Tender Points Are Not Sites of Ongoing Inflammation - In Vivo Evidence in Patients with Chronic Tension-Type Headache

Cephalalgia ◽  
2003 ◽  
Vol 23 (2) ◽  
pp. 109-116 ◽  
Author(s):  
M Ashina ◽  
B Stallknecht ◽  
L Bendtsen ◽  
JF Pedersen ◽  
S Schifter ◽  
...  
Keyword(s):  
Inflammatory Mediators ◽  
Trapezius Muscle ◽  
Tender Point ◽  
Tension Type Headache ◽  
Static Exercise ◽  
Tender Points ◽  
Chronic Tension Type Headache ◽  
Interstitial Concentration ◽  
Type Headache

Increased muscle tenderness is the most prominent finding in patients with tension-type headache, and it has recently been shown that muscle blood flow is diminished in response to static exercise in tender points in these patients. Although tenderness has been ascribed to local inflammation and release of inflammatory mediators, the interstitial concentration of inflammatory mediators has not previously been studied in tender muscles of patients with tension-type headache. The aim of the present study was to investigate in vivo concentrations of prostaglandin E2 (PGE2), adenosine 5'-triphosphate (ATP), glutamate, bradykinin and other metabolites in a tender point of patients with chronic tension-type headache, in the resting state as well as in response to static exercise, and to compare findings with measurements in a matched non-tender point of healthy controls. We recruited 16 patients with chronic tension-type headache and 17 healthy control subjects. Two microdialysis catheters were inserted into the trapezius muscle and dialysates were collected at rest, 15 and 30 min after start of static exercise (10% of maximal force) and 15 and 30 min after end of exercise. All samples were coded and analysed blindly. There was no difference in resting concentration of any inflammatory mediators or metabolites between tender patients and non-tender controls ( P > 0.05). We also found no difference in change in interstitial concentration of ATP, PGE2, glutamate, glucose, pyruvate and urea from baseline to exercise and post-exercise periods between patients and controls ( P > 0.05). The present study provides in vivo evidence of normal interstitial levels of inflammatory mediators and metabolites in tender trapezius muscle in patients with chronic tension-type headache during both rest and static exercise. Thus, our data suggest that tender points in these patients are not sites of ongoing inflammation.

Generalized Neck-Shoulder Hyperalgesia in Chronic Tension-Type Headache and Unilateral Migraine Assessed by Pressure Pain Sensitivity Topographical Maps of the Trapezius Muscle

Cephalalgia ◽  
2009 ◽  
Vol 30 (1) ◽  
pp. 77-86 ◽  
Author(s):  
C Fernández-de-las-Peñas ◽  
P Madeleine ◽  
AB Caminero ◽  
ML Cuadrado ◽  
L Arendt-Nielsen ◽  
...  
Keyword(s):  
Pain Sensitivity ◽  
Trapezius Muscle ◽  
Tension Type Headache ◽  
Healthy Controls ◽  
Pressure Pain ◽  
Chronic Tension Type Headache ◽  
Pressure Pain Thresholds ◽  
Pressure Algometer ◽  
Type Headache ◽  
Topographical Maps

Spatial changes in pressure pain hypersensitivity are present throughout the cephalic region (temporalis muscle) in both chronic tension-type headache (CTTH) and unilateral migraine. The aim of this study was to assess pressure pain sensitivity topographical maps on the trapezius muscle in 20 patients with CTTH and 20 with unilateral migraine in comparison with 20 healthy controls in a blind design. For this purpose, a pressure algometer was used to assess pressure pain thresholds (PPT) over 11 points of the trapezius muscle: four points in the upper part of the muscle, two over the levator scapulae muscle, two in the middle part, and the remaining three points in the lower part of the muscle. Pressure pain sensitivity maps of both sides (dominant/non-dominant; symptomatic/non-symptomatic) were depicted for patients and controls. CTTH patients showed generalized lower PPT levels compared with both migraine patients ( P = 0.03) and controls ( P < 0.001). The migraine group had also lower PPT than healthy controls ( P < 0.001). The most sensitive location for the assessment of PPT was the neck portion of the upper trapezius muscle in both patient groups and healthy controls ( P < 0.001). PPT was negatively related to some clinical pain features in both CTTH and unilateral migraine patients (all P < 0.05). Side-to-side differences were found in strictly unilateral migraine, but not in those subjects with bilateral pain, i.e. CTTH. These data support the influence of muscle hyperalgesia in both CTTH and unilateral migraine patients and point towards a general pressure pain hyperalgesia of neck-shoulder muscles in headache patients, particularly in CTTH.

scholarly journals In vivo evidence of altered skeletal muscle blood flow in chronic tension‐type headache

Brain ◽  
2002 ◽  
Vol 125 (2) ◽  
pp. 320-326 ◽  
Author(s):  
M. Ashina ◽  
B. Stallknecht ◽  
L. Bendtsen ◽  
J. F. Pedersen ◽  
H. Galbo ◽  
...  
Keyword(s):  
Skeletal Muscle ◽  
Blood Flow ◽  
Muscle Blood Flow ◽  
Tension Type Headache ◽  
Skeletal Muscle Blood Flow ◽  
Chronic Tension Type Headache ◽  
Type Headache

Referred pain from trapezius muscle trigger points shares similar characteristics with chronic tension type headache

