112. Trigger Point Injections and Migraines. What Nobody Tells You

If you've been considering trigger point injections for your neck and shoulder pain,or you've already tried them and wondered why the relief didn't last, this episode is for you.

A lot of women with chronic migraines assume the neck is where the problem starts. It makes sense. The tension is real, the pain is real, and it feels like if you could just release that tightness the migraines would stop.

But what if the neck isn't actually where your migraines begin?

In this episode I break down what trigger point injections actually do, when they can offer some relief, and why for most chronic migraine sufferers they hit a real ceiling. I also explain what's actually causing that persistent neck and shoulder tightness, and why addressing the root of it changes everything.

If you’re ready to address the root drivers of your migraines, you can book a free consultation at the link below:

https://www.drlesliecisar.com/apply

Free Training: 5 Proven Steps to Being Migraine Free (Even if you think you've already tried everything.)

https://www.drlesliecisar.com/5SHMN

Connect with us:

Website: https://www.drlesliecisar.com/

Free Facebook Group: Healing Migraines Naturally, with Leslie Cisar, ND

Ready to try something radically different that actually works? Read more about my approach here: https://www.drlesliecisar.com/map

In health,
Dr. Leslie Cisar

Episode Transcript

welcome to the Healing Migraines Naturally podcast
I'm your host Doctor Leslie Caesar
and I'm a licensed naturopathic physician
former chronic migraine sufferer
and I help women all over the country
rediscover a migraine free life
so today I wanna talk about something
that I get asked about a lot
and that's trigger point injections
so a lot of my clients have tried them
or they're considering them
um I have a free Facebook group
which you're welcome to join
which is called Healing Migraines Naturally
with Leslie Caesar and d and within the Facebook group
this is a common uh
question that people will ask
um has anybody done trigger point injections
how did it go did it work for you
do you think I should get them etcetera
so this is a topic that I thought would be really um
really great to talk about
I wanna have I wanna go over sort of what they are
and what the benefit to them might be
and what the limitations are to them
but before we get into the injections themselves
let's talk about why people are considering
trigger point injections in the first place
right and that's because of the neck pain right
I mean you know
amongst chronic migraine sufferers
so many chronic migraine sufferers also have neck pain
neck you know stiffness
I can't move my neck you know
it's like creaking and cracking
um it's tight
my shoulders are tense my
you know my upper back um
it's a sense that everything is like sort of wound up
and it just won't let go and if you relate to that
I want you to know that's very real
it's not in your head
and it makes complete sense that you've been focused
on your neck as the source of the problem
but here's the question I want you to sit with today
what if your neck isn't actually where your migraine
starts okay
so first first off you know
let's start with what trigger point injections
actually are
so a trigger point within the muscle
it's basically a tight painful knot that develops
a spot where the muscle fibers have tensed up
and they won't relax on their own
in migraine suffers these are usually in the neck
the shoulders the upper back
and what the injection does is go
it goes directly into that knot
okay and so
depending on who's doing the injection
and how they're approaching it
the injection might have a local anesthetic
like lidocaine in it right
so lidocaine you know
if you need stitches or something like that
they inject a little lidocaine in there
and then you can't feel the stitches right
so it's a very common
anesthetic so that might be injected into the knot
into the trigger point
some doctors will put a cortical
steroid into the injection okay
and so corticosteroids are fantastic at
stopping inflammation pathways hi there
I wanna jump in real quick
and tell you about my client Beth
she was getting 15 to 20 migraines and headaches
per month and as you can imagine
this was impacting her work performance
and her confidence she also has two small children
and she was
starting to feel like she was a horrible mom
because she had nothing left for them
at the end of the day but she reached out
and she booked a free consult call with me
and after I asked her about her migraines
and her health history
I felt confident that I could help her
I help women uncover
the root drivers of their migraines
and follow a step by step plan to dramatically reduce
the frequency by up to 90%
without adding more medication
or taking a bunch of supplements
so we built her personal migraine map
followed the plan
and now she will get one to two migraines per year
which she uses ibuprofen to treat if she needs to
verses up to 15 to 20 per month
when we first started working together
that weren't responding well to any medication
she just reached out to tell me that
she got a promotion at work
she's on top of her career again
and has been able to come off all of her migraine
medication but most importantly
she's a confident mom again
and she's attending birthday parties at Jump Zone
