scholarly journals Pain Sensitivity Mediates The Relationship between Stress and Headache Intensity in Chronic Tension-Type Headache

2012 ◽  
Vol 17 (6) ◽  
pp. 377-380 ◽  
Author(s):  
Stuart Cathcart ◽  
Navjot Bhullar ◽  
Maarten Immink ◽  
Chris Della Vedova ◽  
John Hayball
Keyword(s):  
General Population ◽  
Pain Sensitivity ◽  
Tension Type Headache ◽  
Nonparametric Bootstrap ◽  
Bootstrap Analysis ◽  
Chronic Tension Type Headache ◽  
Headache Intensity ◽  
Study Support ◽  
Type Headache ◽  
The Relationship

BACKGROUND: A central model for chronic tension-type headache (CTH) posits that stress contributes to headache, in part, by aggravating existing hyperalgesia in CTH sufferers. The prediction from this model that pain sensitivity mediates the relationship between stress and headache activity has not yet been examined.OBJECTIVE: To determine whether pain sensitivity mediates the relationship between stress and prospective headache activity in CTH sufferers.METHOD: Self-reported stress, pain sensitivity and prospective headache activity were measured in 53 CTH sufferers recruited from the general population. Pain sensitivity was modelled as a mediator between stress and headache activity, and tested using a nonparametric bootstrap analysis.RESULTS: Pain sensitivity significantly mediated the relationship between stress and headache intensity.CONCLUSIONS: The results of the present study support the central model for CTH, which posits that stress contributes to headache, in part, by aggravating existing hyperalgesia in CTH sufferers. Implications for the mechanisms and treatment of CTH are discussed.

Amitriptyline Reduces Myofascial Tenderness in Patients with Chronic Tension-Type Headache

Cephalalgia ◽  
2000 ◽  
Vol 20 (6) ◽  
pp. 603-610 ◽  
Author(s):  
L Bendtsen ◽  
R Jensen
Keyword(s):  
Analgesic Effect ◽  
Pain Sensitivity ◽  
Myofascial Pain ◽  
Tension Type Headache ◽  
Temporal Region ◽  
Double Blind ◽  
Chronic Tension Type Headache ◽  
Headache Intensity ◽  
Reduction Of Pain ◽  
Type Headache

The tricyclic anti-depressant amitriptyline is widely used in the treatment of chronic tension-type headache. The aim of the present study was to investigate whether the analgesic effect is caused by a reduction of muscle pain or by a general reduction of pain sensitivity. Thirty-three non-depressed patients with chronic tension-type headache were treated with amitriptyline 75 mg/day and with the highly selective serotonin reuptake inhibitor citalopram 20 mg/day in a 32-week, double-blind, placebo-controlled, three-way crossover study. At the end of each treatment period, actual headache intensity and pericranial myofascial tenderness were recorded, pressure pain detection and tolerance thresholds were measured in the finger and in the temporal region and the electrical pain threshold was measured at the labial commissure. Amitriptyline reduced tenderness and headache intensity significantly more than placebo ( P = 0.01 and P = 0.04, respectively). The reduction in tenderness could be ascribed solely to the group of patients who responded to amitriptyline treatment by at least 30% reduction in headache while tenderness was unchanged in non-responders. Amitriptyline did not affect pressure or electrical pain thresholds at any of the examined locations. Citalopram had no significant effect on any of the examined parameters. These findings indicate that amitriptyline elicits its analgesic effect in chronic myofascial pain by reducing the transmission of painful stimuli from myofascial tissues rather than by reducing overall pain sensitivity. We suggest that this effect is caused by a segmental reduction of central sensitization in combination with a peripheral anti-nociceptive action.

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.

Interrelation of Chronic Tension-Type Headache With and Without Medication Overuse and Migraine in the General Population: The Akershus Study of Chronic Headache

Cephalalgia ◽  
2009 ◽  
Vol 29 (3) ◽  
pp. 331-337 ◽  
Author(s):  
K Aaseth ◽  
RB Grande ◽  
C Lundqvist ◽  
MB Russell
Keyword(s):  
General Population ◽  
Chronic Headache ◽  
Medication Overuse ◽  
Age At Onset ◽  
Tension Type Headache ◽  
Chronic Tension Type Headache ◽  
Increased Risk ◽  
Type Headache ◽  
Complex Matter

