Myofascial trigger points and their relationship to headache clinical parameters in chronic tension-type headache

César Fernández-De-Las-Peñas, Cristina Alonso-Blanco, Maria Luz Cuadrado, Robert Gerwin, Juan A. Pareja

Research output: Contribution to journalArticle

Abstract

Objective. - To assess the presence of trigger points (TrPs) in several head and neck muscles in subjects with chronic tension-type headache (CTTH) and in healthy subjects; and to evaluate the relationship of these TrPs with forward head posture (FHP), headache intensity, duration, and frequency. Background. - Tension-type headache (TTH) is a headache in which myofascial TrPs in head and neck muscles might play an important etiologic role. Design. - A blinded, controlled, pilot study. Methods. - Twenty-five CTTH subjects and 25 matched controls without headache were studied. TrPs in bilateral upper trapezius, sternocleidomastoids, and temporalis muscles were identified according to Simons et al's diagnostic criteria: tenderness in a hyperirritable spot within a palpable taut band, local twitch response elicited by snapping palpation, and elicited referred pain with palpation. A TrP was considered active if the subject recognized the evoked referred pain as familiar headache. If the evoked referred pain was not recognized as familiar headache, the TrP was considered as latent. Side-view pictures of each subject were taken in both sitting and standing positions in order to assess FHP by measuring the cranio-vertebral angle. Both measurements were made by a blinded assessor. A headache diary was kept for 4 weeks in order to assess headache intensity, frequency, and duration. Results. - The mean number of TrPs on each CTTH subject was 3.9 (SD: 1.2), of which 1.9 (SD: 1.2) were active TrPs and 1.9 (SD: 0.8) were latent TrPs. Control subjects only exhibited latent TrPs (mean: 1.4; SD: 0.8). There was a significant difference between the CTTH group and the controls for active TrPs (P <.001), but not for latent TrPs (P >.05). Differences in the distribution of active and latent TrPs within each muscle were also significant for all the analyzed muscles (P <.01). CTTH subjects with active TrPs in the right upper trapezius muscle or left sternocleidomastoid muscle showed a greater headache intensity and duration, but not headache frequency, compared to those with latent TrPs (P <.05). Active TrPs in the right temporalis muscle were associated with longer headache duration (P <.01), whereas active TrPs in the left temporalis muscle were associated with greater headache intensity (P <.05). CTTH subjects with active TrPs in the analyzed muscles had a greater FHP than those with latent TrPs in both sitting and standing positions. Differences were only significant for TrPs in the left sternocleidomastoid and FHP in the sitting position (P <.01). Conclusions. - Active TrPs in upper trapezius, sternocleidomastoid, and temporalis muscles were associated with CTTH. CTTH subjects with active TrPs usually reported a greater headache intensity and longer headache duration than those with latent TrPs. CTTH subjects with active TrPs tended to have a greater FHP than CTTH subjects with latent TrPs.

Original languageEnglish (US)
Pages (from-to)1264-1272
Number of pages9
JournalHeadache
Volume46
Issue number8
DOIs
StatePublished - Sep 1 2006

Fingerprint

Trigger Points
Tension-Type Headache
Headache Disorders
Headache
Posture
Head
Muscles
Referred Pain
Superficial Back Muscles
Neck Muscles
Palpation

Keywords

  • Forward head posture
  • Myofascial trigger points
  • Sternocleidomastoid muscle
  • Temporalis muscle
  • Tension-type headache
  • Trigeminal nucleus caudalis
  • Upper trapezius muscle

ASJC Scopus subject areas

  • Clinical Neurology
  • Neuroscience(all)

Cite this

Myofascial trigger points and their relationship to headache clinical parameters in chronic tension-type headache. / Fernández-De-Las-Peñas, César; Alonso-Blanco, Cristina; Cuadrado, Maria Luz; Gerwin, Robert; Pareja, Juan A.

In: Headache, Vol. 46, No. 8, 01.09.2006, p. 1264-1272.

