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The Journal of Headache and Pain

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Open Access 01-12-2022 | Central Nervous System Trauma | Research

Total tenderness score and pressure pain thresholds in persistent post-traumatic headache attributed to mild traumatic brain injury

Authors: Håkan Ashina, Haidar Muhsen Al-Khazali, Afrim Iljazi, Sait Ashina, Faisal Mohammad Amin, Henrik Winther Schytz

Published in: The Journal of Headache and Pain | Issue 1/2022

Abstract

Objective

To investigate whether persistent post-traumatic headache attributed to mild traumatic brain injury (TBI) is associated with more pronounced pericranial tenderness and lower pressure pain thresholds (PPTs) in the head and neck region, compared with healthy controls.

Methods

Patients with persistent post-traumatic headache (n = 100) and age- and gender-matched healthy controls (n = 100) were included between July 2018 and June 2019. Total tenderness score (TTS) was used to assess pericranial tenderness by bilateral manual palpation in eight muscles or tendon insertions. Summation was then used to calculate a TTS from 0 to 48 based on individual right- and left-sided scores; higher TTS score indicated more pronounced pericranial tenderness. PPTs were examined in m. temporalis and m. trapezius (upper and middle part) using an electronic pressure algometer that applies increasing blunt pressure at a constant rate.

Results

The TTS score was higher in patients with persistent post-traumatic headache (median, 21; IQR, 12–31), compared with healthy controls (median, 10; IQR, 6–17; P < .001). PPTs were lower in patients with persistent post-traumatic headache than in controls in both the left-sided m. temporalis (mean ± SD, 157.5 ± 59.9 vs. 201.1 ± 65.2; P < .001) and right-sided m. temporalis (mean ± SD, 159.5 ± 63.8 vs. 212.3 ± 61.9; P < .001). Furthermore, patients with persistent post-traumatic headache also had lower left- and right-sided PPTs in the upper as well as middle part of m. trapezius, compared with healthy controls; all P values were .05 or less.

Conclusions

Among patients with persistent post-traumatic headache, pericranial tenderness was more pronounced and PPTs in the head and neck region were lower than in healthy controls free of headache and mild TBI. Further research is needed to better understand the involvement of pericranial myofascial nociceptors in the disease mechanisms underlying post-traumatic headache.

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Title: Total tenderness score and pressure pain thresholds in persistent post-traumatic headache attributed to mild traumatic brain injury
Authors: Håkan Ashina
Haidar Muhsen Al-Khazali
Afrim Iljazi
Sait Ashina
Faisal Mohammad Amin
Henrik Winther Schytz
Publication date: 01-12-2022
Publisher: Springer Milan
Keywords: Central Nervous System Trauma
Migraine
Tension Headache
Headache
Published in: The Journal of Headache and Pain / Issue 1/2022
Print ISSN: 1129-2369
Electronic ISSN: 1129-2377
DOI: https://doi.org/10.1186/s10194-022-01457-1

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Total tenderness score and pressure pain thresholds in persistent post-traumatic headache attributed to mild traumatic brain injury

Abstract

Objective

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Objective

Methods

Results

Conclusions

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