Referred pain from the trochlear region in tension-type headache: A myofascial trigger point from the superior oblique muscle

Cesar Fernandez De Las Peñas, Maria Luz Cuadrado, Robert Gerwin, Juan A. Pareja

Research output: Contribution to journalArticle

Abstract

Background.-Tension-type headache (TTH) is a prototypical headache in which myofascial trigger points (MTrPs) can play an important role. To our knowledge, MTrPs in the muscle tissues of the trochlear region, ie, the superior oblique muscle (SOM), have not been previously mentioned, and a referred pain pattern from this region has never been reported. Objective.-To describe the referred pain from the trochlear area based on the examination of MTrPs in the SOM in patients with episodic and chronic TTH (CTTH). Design.-A blinded, controlled study. Methods.-The trochlear region was examined in 15 patients with CTTH, 15 patients with episodic TTH (ETTH), and 15 control subjects. Referred pain elicited by different maneuvers performed during manual palpation, ie, maintained pressure, active muscle contraction, and stretching of the muscle, was assessed with a visual analogue scale. Patients with ETTH were examined on days when they were headache-free, whereas CTTH patients were examined on days in which headache intensity was less than 4 points on a 10-cm horizontal visual analogue scale. Results.-Eighty-six percent of patients with CTTH and 60% with ETTH had referred pain that originated from MTrPs in the SOM, while only 27% of the controls reported referred pain. This pain was perceived as a deep ache located at the retro-orbital region, sometimes extending to the supra-orbital region or the homo-lateral forehead. Pain intensity was greater in CTTH patients than in ETTH patients or control subjects (P < .001). Conclusions.-MTrPs in the SOM may evoke a typical referred pain pattern in patients with TTH. The presence of a myofascial disorder in the trochlear region might contribute to the pathogenesis of TTH.

Original languageEnglish (US)
Pages (from-to)731-737
Number of pages7
JournalHeadache
Volume45
Issue number6
DOIs
StatePublished - Jun 1 2005

Fingerprint

Oculomotor Muscles
Referred Pain
Trigger Points
Tension-Type Headache
Headache
Visual Analog Scale
Pain
Muscles
Headache Disorders
Forehead
Palpation
Muscle Contraction

Keywords

  • Myofascial trigger points
  • Referred pain
  • Superior oblique muscle
  • Tension-type headache
  • Trochlear region

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology

Cite this

Referred pain from the trochlear region in tension-type headache : A myofascial trigger point from the superior oblique muscle. / Fernandez De Las Peñas, Cesar; Cuadrado, Maria Luz; Gerwin, Robert; Pareja, Juan A.

In: Headache, Vol. 45, No. 6, 01.06.2005, p. 731-737.

Research output: Contribution to journalArticle

Fernandez De Las Peñas, Cesar ; Cuadrado, Maria Luz ; Gerwin, Robert ; Pareja, Juan A. / Referred pain from the trochlear region in tension-type headache : A myofascial trigger point from the superior oblique muscle. In: Headache. 2005 ; Vol. 45, No. 6. pp. 731-737.
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abstract = "Background.-Tension-type headache (TTH) is a prototypical headache in which myofascial trigger points (MTrPs) can play an important role. To our knowledge, MTrPs in the muscle tissues of the trochlear region, ie, the superior oblique muscle (SOM), have not been previously mentioned, and a referred pain pattern from this region has never been reported. Objective.-To describe the referred pain from the trochlear area based on the examination of MTrPs in the SOM in patients with episodic and chronic TTH (CTTH). Design.-A blinded, controlled study. Methods.-The trochlear region was examined in 15 patients with CTTH, 15 patients with episodic TTH (ETTH), and 15 control subjects. Referred pain elicited by different maneuvers performed during manual palpation, ie, maintained pressure, active muscle contraction, and stretching of the muscle, was assessed with a visual analogue scale. Patients with ETTH were examined on days when they were headache-free, whereas CTTH patients were examined on days in which headache intensity was less than 4 points on a 10-cm horizontal visual analogue scale. Results.-Eighty-six percent of patients with CTTH and 60{\%} with ETTH had referred pain that originated from MTrPs in the SOM, while only 27{\%} of the controls reported referred pain. This pain was perceived as a deep ache located at the retro-orbital region, sometimes extending to the supra-orbital region or the homo-lateral forehead. Pain intensity was greater in CTTH patients than in ETTH patients or control subjects (P < .001). Conclusions.-MTrPs in the SOM may evoke a typical referred pain pattern in patients with TTH. The presence of a myofascial disorder in the trochlear region might contribute to the pathogenesis of TTH.",
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T2 - A myofascial trigger point from the superior oblique muscle

