Trigger points in the suboccipital muscles and forward head posture in tension-type headache

Objective. - To assess the presence of trigger points (TrPs) in the suboccipital muscles and forward head posture (FHP) in subjects with chronic tension-type headache (CTTH) and in healthy subjects, and to evaluate the relationship of TrPs and FHP with headache intensity, duration, and frequency. Background. - Tension-type headache (TTH) is a prototypical headache in which myofascial TrPs in the cervical and pericranial musculature can play an important role. Design. - A blinded, controlled pilot study. Methods. - Twenty CTTH subjects and 20 matched controls without headache participated. TrPs were identified by eliciting referred pain with palpation, and increased referred pain with muscle contraction. Side-view pictures of each subject were taken in sitting and standing positions, in order to assess FHP by measuring the craniovertebral angle. Both measures were taken by a blinded assessor. A headache diary was kept for 4 weeks in order to assess headache intensity, frequency, and duration. Results. - Sixty-five percent (13/20) CTTH subjects showed active TrPs and 35% (7/20) had latent TrPs in the suboccipital muscles. Six (30%) controls also had latent TrPs. Differences in the presence of suboccipital muscle TrPs between both the groups were significant for active TrPs (P < .001) but not for latent TrPs (P > .5). CTTH subjects with active TrPs reported a greater headache intensity and frequency than those with latent TrPs (P < .05). The degree of FHP was greater in CTTH subjects than in controls in both sitting and standing positions (P < .01). Within the CTTH group, there was a negative correlation between the craniovertebral angle and the frequency of headache (r_s=-0.6, P < .01, in sitting position; r_s=-0.5, P < .05, in standing position). CTTH subjects with active TrPs had a greater FHP than those with latent TrPs, though this difference was not significant. Conclusions. - Suboccipital active TrPs and FHP were associated with CTTH. CCTH subjects with active TrPs reported a greater headache intensity and frequency than those with latent TrPs. The degree of FHP correlated positively with headache duration, headache frequency, and the presence of suboccipital active TrPs.