Topographical Pressure Pain Sensitivity Maps of the Temporalis Muscle in People with Frequent Episodic and Chronic Tension-Type Headache

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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Widespread Pressure Pain Sensitivity over Nerve Trunk Areas in Women with Frequent Episodic Tension-Type Headache as a Sign of Central Sensitization

Pain Medicine ◽

10.1093/pm/pnz146 ◽

2019 ◽

Vol 21 (7) ◽

pp. 1408-1414

Author(s):

Leandro H Caamaño-Barrios ◽

Fernando Galán-del-Río ◽

César Fernández-de-las-Peñas ◽

Gustavo Plaza-Manzano ◽

Lars Arendt-Nielsen ◽

...

Keyword(s):

Central Sensitization ◽

Pain Sensitivity ◽

Pressure Pain Threshold ◽

Depression Scale ◽

Tension Type Headache ◽

Analysis Of Covariance ◽

Tibialis Posterior ◽

Temporalis Muscle ◽

Pressure Pain ◽

Type Headache

Abstract Objective Previous studies reported the presence of widespread pressure pain sensitivity in patients with tension-type headache. However, most of the studies assessed pressure pain sensitivity over muscle tissue. Our aim was to investigate the difference in pressure pain sensitivity over musculoskeletal and nerve symptomatic and distant areas between women with frequent episodic tension-type headache (FETTH) and healthy subjects. Methods Thirty-two women with FETTH and 32 matched healthy women participated. Pressure pain threshold (PPT) was bilaterally assessed over several nerve trunks (greater occipital, median, radial, ulnar, common peroneal, tibialis posterior) and musculoskeletal structures (temporalis muscle, C5/C6 joint, tibialis anterior) by an assessor blinded to the subject’s condition. A four-week headache diary was used to collect the intensity, frequency, and duration of headache. The Hospital Anxiety and Depression Scale was used to determine anxiety and depressive levels. Results Analysis of covariance found lower widespread and bilateral PPTs over all nerve trunks and musculoskeletal structures in women with FETTH pain (P < 0.001). No significant effect of anxiety and depressive levels on PPTs was found (all P > 0.222). PPT over the temporalis muscle was significantly negatively correlated with headache intensity. Conclusions This study found widespread pressure pain hypersensitivity over both nerve trunks and musculoskeletal structures in women with FETTH, suggesting that the presence of central altered nociceptive processing is not just restricted to musculoskeletal areas, for example, muscles, but also pain evoked from directly provoking the nerve trunks by pressure. It is also possible that nerve tissue treatment could lead to a decrease in central sensitization and headache features.

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Exteroceptive Suppression of Temporalis Muscle Activity: Findings in Headache

Cephalalgia ◽

10.1046/j.1468-2982.1993.1301011.x ◽

1993 ◽

Vol 13 (1) ◽

pp. 11-14 ◽

Cited By ~ 16

Author(s):

Thomas-Martin Wallasch ◽

Hartmut Göbel

Keyword(s):

Muscle Activity ◽

Silent Period ◽

Tension Type Headache ◽

Temporalis Muscle ◽

Pharmacological Agents ◽

Chronic Tension Type Headache ◽

Exteroceptive Suppression ◽

Headache Diagnosis ◽

Secondary Phenomenon ◽

Type Headache

Exteroceptive suppression of temporalis muscle activity was proposed by Schoenen and co-workers in 1987 as a tool in headache diagnosis and research. Their finding of a decreased or abolished second silent period (ES2) in chronic tension-type headache sufferers has been confirmed by several independent laboratories during the last five years. Temporalis silent periods have also been studied in various other types of headaches. Their modulation by neuropsychological factors and pharmacological agents has also been investigated as well as their retest reliability. The pathophysiological concept of muscle contraction in tension-type headache has been challenged by studies using temporalis silent periods. The exterocepfive suppression of temporalis muscle activity points unequivocally towards a central pathogenetic mechanism, although it remains unclear whether the abnormalities of temporalis ES2 represent the primary dysfunction or a secondary phenomenon in chronic tension-type headache.

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