with her kids and saying yes
instead of saying maybe later
I've worked with women like Beth
from all over the United States who were told
this is the best we can do
but they were still willing to dig deeper
so
if you are serious about changing your migraine story
go to Doctor Leslie Caesar dot com slash apply
or tap the link in the show notes
and on our free consult
we'll map out why your migraines keep coming back
and the first three steps you can take
over the next 30 days
I do cap new client spots each month
so if the calendar is full
the doors are closed for now
but if you're done feeling helpless
and ready to do the work to heal
pause this episode for 30 seconds
and book that console call now
um I've talked about inflammation on the podcast before
we'll link to a few episodes on inflammation okay
inflammation is a tremendous buzzword right
everybody's trying to stop inflammation
they're taking anti inflammatory supplements
anti inflammatory diet right
it's like
chronic inflammation is the cause of all disease
a lot of people have heard this
this type of thing but inflammation is required
the body has to generate inflammation to heal something
okay inflammation is generated for other purposes too
within the body
but in order for anything to heal to repair
you have to have inflammation okay
it's a biochemical process
and so
what we want the body to do is we want the body to
to generate appropriate inflammation
and then finish the healing process
okay
but if our body doesn't have what it needs to complete
the healing the repair process
then
the body is going to keep generating the inflammation
because the healing hasn't completed
it hasn't finished and so
we go from the necessary acute inflammation
into what is called chronic inflammation
okay and so
steroids are fantastic at shutting down
inflammation pathways in the body okay
if you wanna if you wanna
shut down the biochemistry
that's responsible for generating inflammation
take a take a steroid
take a prednisone right
the problem is you need inflammation
to do a lot of things within the body so
many migraines suffers right
they'll take a steroid pack you know
a a five or six day course of corticosteroids to
knock out like a rebound migraine or
you know they've
they've had continuous head pain for a month
and they're not responding to their
abortive medication anymore
and their doctor will give them a
you know maybe a six day course of steroids
and oh boy I mean
there's a lot of side effects when you take those
those steroid packs but people will say
oh in some ways I felt so good
you know my joints weren't hurting
my muscles weren't stiff right
they were experiencing the lack of inflammation
because
steroids are fantastic at shutting down those pathways
and so people won't feel
the symptoms the
the painful symptoms of inflammation
but you can't stay on them forever
because the body needs
inflammation to do a lot of different things
including repair things
all of this to say in this case
with trigger point injections
they're injecting a little bit of a cortical steroid
which is going to shut down
the inflammation that's occurring
where that nod is okay
and a variation of this is something that's called dry
needling where the needle doesn't have anything in it
so you're just kind of poking the area with a needle
but not injecting anything
and this produces
sort of a controlled injury to the area
and then the body
will respond
and rally to try to heal that little injury
and many times right
it's sort of like um
you're introducing a little bit of an injury to spur
the healing process on
and then hopefully
that will result in the body finally healing
that little area and the
the tension and that not being relieved
some people they will often get some temporary relief
from doing this okay
and that makes sense you're releasing tension
you're reducing pain signals in that area
and for some people
that can provide a real temporary relief
but the keyword here is temporary
because what trigger point injections are not doing is
they're not getting to the root
they're not asking
why is this muscle so tight in the first place
and that's the question
that we really need to be asking
so can they be a useful tool
yes absolutely
sometimes you know
we feel a little bit better
and allows us to make some real changes in our health
and if that's the case great
use it that way it can
give people a little bit of a chance to get a leg up
because they're feeling a little bit better
but you know what so often happens is
you know look
when we're feeling a little bit better we're like great
I feel better now I'm not gonna make any changes right
I'm just I'm gonna keep living the same way that I was
so we want to if we're gonna do a treatment like this
we wanna be very intentional
sort of get the benefits out of the treatment
but you know on their own
it's not a solution to the migraines
and I'm gonna talk about why that is further on
I think as I go through this
it's gonna become obvious to you
why trigger point injections are actually
going to ultimately
contribute to the migraine problem itself okay
is your neck pain actually a migraine symptom
so there's something that I think is really important
and it's something that most people
including a lot of practitioners
don't fully understand so
a very common pattern with migraines is that the pain
starts in the neck and then it moves up into the head
