CHRONIC TENSION-TYPE HEADACHE: MUSCLE OVERACTIVITY VERSUS DEFICIENT PAIN CONTROLS

Objective: The oscillating school of thought between the peripheral and central mechanisms of pain origin hinders the selection of appropriate therapy for chronic tension-type headache (CTTH). The aim of this study was to assess the role of central and peripheral pain mechanisms together in CTTH.Methods: In the present study, we compared surface electromyography (sEMG) amplitudes and nociceptive flexion thresholds in patients diagnosed with CTTH (n=30) with age-matched healthy controls (n=30). For central pain modulation with spinal and supraspinal influences on nociception, we recorded nociceptive flexion reflex (NFR) by stimulating the sural nerve and observing the biceps femoris muscle response. sEMG was done for the temporalis and trapezius muscles at rest, during mental activity and during maximum voluntary contraction to assess contribution from peripheral pain.Results: We observed a decreased NFR threshold in CTTH patients as compared to healthy controls, suggesting a hyperalgesic state due to central factors. Electromyographic activity of trapezius muscle was increased at rest in CTTH while both temporalis and trapezius showed an overactivity in patients during mental task.Conclusion: Central factors are important in the pathogenesis of CTTH while, peripheral factors, such as stress-related muscle spasm may also contribute to pain state.

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Assessment of Pain Modulatory and Somatosensory Profiles in Chronic Tension-Type Headache Patients

Pain Medicine ◽

10.1093/pm/pnab084 ◽

2021 ◽

Author(s):

Fernando G Exposto ◽

Karina H Bendixen ◽

Malin Ernberg ◽

Flemming W Bach ◽

Peter Svensson

Keyword(s):

Pain Catastrophizing ◽

Tension Type Headache ◽

Pain Modulation ◽

Normative Values ◽

Healthy Controls ◽

Single Session ◽

Chronic Tension Type Headache ◽

Type Headache ◽

Underlying Pathophysiology

Abstract Objective The aim of this study was to thoroughly phenotype a group of chronic tension-type headache (CTTH) patients. Methods Fifteen CTTH patients diagnosed according to the International Classification of Headache Disorders–3 and 15 healthy controls were included in this study. Furthermore, 70 healthy controls were included to establish normative values. Quantitative sensory testing (QST), including temporal summation of pain (TSP), conditioned pain modulation (CPM), and psychological and sleep variables, was assessed in a single session. TSP and CPM were then combined to build pain modulation profiles (PMP) for each individual. Results No difference was found between groups for PMP, TSP, and CPM. However, 10 CTTH patients showed a pronociceptive PMP, with 8 related to a deficient CPM and 2 to both a deficient CPM and increased TSP. Increased cold detection thresholds were the most common sensory disturbance found in CTTH patients. Significant differences were seen between groups for pain catastrophizing, depression, and sleep quality although not all patient’s scores were above the clinically meaningful cutoffs. Conclusions In summary, CTTH patients presented with different PMP. These PMP may be related to increased TSP, deficient CPM, alterations in thermal detection that may be related to autonomic dysregulation, or a combination of all three. Overall, this suggests that due to their heterogeneous pathophysiology, CTTH patients should be managed according to their underlying pathophysiology and not with a one-size-fits-all approach.

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Serotonin Metabolism in Chronic Tension-Type Headache

Cephalalgia ◽

10.1046/j.1468-2982.1997.1708843.x ◽

1997 ◽

Vol 17 (8) ◽

pp. 843-848 ◽

Cited By ~ 17

Author(s):

L Bendtsen ◽

R Jensen ◽

I Hindberg ◽

S Gammeltoft ◽

J Olesen

Keyword(s):

