I am dealing with a 19 year old, male patient with transient, unilateral swelling of the temporalis muscle. First episode took place in 2009. The patient is diagnosed with migraine. Patient reports that muscle becomes swollen during stressful situations that he „can’t put his glasses on”. The swelling is painful and disappears in about an hour. MRI revealed small nodule in the affected temporalis muscle. It is also visible in USG as hypoechoic lesion. Doppler USG did not reveal blood flow. The lesion is palpable and painful during palpation. However, I am not if it is a myofascial trigger point. Is it possible that the swelling is caused by temporalis muscle/fascia dysfunction? What other possible causes should be considered?
Is there a relation between his migraine attacks and the sweeping muscle? Or the "preferred" side of his migraine? Interestingly, the temporals muscle is quite sensitive in migraine and can be used to treat an attack by pressure or cold or the two combined. If there are no signs of underlying lymphoma, vascularitis, I would consider this a further vegetative abnormality that is seen in migraine. Astonishingly enough, these signs are frequently reported, when asked, or when headache get better following treatment, but do not receive much attention.
Thank you for reply. In this care, migraine headache is bilateral and felt as intracranial pain rather than pain in the temporal area. The swelling appears during stress and also sometimes with migraine.
Hello,
Myofascial trigger point (MTrP) may induce vegetative symptoms.
Headache and MTrP can interact and grow up together.
Treating MTrP may lower headache.
Have you tried gentle massage?
Thank you for replying.
Yes, I started with gentle fascial therapy and massage. Right side of the face, in temporalis and messeteric are, is for sure affected by myofascial problem. But it can be secondary to the lesion in temporaI area. I also plan to control both sleep and awake bruxism as I found them to be present.
I also think it may be related to TrP’s. However, the clinical picture is rather unusual, so I want to rule out other possibilities.
I know that this might sound a little weird, but try to check pelvic floor on the opposite side. in many cases I treat pelvic floor issues, mandible and relevant muscles react in compensation. look especially for opposite piriformis m. (but - the "internal" part - meaning: palpated vaginally or analy - depends on patient's sex)
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