okay and so naturally
people assume that the migraine is starting in my neck
my neck is the problem I need to treat my neck
but here's what I want you to consider
that neck pain may actually be a migraine symptom
your body is already starting to go into that
what I call the migraine zone okay
and one of the ways that it's expressing right
one of the ways that it's generating
the whole host of migraine symptoms
that you're prone to right
because migraines right it's not just head pain right
it's like that's infuriating right when people are like
oh you have a headache
and we just want to ring their neck right
it's like
the migraine generates
symptoms throughout the entire body right
it's it's not just head pain for most of us right
the classic migraine that's gonna be head pain
is
probably the most prominent component of the symptoms
but we can also have nausea
we can have numbness and tingling
we can have vision changes right
we can have changes to our mood to our emotions
you know
some people will get very dizzy right
I mean it's like
a whole host of symptoms that can be generated
within the whole body
and one of those symptoms is actually neck pain
so it's not that the migraine is starting in the neck
and moving up into the head
it's that you're entering your migraine zone
and the type of migraine that you're prone to
the symptoms the first symptoms
that you're sort of becoming aware of
is in your neck
it's just that you're feeling it there first
and there's actually a really simple way
to tell the difference
so if you take a migraine specific abortive medication
like a triptan like an Imitrex or a Maxalt
or a CGRP antagonist like a nertec or a ubrelvy
and when you take those
those migraine specific abortive medications
and your neck pain goes away
that's your answer okay
those medications
work specifically on migraine mechanisms
they're not general pain relievers
so if you're taking one of those medications
and your neck pain goes away
and as the migraine starts to lift
your neck loosens up and you can move your neck again
and it's not painful
it's not that the it's not like your neck is off
and that is generating the migraine
it's that you have a migraine symptom
that includes neck pain
now here's where it gets a little tricky
because a lot of people also take NSAIDs
nonsteroidal anti inflammatory drugs
things like naproxen Aleve
Toradol or analgesics
pain relieving medication such as fioricet
alongside their tryptans
or CGRP antagonist medications
and so NSAIDs
and analgesics are general pain relieving medications
they'll relieve any type of pain anywhere in the body
so when someone takes like a
in a leave or an aspirin and their neck pain goes away
they think see
it was my neck but that's not what that tells us
that just tells us that the pain reliever
worked on the pain
it doesn't tell us anything about the migraine
symptoms that you're prone
to and when that happens over time
this reinforces the misperception
that the migraine is starting in the neck
and people end up chasing all of these neck treatments
including trigger point injections
for years
without ever addressing what's actually going on okay
so why is your neck so tight in the first place
what I want to get into now is what I think
is the most important part of this conversation
because even if your neck pain is a migraine symptom
even if the migraine
isn't start even if it isn't starting there okay
your neck is still tight and we need to understand why
and before I get into this
I wanna say something that I think will resonate
with a lot of you in nearly nine years now OK
this summer it's gonna be nine years
believe it or not where I've been working exclusively
with women with migraines
in this time I have never
not once
had a client whose body was only generating migraines
okay never
it has never happened
if you are suffering from migraines
your body is generating other symptoms too
always and this matters
because those other symptoms are clues
they're pointing us towards what's going on underneath
they're telling us where the deficiencies are
where the blockers are and what's missing
and nobody has been asking you these questions
that's what I do okay so
let's talk about the three main reasons why
your muscles and specifically your neck
might be so tight and stiff and sore all the time okay
so on the podcast I talk about
the three things that our body needs
in order to restore itself back to health
and maintain its state of health
I call these things the three principles okay
so we're gonna take a look at this symptom of
muscle stiffness and soreness okay
specifically in the neck but this can apply
to any area of the body where you're experiencing
a lot of muscle pain and stiffness
hi there
I wanna jump in real quick and tell you about my client
Beth she was getting 15 to 20 migraines and headaches
per month and as you can imagine
this was impacting her work performance
and her confidence she also has two small children
and she was
starting to feel like she was a horrible mom
because she had nothing left for them
at the end of the day but she reached out
and she booked a free consult call with me
and after I asked her about her migraines
and her health history
I felt confident that I could help her
I help women uncover
the root drivers of their migraines
and follow a step by step plan to dramatically reduce
the frequency by up to 90%
without adding more medication