Urinary Excretion ◽

Tension Type Headache ◽

Serotonin Level ◽

Healthy Controls ◽

Serotonin Metabolism ◽

Serotonergic Neurons ◽

Chronic Tension Type Headache ◽

Hydroxyindoleacetic Acid ◽

Type Headache

Serotonergic neurons play a major role in the regulation of pain and may therefore also be involved in the pathophysiology of tension-type headache. Platelets are important in the regulation of the free serotonin level in plasma and may be a model of serotonergic neurons. The aim of the present study was to investigate the peripheral serotonin (5HT) metabolism in patients with chronic tension-type headache. The 5HT levels in platelets and in plasma, the beta-thromboglobulin (ß-TG) levels in plasma, and the urinary excretion of 5-hydroxyindoleacetic acid (5HIAA) were measured in 40 patients with chronic tension-type headache and in 40 healthy controls. The platelet uptake index was calculated as the ratio between platelet 5HT and plasma 5HT levels. There were, no significant differences in platelet 5HT, plasma 5HT ß-TG, or 5HIAA between patients and controls. The platelet uptake index was significantly lower in patients 243 (136-367) than in controls 352 (202-508), p=0.03. Our results indicate that the peripheral 5HT metabolism is largely normal in patients with chronic tension-type headache.

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

Cephalalgia ◽

10.1111/j.1468-2982.2009.01901.x ◽

2009 ◽

Vol 30 (1) ◽

pp. 77-86 ◽

Cited By ~ 64

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.

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Stretch Reflex and Pressure Pain Thresholds in Chronic Tension-Type Headache Patients and Healthy Controls

Cephalalgia ◽

10.1111/j.1468-2982.2008.01772.x ◽

2009 ◽

Vol 29 (5) ◽

pp. 556-565 ◽

Cited By ~ 10

Author(s):

A Peddireddy ◽

K Wang ◽

P Svensson ◽

L Arendt-Nielsen

Keyword(s):

Stretch Reflex ◽

Tension Type Headache ◽

Healthy Controls ◽

Pain Thresholds ◽

Pressure Pain ◽

Chronic Tension Type Headache ◽

Control Subjects ◽

Pressure Pain Thresholds ◽

Type Headache ◽

Masseter Muscles

To compare the jaw-stretch reflex and pressure pain thresholds (PPT) in chronic tension-type headache (CTTH) patients and healthy controls, 30 patients (15 male and 15 female) and 30 age- and sex-matched healthy subjects were investigated. Stretch reflexes were recorded in the temporalis and masseter muscles and PPT was determined in the anterior temporalis, splenius capitis and masseter muscles. The results showed that the amplitude of the stretch reflex in CTTH patients was higher compared with control subjects ( P < 0.045), and higher in women compared with men in the right and left anterior temporalis muscles ( P < 0.009). There were no differences in the PPT value between CTTH and control subjects ( P > 0.509), whereas women showed significantly lower PPT measurements ( P < 0.046). The results demonstrated a facilitation of the stretch reflex pathways in CTTH patients that is unrelated to measures of pericranial sensitivity.

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Exteroceptive Suppression Patterns of Masseter and Temporalis Muscles in Central and Peripheral Headache Disorders

Cephalalgia ◽

10.1046/j.1468-2982.2002.00389.x ◽

2002 ◽

Vol 22 (6) ◽

pp. 444-452 ◽

Cited By ~ 19

Author(s):

C Tataroglu ◽

A Kanik ◽

G Sahin ◽

A özge ◽

D Yalçinkaya ◽

...

Keyword(s):

Differential Diagnosis ◽

Temporomandibular Joint ◽

Tension Type Headache ◽

Secondary Headache ◽

Healthy Controls ◽

Headache Disorders ◽

Onset Latency ◽

Chronic Tension Type Headache ◽

Exteroceptive Suppression ◽

Type Headache

The objective of this study was to compare the exteroceptive suppression patterns of masseter and temporalis muscles in patients with primary and secondary headache disorders originating from peripheral joint dysfunction. We accomplished the temporalis and masseter exteroceptive suppression in 28 patients with migraine, 25 patients with chronic tension-type headache (CTH), 22 patients with temporomandibular joint (TMJ) dysfunction and 18 healthy controls. The onset latencies and duration of the first suppression period (S1) was not significantly different between the patients and controls. The duration of the second suppression period (S2) was shorter in patients with CTH, migraine (analysed during attack) and TMJ dysfunction than those obtained from controls. A distinctive finding was significantly prolonged onset latency in patients with TMJ over those obtained from patients with CTH and migraine. We concluded that the onset latency of the S2 period is a useful parameter in the differential diagnosis of primary and peripheral headache disorders.