Research output: Contribution to journalArticle

Fernández-De-Las-Peñas, César ; Alonso-Blanco, Cristina ; Cuadrado, Maria Luz ; Gerwin, Robert ; Pareja, Juan A. / Myofascial trigger points and their relationship to headache clinical parameters in chronic tension-type headache. In: Headache. 2006 ; Vol. 46, No. 8. pp. 1264-1272.
@article{ab97c9d4f2ab42b3b6831b686b956977,
title = "Myofascial trigger points and their relationship to headache clinical parameters in chronic tension-type headache",
abstract = "Objective. - To assess the presence of trigger points (TrPs) in several head and neck muscles in subjects with chronic tension-type headache (CTTH) and in healthy subjects; and to evaluate the relationship of these TrPs with forward head posture (FHP), headache intensity, duration, and frequency. Background. - Tension-type headache (TTH) is a headache in which myofascial TrPs in head and neck muscles might play an important etiologic role. Design. - A blinded, controlled, pilot study. Methods. - Twenty-five CTTH subjects and 25 matched controls without headache were studied. TrPs in bilateral upper trapezius, sternocleidomastoids, and temporalis muscles were identified according to Simons et al's diagnostic criteria: tenderness in a hyperirritable spot within a palpable taut band, local twitch response elicited by snapping palpation, and elicited referred pain with palpation. A TrP was considered active if the subject recognized the evoked referred pain as familiar headache. If the evoked referred pain was not recognized as familiar headache, the TrP was considered as latent. Side-view pictures of each subject were taken in both sitting and standing positions in order to assess FHP by measuring the cranio-vertebral angle. Both measurements were made by a blinded assessor. A headache diary was kept for 4 weeks in order to assess headache intensity, frequency, and duration. Results. - The mean number of TrPs on each CTTH subject was 3.9 (SD: 1.2), of which 1.9 (SD: 1.2) were active TrPs and 1.9 (SD: 0.8) were latent TrPs. Control subjects only exhibited latent TrPs (mean: 1.4; SD: 0.8). There was a significant difference between the CTTH group and the controls for active TrPs (P <.001), but not for latent TrPs (P >.05). Differences in the distribution of active and latent TrPs within each muscle were also significant for all the analyzed muscles (P <.01). CTTH subjects with active TrPs in the right upper trapezius muscle or left sternocleidomastoid muscle showed a greater headache intensity and duration, but not headache frequency, compared to those with latent TrPs (P <.05). Active TrPs in the right temporalis muscle were associated with longer headache duration (P <.01), whereas active TrPs in the left temporalis muscle were associated with greater headache intensity (P <.05). CTTH subjects with active TrPs in the analyzed muscles had a greater FHP than those with latent TrPs in both sitting and standing positions. Differences were only significant for TrPs in the left sternocleidomastoid and FHP in the sitting position (P <.01). Conclusions. - Active TrPs in upper trapezius, sternocleidomastoid, and temporalis muscles were associated with CTTH. CTTH subjects with active TrPs usually reported a greater headache intensity and longer headache duration than those with latent TrPs. CTTH subjects with active TrPs tended to have a greater FHP than CTTH subjects with latent TrPs.",
keywords = "Forward head posture, Myofascial trigger points, Sternocleidomastoid muscle, Temporalis muscle, Tension-type headache, Trigeminal nucleus caudalis, Upper trapezius muscle",
author = "C{\'e}sar Fern{\'a}ndez-De-Las-Pe{\~n}as and Cristina Alonso-Blanco and Cuadrado, {Maria Luz} and Robert Gerwin and Pareja, {Juan A.}",
year = "2006",
month = "9",
day = "1",
doi = "10.1111/j.1526-4610.2006.00440.x",
language = "English (US)",
volume = "46",
pages = "1264--1272",
journal = "Headache",
issn = "0017-8748",
publisher = "Wiley-Blackwell",
number = "8",

}

TY - JOUR

T1 - Myofascial trigger points and their relationship to headache clinical parameters in chronic tension-type headache

AU - Fernández-De-Las-Peñas, César

AU - Alonso-Blanco, Cristina

AU - Cuadrado, Maria Luz

AU - Gerwin, Robert

AU - Pareja, Juan A.