or taking a bunch of supplements
so we built her personal migraine map
followed the plan
and now she will get one to two migraines per year
which she uses ibuprofen to treat if she needs to
verses up to 15 to 20 per month
when we first started working together
that weren't responding well to any medication
she just reached out to tell me that
she got a promotion at work
she's on top of her career again
and has been able to come off all of her migraine
medication but most importantly
she's a confident mom again
and she's attending birthday parties at Jump Zone
with her kids and saying yes
instead of saying maybe later
I've worked with women like Beth
from all over the United States
who were told this is the best we can do
but they were still willing to dig deeper
so
if you are serious about changing your migraine story
go to Doctor Leslie Caesar dot com slash apply
or tap the link in the show notes
and on our free consult
we'll map out why your migraines keep coming back
and the first three steps you can take
over the next 30 days
I do cap new client spots each month
so if the calendar is full
the doors are closed for now
but if you're done feeling helpless
and ready to do the work to heal
pause this episode for 30 seconds
and book that console call now
so the first principle
the first thing that our body needs is nutrients
our cells run on nutrients
nothing happens in the body
without the specific
nutrients that are needed to run our biochemistry okay
so if
your cells don't have the nutrients
that they need to function properly
we're not going to feel good
and your muscles are no exception okay
so the first thing I look at is
whether the muscles are actually getting
what they need to function properly
and if they're not you're gonna have muscle pain
stiffness and tension so for migraine sufferers
I'm looking at specific symptoms that go alongside
the migraines things like Charlie horses
muscle twitching restless legs
a lot of general aches and pains
these are symptoms that tell me that the muscles
are not getting the nutrients that they need
and particularly the minerals that they need now
most people in the migraine
world have heard about magnesium okay
I've done a couple podcasts
like
if I hear this magnesium recommendation one more time
right
magnesium is important okay
it's an important mineral
but what I found in my work
is that
when someone has these types of muscle symptoms
the twitching you know
the muscle twitching the Charlie horses
the restless legs the mineral that they're most often
actually deficient in is potassium
not magnesium
but potassium but here's what I also wanna say
it's not just about eating well or taking a supplement
right I mean everybody jumps straight to supplements oh
I'll just I'll just take some potassium
or I'll eat more bananas and avocados
but we need to ask a deeper question
why isn't this person getting the nutrients
that they need from the food that they're eating
and I want to be clear
like migraine sufferers they tend to eat pretty clean
okay
they're avoiding food triggers right
they're paying attention to their food right
and you know I'm just I'm just chuckling right
because I've been there too I've had the food paranoia
right oh gosh
should I have this piece of chocolate after dinner
I don't know what's gonna happen right
you know my clients right
they're not eating bags of Doritos
and going through drive throughs and so on right
generally my clients are already
putting quite a bit of effort into their eating habits
and they're trying to eat good
they're trying to avoid additives and
and everything else in fact
so many migraine sufferers
that they've
developed a paranoia and anxiety around eating
so that's usually not the problem OK
the problem is the whole chain of what happens
after you eat are you breaking your food down properly
are those nutrients
actually being absorbed through your gut
and are they getting into your blood
are they being circulated and delivered to the cells
and can your cells actually take them in okay
that whole chain matters and nobody's looking
so let's talk about the second principle okay
your body is storing toxins and waste material
in your muscles okay
the second thing that I look at is what I call
clearance your body's ability to process and eliminate
metabolic waste materials
and environmental toxins
and the main organ that does this is your liver
when your liver can't keep up with the load
and there are a lot of reasons why that might happen
your body has to do something
with those toxin molecules
that are floating around in your bloodstream
because those molecules cause damage as they circulate
so your body wants to get them out of the blood
and so what does it do
it pulls them out and puts them into storage
now where are we going to store this stuff okay
it stores them in the places
where they're going to cause
the least amount of damage
your body is not going to store these damaging
molecules in a vital organ
like your pancreas or your eyes okay
instead it stores them in your fat cells
your muscle cells your joints okay
now I'm not saying that your muscles aren't important
but your body is making a strategic choice
it's protecting your vital organs
by parking these things somewhere safer
and over time as that storage builds up
your muscles start to hurt they get stiff
they get achy
they get tight and for migraine sufferers