AU - Fernandez De Las Peñas, Cesar

AU - Cuadrado, Maria Luz

AU - Gerwin, Robert

AU - Pareja, Juan A.

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N2 - Background.-Tension-type headache (TTH) is a prototypical headache in which myofascial trigger points (MTrPs) can play an important role. To our knowledge, MTrPs in the muscle tissues of the trochlear region, ie, the superior oblique muscle (SOM), have not been previously mentioned, and a referred pain pattern from this region has never been reported. Objective.-To describe the referred pain from the trochlear area based on the examination of MTrPs in the SOM in patients with episodic and chronic TTH (CTTH). Design.-A blinded, controlled study. Methods.-The trochlear region was examined in 15 patients with CTTH, 15 patients with episodic TTH (ETTH), and 15 control subjects. Referred pain elicited by different maneuvers performed during manual palpation, ie, maintained pressure, active muscle contraction, and stretching of the muscle, was assessed with a visual analogue scale. Patients with ETTH were examined on days when they were headache-free, whereas CTTH patients were examined on days in which headache intensity was less than 4 points on a 10-cm horizontal visual analogue scale. Results.-Eighty-six percent of patients with CTTH and 60% with ETTH had referred pain that originated from MTrPs in the SOM, while only 27% of the controls reported referred pain. This pain was perceived as a deep ache located at the retro-orbital region, sometimes extending to the supra-orbital region or the homo-lateral forehead. Pain intensity was greater in CTTH patients than in ETTH patients or control subjects (P < .001). Conclusions.-MTrPs in the SOM may evoke a typical referred pain pattern in patients with TTH. The presence of a myofascial disorder in the trochlear region might contribute to the pathogenesis of TTH.

AB - Background.-Tension-type headache (TTH) is a prototypical headache in which myofascial trigger points (MTrPs) can play an important role. To our knowledge, MTrPs in the muscle tissues of the trochlear region, ie, the superior oblique muscle (SOM), have not been previously mentioned, and a referred pain pattern from this region has never been reported. Objective.-To describe the referred pain from the trochlear area based on the examination of MTrPs in the SOM in patients with episodic and chronic TTH (CTTH). Design.-A blinded, controlled study. Methods.-The trochlear region was examined in 15 patients with CTTH, 15 patients with episodic TTH (ETTH), and 15 control subjects. Referred pain elicited by different maneuvers performed during manual palpation, ie, maintained pressure, active muscle contraction, and stretching of the muscle, was assessed with a visual analogue scale. Patients with ETTH were examined on days when they were headache-free, whereas CTTH patients were examined on days in which headache intensity was less than 4 points on a 10-cm horizontal visual analogue scale. Results.-Eighty-six percent of patients with CTTH and 60% with ETTH had referred pain that originated from MTrPs in the SOM, while only 27% of the controls reported referred pain. This pain was perceived as a deep ache located at the retro-orbital region, sometimes extending to the supra-orbital region or the homo-lateral forehead. Pain intensity was greater in CTTH patients than in ETTH patients or control subjects (P < .001). Conclusions.-MTrPs in the SOM may evoke a typical referred pain pattern in patients with TTH. The presence of a myofascial disorder in the trochlear region might contribute to the pathogenesis of TTH.

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KW - Tension-type headache

KW - Trochlear region

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