Top

Published in:

01-12-2011

The Role of Muscles in Tension-Type Headache

Authors: Lars Bendtsen, César Fernández-de-la-Peñas

Published in: Current Pain and Headache Reports | Issue 6/2011

Abstract

The tenderness of pericranial myofascial tissues and number of myofascial trigger points are considerably increased in patients with tension-type headache (TTH). Mechanisms responsible for the increased myofascial pain sensitivity have been studied extensively. Peripheral activation or sensitization of myofascial nociceptors could play a role in causing increased pain sensitivity, but firm evidence for a peripheral abnormality still is lacking. Peripheral mechanisms are most likely of major importance in episodic TTH. Sensitization of pain pathways in the central nervous system due to prolonged nociceptive stimuli from pericranial myofascial tissues seem to be responsible for the conversion of episodic to chronic TTH. Treatment directed toward muscular factors include electromyography biofeedback, which has a documented effect in patients with TTH, as well as physiotherapy and muscle relaxation therapy, which are most likely effective. Future studies should aim to identify the source of peripheral nociception.

Schwartz BS, Stewart WF, Lipton RB. Lost workdays and decreased work effectiveness associated with headache in the workplace. J Occup Environ Med. 1997;39:320–7.PubMedCrossRef

Mathew NT. Tension-type headache. Curr Neurol Neurosci Rep. 2006;6:100–5.PubMedCrossRef

Bendtsen L. Central sensitization in tension-type headache - possible pathophysiological mechanisms. Cephalalgia. 2000;20:486–508.PubMedCrossRef

Bendtsen L, Jensen R. Tension-type headache: the most common, but also the most neglected, headache disorder. Curr Opin Neurol. 2006;19:305–9.PubMed

Ashina M. Neurobiology of chronic tension-type headache. Cephalalgia. 2004;24:161–72.PubMedCrossRef

Jensen R. Pathophysiological mechanisms of tension-type headache: a review of epidemiological and experimental studies. Cephalalgia. 1999;19:602–21.PubMedCrossRef

Vandenheede M, Schoenen J. Central mechanisms in tension-type headaches. Curr Pain Headache Rep. 2002;6:392–400.PubMedCrossRef

Ashina S, Bendtsen L, Ashina M. Pathophysiology of tension-type headache. Curr Pain Headache Rep. 2005;9:415–22.PubMedCrossRef

Fernandez-de-Las-Penas C, Cuadrado ML, Arendt-Nielsen L, Simons DG, Pareja JA. Myofascial trigger points and sensitization: an updated pain model for tension-type headache. Cephalalgia. 2007;27:383–93.PubMedCrossRef

10.

Fumal A, Schoenen J. Tension-type headache: current research and clinical management. Lancet Neurol. 2008;7:70–83.PubMedCrossRef

11.

Bendtsen L, Jensen R. Tension-type headache. Neurol Clin. 2009;27:525–35.PubMedCrossRef

12.

Lipchik GL, Holroyd KA, O’Donnell FJ, et al. Exteroceptive suppression periods and pericranial muscle tenderness in chronic tension-type headache: effects of psychopathology, chronicity and disability. Cephalalgia. 2000;20:638–46.PubMed

13.

Buchgreitz L, Lyngberg AC, Bendtsen L, Jensen R. Frequency of headache is related to sensitization: a population study. Pain. 2006;123:19–27.PubMedCrossRef

14.

Fernandez-de-Las-Penas C, Cuadrado ML, Arendt-Nielsen L, Ge HY, Pareja JA. Increased pericranial tenderness, decreased pressure pain threshold, and headache clinical parameters in chronic tension-type headache patients. Clin J Pain. 2007;23:346–52.PubMedCrossRef

15.

Langemark M, Olesen J. Pericranial tenderness in tension headache. A blind, controlled study. Cephalalgia. 1987;7:249–55.PubMedCrossRef

16.

Jensen R, Bendtsen L, Olesen J. Muscular factors are of importance in tension-type headache. Headache. 1998;38:10–7.PubMedCrossRef

17.

Ashina M, Bendtsen L, Jensen R, Sakai F, Olesen J. Muscle hardness in patients with chronic tension-type headache: relation to actual headache state. Pain. 1999;79:201–5.PubMedCrossRef

18.

Newham DJ, Edwards RHT, Mills KR. Skeletal muscle pain. In: Wall PD, Melzack R, editors. Textbook of pain. 3rd ed. Edinburgh: Churchill Livingstone; 1994. p. 423–40.

19.

Mense S. Nociception from skeletal muscle in relation to clinical muscle pain. Pain. 1993;54:241–89.PubMedCrossRef

20.

Jensen R, Olesen J. Initiating mechanisms of experimentally induced tension-type headache. Cephalalgia. 1996;16:175–82.PubMedCrossRef

21.