2007 ◽  
Vol 11 (4) ◽  
pp. 475-482 ◽  
Author(s):  
César Fernández-de-las-Peñas ◽  
Hong-You Ge ◽  
Lars Arendt-Nielsen ◽  
Maria Luz Cuadrado ◽  
Juan A. Pareja
Keyword(s):  
Trapezius Muscle ◽  
Trigger Points ◽  
Tension Type Headache ◽  
Referred Pain ◽  
Chronic Tension Type Headache ◽  
Type Headache

Exteroceptive Suppression of Temporalis Muscle Activity: Findings in Headache

Cephalalgia ◽  
1993 ◽  
Vol 13 (1) ◽  
pp. 11-14 ◽  
Author(s):  
Thomas-Martin Wallasch ◽  
Hartmut Göbel
Keyword(s):  
Muscle Activity ◽  
Silent Period ◽  
Tension Type Headache ◽  
Temporalis Muscle ◽  
Pharmacological Agents ◽  
Chronic Tension Type Headache ◽  
Exteroceptive Suppression ◽  
Headache Diagnosis ◽  
Secondary Phenomenon ◽  
Type Headache

Exteroceptive suppression of temporalis muscle activity was proposed by Schoenen and co-workers in 1987 as a tool in headache diagnosis and research. Their finding of a decreased or abolished second silent period (ES2) in chronic tension-type headache sufferers has been confirmed by several independent laboratories during the last five years. Temporalis silent periods have also been studied in various other types of headaches. Their modulation by neuropsychological factors and pharmacological agents has also been investigated as well as their retest reliability. The pathophysiological concept of muscle contraction in tension-type headache has been challenged by studies using temporalis silent periods. The exterocepfive suppression of temporalis muscle activity points unequivocally towards a central pathogenetic mechanism, although it remains unclear whether the abnormalities of temporalis ES2 represent the primary dysfunction or a secondary phenomenon in chronic tension-type headache.

The Local and Referred Pain From Myofascial Trigger Points in the Temporalis Muscle Contributes to Pain Profile in Chronic Tension-type Headache

2007 ◽  
Vol 23 (9) ◽  
pp. 786-792 ◽  
Author(s):  
César Fernández-de-las-Peñas ◽  
Hong-You Ge ◽  
Lars Arendt-Nielsen ◽  
Maria Luz Cuadrado ◽  
Juan A. Pareja
Keyword(s):  
Trigger Points ◽  
Tension Type Headache ◽  
Referred Pain ◽  
Temporalis Muscle ◽  
Myofascial Trigger Points ◽  
Chronic Tension Type Headache ◽  
Type Headache

scholarly journals Variables associated with sleep quality in chronic tension-type headache: A cross-sectional and longitudinal design

PLoS ONE ◽  
2018 ◽  
Vol 13 (5) ◽  
pp. e0197381 ◽  
Author(s):  
Elena Benito-González ◽  
Maria Palacios-Ceña ◽  
Juan J. Fernández-Muñoz ◽  
Matteo Castaldo ◽  
Kelun Wang ◽  
...  
Keyword(s):  
Sleep Quality ◽  
Longitudinal Design ◽  
Tension Type Headache ◽  
Cross Sectional ◽  
Chronic Tension Type Headache ◽  
Type Headache

Chronic Tension-Type Headache in Children and Adolescents

Cephalalgia ◽  
2001 ◽  
Vol 21 (8) ◽  
pp. 830-836 ◽  
Author(s):  
Ishaq Abu-Arafeh
Keyword(s):  
Children And Adolescents ◽  
Clinical Features ◽  
Chronic Daily Headache ◽  
Adult Population ◽  
Tension Type Headache ◽  
Stressful Events ◽  
Chronic Tension Type Headache ◽  
Daily Headache ◽  
Ihs Criteria ◽  
Type Headache

In this study, the causes, predisposing factors and clinical features of chronic daily headache in children and adolescents were studied within the population of patients attending a specialist headache. The International Headache Society's (IHS) criteria for the diagnosis of chronic tension type headache (CTTH) were assessed for their applicability in the paediatric age group. Over a period of three years, demographic and clinical data were collected prospectively on all children who attended the clinic and suffered from daily attacks of headache. One hundred and fifteen children and adolescents (32% of all clinic population) had chronic daily headache, of whom 93 patients (81%) fulfilled the IHS criteria for the diagnosis of CTTH. They were between 3-15 years of age (mean: 11.1, SD: 2.3) and their female to male ratio was 1.2: 1. Around one third of the patients also suffered from migraine (mainly migraine without aura). The headache was described as mild in 60.9%, moderate 36.5% and severe 2.6%. Headache was located at the forehead in 53% or over the whole of the head in 29.6%. Pain was described as ‘just sore’ or dull by 73.9%. During attacks of headache, at least half the patients reported light intolerance, noise intolerance, anorexia or nausea. Thirty-two percent of patients had at least one underlying chronic disease that may have contributed to the pathogenesis of the CTTH. Eleven percent had serious stressful events related to family illnesses and in four patients headaches were triggered by family bereavement. Fourteen percent were investigated with neuroimaging and 22% were referred for clinical psychology assessment and management. In conclusion, CTTH is a common cause of headache in children attending a specialist headache clinic. The clinical features closely match those of adult population and the IHS criteria for the diagnosis of CTTH can be adapted for use in children. Predisposing stressful risk factors, physical or emotional, are present in a large proportion.

Chronic Tension-Type Headache

CNS Drugs ◽  
1995 ◽  
Vol 4 (2) ◽  
pp. 90-98 ◽  
Author(s):  
Alessandro S. Zagami
Keyword(s):  
Tension Type Headache ◽  
Chronic Tension Type Headache ◽  
Type Headache
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