We studied the interrelation of chronic tension-type headache with and without medication overuse (CTTH) and migraine in a random sample of 30 000 persons aged 30–44 years. They received a mailed questionnaire. Those with a possible chronic headache were interviewed by neurological residents. The International Classification of Headache Disorders was used. A total of 386 persons had CTTH. Compared with the general population, men had a 2.8-fold and women a 2.4-fold significantly increased risk of migraine without aura (MO). The risk of migraine with aura (MA) was not increased. The mean age at onset of CTTH was significantly higher in those with than in those without co-occurrence of MO. Bilateral MO attacks were significantly more frequent in those with age at onset of CTTH prior to age at onset of MO compared with those with age at onset in reverse order. CTTH and MO are interrelated, possibly in a complex matter. In contrast, CTTH and MA are not interrelated.

Neck Mobility and Forward Head Posture are not Related to Headache Parameters in Chronic Tension-Type Headache

Cephalalgia ◽  
2007 ◽  
Vol 27 (2) ◽  
pp. 158-164 ◽  
Author(s):  
C Fernández-de-las-Peñas ◽  
C Alonso-Blanco ◽  
ML Cuadrado ◽  
JA Pareja
Keyword(s):  
Physical Therapy ◽  
Statistical Significance ◽  
Tension Type Headache ◽  
Forward Head Posture ◽  
Chronic Tension Type Headache ◽  
Head Posture ◽  
Headache Intensity ◽  
Headache Diary ◽  
Type Headache ◽  
Neck Mobility

The relationship between the changes in forward head posture (FHP), neck mobility and headache parameters was analysed in 25 patients with chronic tension-type headache (CTTH) undergoing a physical therapy programme. Side-view pictures were taken to measure the cranio-vertebral angle in the sitting and standing positions. A cervical goniometer was employed to measure the range of all cervical motions. A headache diary was kept to assess headache intensity, frequency and duration. All patients received six sessions of physical therapy over 3 weeks. Outcomes were assessed at baseline, after treatment and 1 month later. Neck mobility and headache parameters showed a significant improvement after the intervention, whereas posture changes did not reach statistical significance. No correlations were found between FHP, neck mobility and headache parameters at any stage. Changes in these outcomes throughout the study were not correlated either. FHP and neck mobility appear not to be related to headache intensity, duration or frequency in patients suffering from CTTH. Although patients showed a reduction in the range of motion in the neck, it is uncertain whether this is consistent with TTH.

Magnetic Resonance Imaging Study of The Morphometry of Cervical Extensor Muscles in Chronic Tension-Type Headache

Cephalalgia ◽  
2007 ◽  
Vol 27 (4) ◽  
pp. 355-362 ◽  
Author(s):  
C Fernández-de-las-Peñas ◽  
A Bueno ◽  
J Ferrando ◽  
JM Elliott ◽  
ML Cuadrado ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Muscle Atrophy ◽  
Tension Type Headache ◽  
Resonance Imaging ◽  
Chronic Tension Type Headache ◽  
Headache Intensity ◽  
Extensor Muscles ◽  
Splenius Capitis ◽  
Type Headache

This study analyses the differences in the relative cross-sectional area (rCSA) of several cervical extensor muscles, assessed by magnetic resonance imaging (MRI), between patients with chronic tension-type headache (CTTH) and healthy controls. MRI of the cervical spine was performed on 15 CTTH females and 15 matched controls. The rCSA values for the rectus capitis posterior minor (RCPmin), rectus capitis posterior major (RCPmaj), semispinalis capitis and splenius capitis muscles were measured from axial T1-weighted images using axial MR slices aligned parallel to the C2/3 intervertebral disc. A headache diary was kept for 4 weeks in order to substantiate the diagnosis and record the pain history. CTTH patients showed reduced rCSA for both RCPmin and RCPmaj muscles ( P < 0.01), but not for semispinalis and splenius capitis muscles, compared with controls. Headache intensity, duration or frequency and rCSA in both RCPmin and RCPmaj muscles were negatively correlated ( P < 0.05): the greater the headache intensity, duration or frequency, the smaller the rCSA in the RCPmin and RCPmaj muscles. CTTH patients demonstrate muscle atrophy of the rectus capitis posterior muscles. Whether this selective muscle atrophy is a primary or secondary phenomenon remains unclear. In any case, muscle atrophy could possibly account for a reduction of proprioceptive output from these muscles, and thus contribute to the perpetuation of pain.

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