Christensen M, Bendtsen L, Ashina M, Jensen R. Experimental induction of muscle tenderness and headache in tension-type headache patients. Cephalalgia. 2005;25:1061–7.PubMedCrossRef

22.

Hubbard DR, Berkoff GM. Myofascial trigger points show spontaneous needle EMG activity. Spine. 1993;18:1803–7.PubMedCrossRef

23.

Fernandez-de-Las-Penas C, Alonso-Blanco C, Cuadrado ML, Gerwin RD, Pareja JA. Myofascial trigger points and their relationship to headache clinical parameters in chronic tension-type headache. Headache. 2006;46:1264–72.PubMedCrossRef

24.

Fernandez-de-Las-Penas C, Alonso-Blanco C, Cuadrado ML, Gerwin RD, Pareja JA. Trigger points in the suboccipital muscles and forward head posture in tension-type headache. Headache. 2006;46:454–60.PubMedCrossRef

25.

Fernandez-de-Las-Penas C, Cuadrado ML, Pareja JA. Myofascial trigger points, neck mobility, and forward head posture in episodic tension-type headache. Headache. 2007;47:662–72.PubMedCrossRef

26.

Fernandez-de-Las-Penas C, Ge HY, Arendt-Nielsen L, Cuadrado ML, Pareja JA. Referred pain from trapezius muscle trigger points shares similar characteristics with chronic tension type headache. Eur J Pain. 2007;11:475–82.PubMedCrossRef

27.

Shah JP, Danoff JV, Desai MJ, Parikh S, Nakamura LY, Phillips TM, et al. Biochemicals associated with pain and inflammation are elevated in sites near to and remote from active myofascial trigger points. Arch Phys Med Rehabil. 2008;89:16–23.PubMedCrossRef

28.

Fernandez-de-Las-Penas C, Schoenen J. Chronic tension-type headache: what is new? Curr Opin Neurol. 2009;22:254–61.PubMedCrossRef

29.

•• Buchgreitz L, Lyngberg AC, Bendtsen L, Jensen R. Increased pain sensitivity is not a risk factor but a consequence of frequent headache: a population-based follow-up study. Pain. 2008;137:623–30. This is a very important longitudinal study indicating that central sensitization is the consequence of prolonged muscle pain. PubMedCrossRef

30.

Simons DG, Mense S. Understanding and measurement of muscle tone as related to clinical muscle pain. Pain. 1998;75:1–17.PubMedCrossRef

31.

Mense S, Simons DG, Hoheisel U, Quenzer B. Lesions of rat skeletal muscle after local block of acetylcholinesterase and neuromuscular stimulation. J Appl Physiol. 2003;94:2494–501.PubMedCrossRef

32.

Ashina M, Stallknecht B, Bendtsen L, et al. In vivo evidence of altered skeletal muscle blood flow in chronic tension-type headache. Brain. 2002;125:320–6.PubMedCrossRef

33.

Fernandez-Carnero J, Ge HY, Kimura Y, Fernandez-de-Las-Penas C, Arendt-Nielsen L. Increased spontaneous electrical activity at a latent myofascial trigger point after nociceptive stimulation of another latent trigger point. Clin J Pain. 2010;26:138–43.PubMedCrossRef

34.

Ashina M, Stallknecht B, Bendtsen L, et al. Tender points are not sites of ongoing inflammation - in vivo evidence in patients with chronic tension-type headache. Cephalalgia. 2003;23:109–16.PubMedCrossRef

35.

Mense S. Differences between myofascial trigger points and tender points. Schmerz. 2011;25:93–103.PubMedCrossRef

36.

Schmidt-Hansen PT, Svensson P, Jensen TS, Graven-Nielsen T, Bach FW. Patterns of experimentally induced pain in pericranial muscles. Cephalalgia. 2006;26:568–77.PubMedCrossRef

37.

Mork H, Ashina M, Bendtsen L, Olesen J, Jensen R. Possible mechanisms of pain perception in patients with episodic tension-type headache. A new experimental model of myofascial pain. Cephalalgia. 2004;24:466–75.PubMedCrossRef

38.

Göbel H, Weigle L, Kropp P, Soyka D. Pain sensitivity and pain reactivity of pericranial muscles in migraine and tension-type headache. Cephalalgia. 1992;12:142–51.PubMedCrossRef

39.

Jensen R, Rasmussen BK, Pedersen B, Olesen J. Muscle tenderness and pressure pain thresholds in headache. A population study. Pain. 1993;52:193–9.PubMedCrossRef

40.

Bovim G. Cervicogenic headache, migraine, and tension-type headache. Pressure-pain threshold measurements. Pain. 1992;51:169–73.PubMedCrossRef

41.

Jensen R. Mechanisms of spontaneous tension-type headaches: an analysis of tenderness, pain thresholds and EMG. Pain. 1996;64:251–6.PubMedCrossRef

42.

