting the pain phenomenon and non-painful manifestations by inactivating muscle triggers. The importance of joint supervision of a patient with myofascial syndrome by a multidisciplinary medical team, including, if necessary, not only neurologist and osteopath, but also an ENT doctor and a dentist, is emphasized. In conclusion, it was concluded that it is necessary to develop recommendations at the federal level for the diagnosis and treatment of myofascial syndrome.</p>cochleovestibular syndromeCosten syndromefacial musclesmyofascial syndromemuscles of masticationskeletal musclestemporomandibular jointtrigger pointвисочно-нижнечелюстной суставжевательные мышцыКостена синдромкохлеовестибулярный синдроммимические мышцымиофасциальный синдромскелетные мышцытриггерная точка[Travell JG, Simons DG. Myofascial pain. In 2 volumes. Vol. 1. Translation from English. Moscow: Meditsina Publisher; 1989. 422 р. (In Russ.)][Hoyle JA, Marras WS, Sheedy JE, et al. Effects of postural and visual stressors on myofascial trigger point development and motor unit rotation during computer work. J Electromyogr Kinesiol. 2011;21:41–48. DOI: 10.1016/j.jelekin.2010.04.006][Bubnov R.V., Klitinsky Yu.V., The use of “dry” trigger point acupuncture under ultrasound control in the treatment of temporomandibular joint dysfunction. Primary experience. Dental’nye tekhnologii. 2010;1(44):45–52. (In Russ.)][Ivanichev GA. Pathogenetic aspects of the formation and manifestation of classic muscle pain syndromes. Manual’naya terapiya. 2009;(3(35)):3–12. (In Russ.)][The International Classification of Headache Disorders, 3rd edition. Cephalalgia. 2018, Vol. 38(1) 1–211. DOI: 10.1177/0333102417738202][International Classification of Orofacial Pain, 1st edition (ICOP). Cephalalgia. 2020;40(Issue 2):129–221 DOI: 10.1177/0333102419893823][Boldin AV, Agasarov LG, Tardov MV, Kunelskaya NL. The role of temporomandibular joint dysfunction and occlusal disorders in the pathogenesis of somatogenic cochleovestibular syndrome. Almanac of Clinical Medicine. 2016;44(7):798–808. (In Russ.) DOI: 10.18786/2072-0505-2016-44-7-798-808][Fernández-Pérez AM, Villaverde-Gutiérrez C, Mora-Sánchez A, et al. Muscle trigger points, pressure pain threshold, and cervical range of motion in patients with high level of disability related to acute whiplash injury. J Orthop Sports Phys Ther. 2012;42(7):634–641. DOI: 10.2519/jospt.2012.4117][Kunelskaya NL, Tardov MV, Rudkovsky AI. et al. Meniere’s disease or…? Difficult patient. 2015;13(10–11): 47–49. (In Russ.)][Ivanov VV, Markov NM. Influence of the dentition on the postural status of the patient. Manual Therapy. 2013;3(51):83–89 (In Russ.)][Manolopoulos L, Vlastarakos PV, Georgiou L, et al. Myofascial pain syndromes in the maxillofacial area: a common but underdiagnosed cause of head and neck pain. Int J Oral Maxillofac Surg. 2008;37(11):975–984. DOI: 10.1016/j.ijom.2008.04.023][Isaykin AI, Smirnova DS. Temporomandibular joint dysfunction. Russian Medical Journal. 2017;(24):1750–1755 (In Russ.)][Rowicki T., Zakrzewska J. A study of the discomalleolar ligament in the adult human. Folia Morphol. 2006;65(2):121–125.][Gerwin R. Chronic Facial Pain: Trigeminal Neuralgia, Persistent Idiopathic Facial Pain, and Myofascial Pain Syndrome-An Evidence-Based Narrative Review and Etiological Hypothesis. Int J Environ Res Public Health. 2020;17(19):7012. DOI: 10.3390/ijerph17197012][Do TP, Heldarskard GF, Kolding LT, Hvedstrup J, Schytz HW. Myofascial trigger points in migraine and tension-type headache. J Headache Pain. 2018;19(1):84. DOI: 10.1186/s10194-018-0913-8][Evdokimova EM, Shagbazyan AE, Tabeeva GR. Myofascial pain syndrome: clinical and pathophysiological aspects and effective pain relief. Effective pharmacotherapy. 2017;(38):18–27. (In Russ)][Siritsyna Y., Sivakov A. Myofascial syndrome: etiology, clinical findings, treatment principles, Medical news, 2020;(8):13–17 (In Russ.)][Costen JB. A syndrome of ear and sinus symptoms dependent upon disturbed function of the temporomandibular joint. The Annals of otology, rhinology and laryngology. 1934;43:1–15. DOI: 10.1177/000348943404300101][Ortiz-Comino L, Fernández-Lao C, Castro-Martín E, et al. Myofascial pain, widespread pressure hypersensitivity, and hyperalgesia in the face, neck, and shoulder regions, in survivors of head and neck cancer. Support Care Cancer. 2020;28(6):2891–2898. DOI: 10.1007/s00520-019-05173-6][Fernández-de-Las-Peñas C, Simons D, Cuadrado ML, Pareja J. The role of myofascial trigger points in musculoskeletal pain syndromes of the head and neck. Curr Pain Headache Rep. 2007;11(5):365–372. DOI: 10.1007/s11916-007-0219-z][Costa YM, Ariji Y, Ferreira DMAO, et al. Muscle hardness and masticatory myofascial pain: Assessment and clinical relevance. J Oral Rehabil. 2018;45(8):640–646. DOI: 10.1111/joor.12644][Hong SW, Lee JK, Kang JH. Relationship among Cervical Spine Degeneration, Head and Neck postures, and Myofascial Pain in Masticatory and Cervical Muscles in Elderly with Temporomandibular Disorder. Arch Gerontol Geriatr. 2019;81:119–128. DOI: 10.1016/j.archger.2018.12.004]