Referred pain from trapezius muscle trigger points shares similarcharacteristics with chronic tension type headache
, Hong-You Ge
, Lars Arendt-Nielsen
,Maria Luz Cuadrado
, Juan A. Pareja
Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation of Universidad Rey Juan Carlos,Alcorco´ n, Madrid, Spain
Centre for Sensory-Motor Interaction (SMI), Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
Departments of Neurology of Fundacio´ n Hospital Alcorco´ n and Universidad Rey Juan Carlos, Alcorco´ n, Madrid, Spain
Received 26 January 2006; received in revised form 3 July 2006; accepted 10 July 2006Available online 21 August 2006
Referred pain and pain characteristics evoked from the upper trapezius muscle was investigated in 20 patients with chronic ten-sion-type headache (CTTH) and 20 age- and gender-matched controls. A headache diary was kept for 4 weeks in order to conﬁrmthe diagnosis and record the pain history. Both upper trapezius muscles were examined for the presence of myofascial trigger points(TrPs) in a blinded fashion. The local and referred pain intensities, referred pain pattern, and pressure pain threshold (PPT) wererecorded. The results show that referred pain was evoked in 85% and 50% on the dominant and non-dominant sides in CTTHpatients, much higher than 55% and 25% in controls (
< 0.01). Referred pain spread to the posterior-lateral aspect of the neckipsi-lateral to the stimulated muscle in both patients and controls, with additional referral to the temple in most patients, but nonein controls. Nearly half of the CTTH patients (45%) recognized the referred pain as their usual headache sensation, i.e. active TrPs.CTTH patients with active TrPs in the right upper trapezius muscle showed greater headache intensity and frequency, and longerheadache duration than those with latent TrPs. CTTH patients with bilateral TrPs reported signiﬁcantly decreased PPT than thosewith unilateral TrP (
< 0.01). Our results showed that manual exploration of TrPs in the upper trapezius muscle elicited referredpain patterns in both CTTH patients and healthy subjects. In CTTH patients, the evoked referred pain and its sensory character-istics shared similar patterns as their habitual headache pain, consistent with active TrPs. Our results suggest that spatial summationof perceived pain and mechanical pain sensitivity exists in CTTH patients.
2006 European Federation of Chapters of the International Association for the Study of Pain. Published by Elsevier Ltd. Allrights reserved.
Referred pain; Muscle pain; Myofascial trigger point; Pressure pain threshold; Tension type headache
Tension-type headache (TTH) is the most commontype of headache with one-year prevalence rates of 38.3% for the episodic form, and 2.2% for the chronicform (CTTH) (Schwartz et al., 1998). Despite someadvances, the pathogenesis of this primary headache isnot clearly understood. TTH is a prototypical headachein which peripheral, i.e. muscular, factors may play animportant etiologic role (Jensen et al., 1998). Althoughthe most prominent clinical ﬁnding in TTH subjects isan increased tenderness to palpation of pericranial tis-sues (Langemark and Olesen, 1987; Jensen and Olesen,
2006 European Federation of Chapters of the International Association for the Study of Pain. Published by Elsevier Ltd. All rightsreserved.doi:10.1016/j.ejpain.2006.07.005
Corresponding author. Address: Facultad de Ciencias de la Salud,Universidad Rey Juan Carlos, Avenida de Atenas s/n, 28922 Alcorco´n,Madrid, Spain. Tel.: + 34 91 488 88 84; fax: + 34 91 488 89 57.
European Journal of Pain 11 (2007) 475–482