Schmidt-Hansen PT, Svensson P, Bendtsen L, Graven-Nielsen T, Bach FW. Increased muscle pain sensitivity in patients with tension-type headache. Pain. 2007;129:113–21.PubMedCrossRef

43.

Mork H, Ashina M, Bendtsen L, Olesen J, Jensen R. Induction of prolonged tenderness in patients with tension-type headache by means of a new experimental model of myofascial pain. Eur J Neurol. 2003;10:249–56.PubMedCrossRef

44.

Bendtsen L, Jensen R, Olesen J. Decreased pain detection and tolerance thresholds in chronic tension-type headache. Arch Neurol. 1996;53:373–6.PubMed

45.

Langemark M, Jensen K, Jensen TS, Olesen J. Pressure pain thresholds and thermal nociceptive thresholds in chronic tension-type headache. Pain. 1989;38:203–10.PubMedCrossRef

46.

Langemark M, Bach FW, Jensen TS, Olesen J. Decreased nociceptive flexion reflex threshold in chronic tension-type headache. Arch Neurol. 1993;50:1061–4.PubMed

47.

Schoenen J, Bottin D, Hardy F, Gerard P. Cephalic and extracephalic pressure pain thresholds in chronic tension-type headache. Pain. 1991;47:145–9.PubMedCrossRef

48.

Sandrini G, Rossi P, Milanov I, Serrao M, Cecchini AP, Nappi G. Abnormal modulatory influence of diffuse noxious inhibitory controls in migraine and chronic tension-type headache patients. Cephalalgia. 2006;26:782–9.PubMedCrossRef

49.

Ashina S, Bendtsen L, Ashina M, Magerl W, Jensen R. Generalized hyperalgesia in patients with chronic tension-type headache. Cephalalgia. 2006;26:940–8.PubMedCrossRef

50.

Lindelof K, Ellrich J, Jensen R, Bendtsen L. Central pain processing in chronic tension-type headache. Clin Neurophysiol. 2009;120:1364–70.PubMedCrossRef

51.

Cathcart S, Winefield AH, Lushington K, Rolan P. Noxious inhibition of temporal summation is impaired in chronic tension-type headache. Headache. 2010;50:403–12.PubMedCrossRef

52.

Cathcart S, Winefield AH, Lushington K, Rolan P. Effect of mental stress on cold pain in chronic tension-type headache sufferers. J Headache Pain. 2009;10:367–73.PubMedCrossRef

53.

Buchgreitz L, Lyngberg A, Bendtsen L, Jensen R. Increased prevalence of tension-type headache over a 12-year period is related to increased pain sensitivity. A population study. Cephalalgia. 2007;27:145–52.PubMedCrossRef

54.

Treede RD, Meyer RA, Raja SN, Campbell JN. Peripheral and central mechanisms of cutaneous hyperalgesia. Prog Neurobiol. 1992;38:397–421.PubMedCrossRef

55.

Milanov I, Bogdanova D. Pain and tension-type headache: a review of the possible pathophysiological mechanisms. J Headache Pain. 2004;5:4–11.CrossRef

56.

Bendtsen L, Jensen R, Olesen J. Qualitatively altered nociception in chronic myofascial pain. Pain. 1996;65:259–64.PubMedCrossRef

57.

Srbely JZ, Dickey JP, Bent LR, Lee D, Lowerison M. Capsaicin-induced central sensitization evokes segmental increases in trigger point sensitivity in humans. J Pain. 2010;11:636–43.PubMedCrossRef

58.

Pielsticker A, Haag G, Zaudig M, Lautenbacher S. Impairment of pain inhibition in chronic tension-type headache. Pain. 2005;118:215–23.PubMedCrossRef

59.

Buchgreitz L, Egsgaard LL, Jensen R, Arendt-Nielsen L, Bendtsen L. Abnormal pain processing in chronic tension-type headache: a high-density EEG brain mapping study. Brain. 2008;131:3232–8.PubMedCrossRef

60.

Merskey H. Pain and psychological medicine. In: Wall PD, Melzack R, editors. Textbook of pain. 3rd ed. Edinburgh: Churchill Livingstone; 1994. p. 903–20.

61.

Coderre TJ, Katz J, Vaccarino AL, Melzack R. Contribution of central neuroplasticity to pathological pain: review of clinical and experimental evidence. Pain. 1993;52:259–85.PubMedCrossRef

62.

•• Cathcart S, Winefield AH, Lushington K, Rolan P. Stress and tension-type headache mechanisms. Cephalalgia. 2010;30:1250–67. This is an interesting series of studies on the relation between stress and headache. PubMedCrossRef

63.

Cathcart S, Petkov J, Winefield AH, Lushington K, Rolan P. Central mechanisms of stress-induced headache. Cephalalgia. 2010;30:285–95.PubMedCrossRef

64.