PY - 2006/9/1

Y1 - 2006/9/1

N2 - Objective. - To assess the presence of trigger points (TrPs) in several head and neck muscles in subjects with chronic tension-type headache (CTTH) and in healthy subjects; and to evaluate the relationship of these TrPs with forward head posture (FHP), headache intensity, duration, and frequency. Background. - Tension-type headache (TTH) is a headache in which myofascial TrPs in head and neck muscles might play an important etiologic role. Design. - A blinded, controlled, pilot study. Methods. - Twenty-five CTTH subjects and 25 matched controls without headache were studied. TrPs in bilateral upper trapezius, sternocleidomastoids, and temporalis muscles were identified according to Simons et al's diagnostic criteria: tenderness in a hyperirritable spot within a palpable taut band, local twitch response elicited by snapping palpation, and elicited referred pain with palpation. A TrP was considered active if the subject recognized the evoked referred pain as familiar headache. If the evoked referred pain was not recognized as familiar headache, the TrP was considered as latent. Side-view pictures of each subject were taken in both sitting and standing positions in order to assess FHP by measuring the cranio-vertebral angle. Both measurements were made by a blinded assessor. A headache diary was kept for 4 weeks in order to assess headache intensity, frequency, and duration. Results. - The mean number of TrPs on each CTTH subject was 3.9 (SD: 1.2), of which 1.9 (SD: 1.2) were active TrPs and 1.9 (SD: 0.8) were latent TrPs. Control subjects only exhibited latent TrPs (mean: 1.4; SD: 0.8). There was a significant difference between the CTTH group and the controls for active TrPs (P <.001), but not for latent TrPs (P >.05). Differences in the distribution of active and latent TrPs within each muscle were also significant for all the analyzed muscles (P <.01). CTTH subjects with active TrPs in the right upper trapezius muscle or left sternocleidomastoid muscle showed a greater headache intensity and duration, but not headache frequency, compared to those with latent TrPs (P <.05). Active TrPs in the right temporalis muscle were associated with longer headache duration (P <.01), whereas active TrPs in the left temporalis muscle were associated with greater headache intensity (P <.05). CTTH subjects with active TrPs in the analyzed muscles had a greater FHP than those with latent TrPs in both sitting and standing positions. Differences were only significant for TrPs in the left sternocleidomastoid and FHP in the sitting position (P <.01). Conclusions. - Active TrPs in upper trapezius, sternocleidomastoid, and temporalis muscles were associated with CTTH. CTTH subjects with active TrPs usually reported a greater headache intensity and longer headache duration than those with latent TrPs. CTTH subjects with active TrPs tended to have a greater FHP than CTTH subjects with latent TrPs.

AB - Objective. - To assess the presence of trigger points (TrPs) in several head and neck muscles in subjects with chronic tension-type headache (CTTH) and in healthy subjects; and to evaluate the relationship of these TrPs with forward head posture (FHP), headache intensity, duration, and frequency. Background. - Tension-type headache (TTH) is a headache in which myofascial TrPs in head and neck muscles might play an important etiologic role. Design. - A blinded, controlled, pilot study. Methods. - Twenty-five CTTH subjects and 25 matched controls without headache were studied. TrPs in bilateral upper trapezius, sternocleidomastoids, and temporalis muscles were identified according to Simons et al's diagnostic criteria: tenderness in a hyperirritable spot within a palpable taut band, local twitch response elicited by snapping palpation, and elicited referred pain with palpation. A TrP was considered active if the subject recognized the evoked referred pain as familiar headache. If the evoked referred pain was not recognized as familiar headache, the TrP was considered as latent. Side-view pictures of each subject were taken in both sitting and standing positions in order to assess FHP by measuring the cranio-vertebral angle. Both measurements were made by a blinded assessor. A headache diary was kept for 4 weeks in order to assess headache intensity, frequency, and duration. Results. - The mean number of TrPs on each CTTH subject was 3.9 (SD: 1.2), of which 1.9 (SD: 1.2) were active TrPs and 1.9 (SD: 0.8) were latent TrPs. Control subjects only exhibited latent TrPs (mean: 1.4; SD: 0.8). There was a significant difference between the CTTH group and the controls for active TrPs (P <.001), but not for latent TrPs (P >.05). Differences in the distribution of active and latent TrPs within each muscle were also significant for all the analyzed muscles (P <.01). CTTH subjects with active TrPs in the right upper trapezius muscle or left sternocleidomastoid muscle showed a greater headache intensity and duration, but not headache frequency, compared to those with latent TrPs (P <.05). Active TrPs in the right temporalis muscle were associated with longer headache duration (P <.01), whereas active TrPs in the left temporalis muscle were associated with greater headache intensity (P <.05). CTTH subjects with active TrPs in the analyzed muscles had a greater FHP than those with latent TrPs in both sitting and standing positions. Differences were only significant for TrPs in the left sternocleidomastoid and FHP in the sitting position (P <.01). Conclusions. - Active TrPs in upper trapezius, sternocleidomastoid, and temporalis muscles were associated with CTTH. CTTH subjects with active TrPs usually reported a greater headache intensity and longer headache duration than those with latent TrPs. CTTH subjects with active TrPs tended to have a greater FHP than CTTH subjects with latent TrPs.

KW - Forward head posture

KW - Myofascial trigger points

KW - Sternocleidomastoid muscle

KW - Temporalis muscle

KW - Tension-type headache

KW - Trigeminal nucleus caudalis

KW - Upper trapezius muscle

UR - http://www.scopus.com/inward/record.url?scp=33747608172&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=33747608172&partnerID=8YFLogxK

U2 - 10.1111/j.1526-4610.2006.00440.x

DO - 10.1111/j.1526-4610.2006.00440.x

M3 - Article

C2 - 16942471

AN - SCOPUS:33747608172

VL - 46

SP - 1264

EP - 1272

JO - Headache

JF - Headache

SN - 0017-8748

IS - 8

ER -