Multiple Active Myofascial Trigger Points and Pressure Pain Sensitivity Maps in the Temporalis Muscle Are Related in Women With Chronic Tension Type Headache

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.

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Referred pain areas of active myofascial trigger points in head, neck, and shoulder muscles, in chronic tension type headache

Journal of Bodywork and Movement Therapies ◽

10.1016/j.jbmt.2009.06.008 ◽

2010 ◽

Vol 14 (4) ◽

pp. 391-396 ◽

Cited By ~ 23

Author(s):

César Fernández-de-las-Peñas ◽

Hong-You Ge ◽

Cristina Alonso-Blanco ◽

Javier González-Iglesias ◽

Lars Arendt-Nielsen

Keyword(s):

Trigger Points ◽

Tension Type Headache ◽

Referred Pain ◽

Myofascial Trigger Points ◽

Chronic Tension Type Headache ◽

Shoulder Muscles ◽

Type Headache ◽

Head Neck

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Trigger points are associated with widespread pressure pain sensitivity in people with tension-type headache

Cephalalgia ◽

10.1177/0333102416679965 ◽

2016 ◽

Vol 38 (2) ◽

pp. 237-245 ◽

Cited By ~ 6

Author(s):

María Palacios-Ceña ◽

Kelun Wang ◽

Matteo Castaldo ◽

Amparo Guillem-Mesado ◽

Carlos Ordás-Bandera ◽

...

Keyword(s):

Pain Sensitivity ◽

Tibialis Anterior Muscle ◽

Trigger Points ◽

Cross Sectional Study ◽

Tension Type Headache ◽

Cross Sectional ◽

Pressure Pain ◽

Upper Trapezius ◽

Pressure Pain Thresholds ◽

Type Headache

Objective To investigate the association between trigger points (TrPs) and widespread pressure pain sensitivity in people with tension-type headache (TTH) and to determine if this association is different between frequent episodic (FETTH) or chronic (CTTH) headache. Design A cross-sectional study. Methods One hundred and fifty-seven individuals (29% male) with TTH participated. Clinical features of headache, i.e., intensity, duration, and frequency, were recorded in a headache diary. Active and latent TrPs were bilaterally explored in the temporalis, masseter, suboccipital, upper trapezius, sternocleidomastoid, and splenius capitis muscles. Pressure pain thresholds (PPT) were assessed over the trigeminal area (i.e., temporalis muscle), extra-trigeminal (i.e., C5/C6 zygapophyseal joint), and two distant pain-free points (i.e., second metacarpal and tibialis anterior muscle). Results Eighty (51%) patients were classified as FETTH, whereas 77 (49%) were classified as CTTH. No differences in the number of either active or latent TrPs (all p > 0.171) or widespread pressure pain sensitivity (all p > 0.351) were observed between FETTH and CTTH groups. The number of active and latent TrPs was significantly and negatively associated with PPTs: The higher the number of active or latent TrPs, the lower the widespread PPT, and the more generalized sensitization. This association was stronger within the FETTH group than the CTTH group. Conclusions This study found that the number of TrPs in head and neck/shoulder muscles was associated with widespread pressure hypersensitivity independently of the frequency of headache.

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Widespread Pressure Pain Sensitivity over Nerve Trunk Areas in Women with Frequent Episodic Tension-Type Headache as a Sign of Central Sensitization

Pain Medicine ◽

10.1093/pm/pnz146 ◽

2019 ◽

Vol 21 (7) ◽

pp. 1408-1414

Author(s):

Leandro H Caamaño-Barrios ◽

Fernando Galán-del-Río ◽

César Fernández-de-las-Peñas ◽

Gustavo Plaza-Manzano ◽

Lars Arendt-Nielsen ◽

...

Keyword(s):

Central Sensitization ◽

Pain Sensitivity ◽

Pressure Pain Threshold ◽

Depression Scale ◽

Tension Type Headache ◽

Analysis Of Covariance ◽

Tibialis Posterior ◽

Temporalis Muscle ◽

Pressure Pain ◽

Type Headache

Abstract Objective Previous studies reported the presence of widespread pressure pain sensitivity in patients with tension-type headache. However, most of the studies assessed pressure pain sensitivity over muscle tissue. Our aim was to investigate the difference in pressure pain sensitivity over musculoskeletal and nerve symptomatic and distant areas between women with frequent episodic tension-type headache (FETTH) and healthy subjects. Methods Thirty-two women with FETTH and 32 matched healthy women participated. Pressure pain threshold (PPT) was bilaterally assessed over several nerve trunks (greater occipital, median, radial, ulnar, common peroneal, tibialis posterior) and musculoskeletal structures (temporalis muscle, C5/C6 joint, tibialis anterior) by an assessor blinded to the subject’s condition. A four-week headache diary was used to collect the intensity, frequency, and duration of headache. The Hospital Anxiety and Depression Scale was used to determine anxiety and depressive levels. Results Analysis of covariance found lower widespread and bilateral PPTs over all nerve trunks and musculoskeletal structures in women with FETTH pain (P < 0.001). No significant effect of anxiety and depressive levels on PPTs was found (all P > 0.222). PPT over the temporalis muscle was significantly negatively correlated with headache intensity. Conclusions This study found widespread pressure pain hypersensitivity over both nerve trunks and musculoskeletal structures in women with FETTH, suggesting that the presence of central altered nociceptive processing is not just restricted to musculoskeletal areas, for example, muscles, but also pain evoked from directly provoking the nerve trunks by pressure. It is also possible that nerve tissue treatment could lead to a decrease in central sensitization and headache features.

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