Penacoba-Puente C, Fernandez-de-Las-Penas C, Gonzalez-Gutierrez JL, Miangolarra-Page JC, Pareja JA. Interaction between anxiety, depression, quality of life and clinical parameters in chronic tension-type headache. Eur J Pain. 2008;12:886–94.PubMedCrossRef

65.

Schmidt-Wilcke T, Leinisch E, Straube A, Kampfe N, Draganski B, Diener HC, et al. Gray matter decrease in patients with chronic tension type headache. Neurology. 2005;65:1483–6.PubMedCrossRef

66.

Bendtsen L. Sensitization: its role in primary headache. Curr Opin Investig Drugs. 2002;3:449–53.PubMed

67.

Bendtsen L, Jensen R. Amitriptyline reduces myofascial tenderness in patients with chronic tension-type headache. Cephalalgia. 2000;20:603–10.PubMedCrossRef

68.

Meller ST, Gebhart GF. Nitric oxide (NO) and nociceptive processing in the spinal cord. Pain. 1993;52:127–36.PubMedCrossRef

69.

Ashina M, Bendtsen L, Jensen R, Olesen J. Nitric oxide-induced headache in patients with chronic tension-type headache. Brain. 2000;123:1830–7.PubMedCrossRef

70.

Ashina M, Lassen LH, Bendtsen L, Jensen R, Olesen J. Effect of inhibition of nitric oxide synthase on chronic tension-type headache: a randomised crossover trial. Lancet. 1999;353:287–9.PubMedCrossRef

71.

Ashina M, Bendtsen L, Jensen R, Lassen LH, Sakai F, Olesen J. Possible mechanisms of action of nitric oxide synthase inhibitors in chronic tension-type headache. Brain. 1999;122:1629–35.PubMedCrossRef

72.

Sarchielli P, Alberti A, Floridi A, Gallai V. L-Arginine/nitric oxide pathway in chronic tension-type headache: relation with serotonin content and secretion and glutamate content. J Neurol Sci. 2002;198:9–15.PubMedCrossRef

73.

Makowska A, Panfil C, Ellrich J. Long-term potentiation of orofacial sensorimotor processing by noxious input from the semispinal neck muscle in mice. Cephalalgia. 2005;25:109–16.PubMedCrossRef

74.

Makowska A, Panfil C, Ellrich J. Nerve growth factor injection into semispinal neck muscle evokes sustained facilitation of the jaw-opening reflex in anesthetized mice – possible implications for tension-type headache. Exp Neurol. 2005;191:301–9.PubMedCrossRef

75.

Makowska A, Panfil C, Ellrich J. ATP induces sustained facilitation of craniofacial nociception through P2X receptors on neck muscle nociceptors in mice. Cephalalgia. 2006;26:697–706.PubMedCrossRef

76.

Panfil C, Makowska A, Ellrich J. Brainstem and cervical spinal cord Fos immunoreactivity evoked by nerve growth factor injection into neck muscles in mice. Cephalalgia. 2006;26:128–35.PubMedCrossRef

77.

•• Bendtsen L, Evers S, Linde M, Mitsikostas DD, Sandrini G, Schoenen J. EFNS guideline on the treatment of tension-type headache - report of an EFNS task force. Eur J Neurol. 2010;17:1318–25. This is an important guideline on the treatment of tension-type headache. PubMed

78.

Nestoriuc Y, Rief W, Martin A. Meta-analysis of biofeedback for tension-type headache: efficacy, specificity, and treatment moderators. J Consult Clin Psychol. 2008;76:379–96.PubMedCrossRef

79.

Soderberg EI, Carlsson JY, Stener-Victorin E, Dahlof C. Subjective well-being in patients with chronic tension-type headache: Effect of acupuncture, physical training, and relaxation training. Clin J Pain. 2011 Feb 11.

Title: The Role of Muscles in Tension-Type Headache
Authors: Lars Bendtsen
César Fernández-de-la-Peñas
Publication date: 01-12-2011
Publisher: Current Science Inc.
Published in: Current Pain and Headache Reports / Issue 6/2011
Print ISSN: 1531-3433
Electronic ISSN: 1534-3081
DOI: https://doi.org/10.1007/s11916-011-0216-0

Keynote webinar | Spotlight on medication adherence

Springer Medicine

The Role of Muscles in Tension-Type Headache

Abstract

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 6/2011

Erratum to: Epidemiology of Cancer Pain

Taking Care of the Challenging Tension Headache Patient

Effects of Exercise and Physical Activity on Knee Osteoarthritis

Tension-Type Headache Mimics

Tension-type Headache and Systemic Medical Disorders

Complementary and Alternative Medicine for Rheumatoid Arthritis and Osteoarthritis: an Overview of Systematic Reviews