this often shows up as that
neck and shoulder tightness OK
that's that's for many people always there right
not just during a migraine
but all the time so
this is why trigger point injections
have a real limitation for people
in this situation so
if a stored toxin load is part
of why your muscles are so tight
then injecting more substances into that area
even an anesthetic
you know even Botox right
that's that is the botulinum toxin right
unfortunately you're adding to the burden okay
so you might get some temporary relief
but you're working against the very thing
that ultimately needs to happen
so now I wanna talk about Principle 3 okay
so mental and emotional stress
is creating real physical tension
so the third principle the third thing
that our body needs to restore itself back to health
maintain its state of health so that we feel good
the third principle is about your body's resiliency
and its ability to handle stress without tipping
into your migraine zone
I know migraine sufferers hear this all the time right
don't get so stressed out
try to relax do some deep breathing
take a bath get a massage self care right
and I'm sure that that is well intentioned advice
but I also know that it is infuriating to hear right
because it puts the whole responsibility
on you to just manage your reaction better okay
and this leads to a lot of what I call white knuckling
okay so this puts the focus on us okay
now I've gotta right
I'm already stressed I'm already on my last nerve
but now I've gotta do some deep breathing
I gotta keep it under control right
now we're white knuckling our way back to
not being stressed okay
so what is not happening right
is
no one is ever asking
why your body is responding the way that it is
in the first place and this is what is absolutely true
and well documented
mental and emotional stress causes real
physical muscle tension okay
this is not metaphorical when you're short
when you're stressed your shoulders come up
your neck tightens your jaw clenches
these are real physiological responses
your body is responding to stress
by tensing your muscles
and how many of you have said this
oh yeah it was that argument
that's what gave me the migraine right
or oh yeah that work deadline
I knew I was gonna get a migraine after that
I am confident that almost every migraine
sufferer has had that experience
at some point so yes
stress is a real factor
but here's where I wanna go deeper on this
because this is where
the most important work actually lives
the mental and emotional connection
so we are told all the time to manage our stress
we're told to relax to do self care
to not let things bother us
but nobody is asking why is this particular situation
generating so much stress inside of you
in the first place
and I wanna be really precise about this
because I think this is something people misunderstand
it's not that two different people are in the same
stressful situation
and one gets a migraine and one doesn't
it's more personal than that
it's that you yourself
can have a conflict with a coworker and get a migraine
and then have a conflict with a family member
that seems just as stressful on the surface
and not get a migraine
same general type of event
very different response from your body
and that difference is a clue
something about that specific dynamic
that specific relationship
that specific type of conflict
is activating something deeper in you
a pattern an old wound
a belief a story you've been carrying
and until we understand what that is
we're just managing symptoms
we're not getting to the root
and that is the work that nobody else is doing
with migraine sufferers
and this is the work that I do with my clients
I ask the right questions
not just the clinical questions
what are your mineral levels
and what does your digestion look like
and what does your liver load look like
those are important
but also the deeper questions
what is it about this situation that your body is
responding to so intensely
what is underneath the stress response
because that's where the real answers live
so I wanna leave you to with something to sit with
start noticing your stress triggers
but get specific not just I was stressed
which specific situations
which specific relationships
which type of conflict or dynamic
and why might that particular one
be hitting you so hard
when another similar situation doesn't
you don't need to answer that today
just start
paying attention because your body is always talking
and those patterns are telling you something
and if you want to explore these questions
with someone who has spent 9 years
working exclusively with women with migraines
someone who is going to ask you the questions
that no one else has asked
here's how to find me
you can join my free Facebook group
it's called Healing Migraines Naturally with Leslie
Caesar and d
and that's where I share a lot of this type of content
and where you can connect with other women
who are on the same journey
and you can also book a free consultation call with me
we'll look at the full picture together
your migraines your other symptoms
what your body is telling us
and I'll be honest with you
if I can help you I'll tell you that
if I can't I'll tell you that too
thanks so much for being here today
it was great talking to you
and I hope this was helpful for you
please give us a like
or give us a subscribe on your way out
and I'll talk to you next time