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Electromyographic Activity in Pericranial Muscles during Postural Variation and Mental Activity in Healthy Volunteers and Patients with Chronic Tension-Type Headache

Cephalalgia ◽

10.1177/0333102489009s1065 ◽

1989 ◽

Vol 9 (10_suppl) ◽

pp. 117-118 ◽

Cited By ~ 1

Author(s):

J. Schoenen ◽

F. Hardy ◽

M. Juprelle ◽

P. Deravet ◽

P. Gerard

Keyword(s):

Healthy Volunteers ◽

Tension Type Headache ◽

Mental Activity ◽

Electromyographic Activity ◽

Chronic Tension Type Headache ◽

Type Headache

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Cervical Muscle Co-Activation in Isometric Contractions is Enhanced in Chronic Tension-Type Headache Patients

Cephalalgia ◽

10.1111/j.1468-2982.2008.01584.x ◽

2008 ◽

Vol 28 (7) ◽

pp. 744-751 ◽

Cited By ~ 44

Author(s):

C Fernández-de-las-Peñas ◽

D Falla ◽

L Arendt-Nielsen ◽

D Farina

Keyword(s):

Maximum Voluntary Contraction ◽

Tension Type Headache ◽

Voluntary Contraction ◽

Antagonist Muscle ◽

Chronic Tension Type Headache ◽

Co Activation ◽

Splenius Capitis ◽

Type Headache ◽

Force Range ◽

Flexion And Extension

The purpose of the study was to compare the co-activation of cervical agonist and antagonist muscles between people with chronic tension-type headache (CTTH) and healthy controls during brief isometric cervical flexion and extension contractions. Nine women with CTTH and 10 matched controls participated. Surface electromyographic (EMG) signals were detected from the sternocleidomastoid and splenius capitis muscles bilaterally during cervical flexion and extension contractions of linearly increasing force from 0% to 60% of the maximum voluntary contraction (MVC) in 3 s. Sternocleidomastoid and splenius capitis EMG average rectified values (ARV) were estimated at 10% MVC force increments. During cervical extension contraction, sternocleidomastoid (i.e. antagonist muscle) ARV was greater for patients than for controls in the force range 20-60% MVC ( P = 0.029). During cervical flexion, the left splenius capitis (i.e. antagonist muscle) ARV was greater for CTTH patients regardless of the force level ( P = 0.02). Maximum cervical flexion and extension force was lower for the CTTH patients compared with controls ( P = 0.001). In conclusion, women with CTTH demonstrated greater co-activation of antagonist musculature during cervical extension and flexion contractions compared with healthy women. Increased co-activation of antagonist musculature may reflect reorganization of the motor control strategy in CTTH patients, potentially leading to muscle overload and increased nociception.

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Abnormal Modulatory Influence of Diffuse Noxious Inhibitory Controls in Migraine and Chronic Tension-Type Headache Patients

Cephalalgia ◽

10.1111/j.1468-2982.2006.01130.x ◽

2006 ◽

Vol 26 (7) ◽

pp. 782-789 ◽

Cited By ~ 187

Author(s):

G Sandrini ◽

P Rossi ◽

I Milanov ◽

M Serrao ◽

AP Cecchini ◽

...

Keyword(s):

Cold Pressor Test ◽

Cold Pressor ◽

Tension Type Headache ◽

Significant Inhibition ◽

Pain Modulation ◽

Primary Headaches ◽

Diffuse Noxious Inhibitory Controls ◽

Chronic Tension Type Headache ◽

Subjective Pain ◽

Type Headache

The aim of this study was to evaluate the function of pain modulating systems subserving diffuse noxious inhibitory controls (DNICs) in primary headaches. DNICs were examined in 24 migraineurs, 17 patients with chronic tension-type headache (CTTH) and 20 healthy subjects by means of nociceptive flexion RIII reflex and the cold pressor test (CPT) as heterotopic noxious conditioning stimulation (HNCS). The subjective pain thresholds (Tp) and the RIII reflex threshold (Tr) were significantly lower in CTTH vs. controls. In controls a significant inhibition of the RIII reflex was observed during the CPT (-30±, P < 0.05). Conversely, migraine and CTTH patients showed facilitation (+31±, P < 0.05 and +40±, P < 0.01, respectively) of the RIII reflex during the HNCS. This study demonstrates a dysfunction in systems subserving DNICs in both migraine and CTTH. Impairment of endogenous supraspinal pain modulation systems may contribute to the development and/or maintenance of central sensitization in primary headaches.

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