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Research for Doctors
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Trigger Points
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Fernandez-de-Las-Penas, C et al. Myofascial trigger points and their relationship to headache clinical parameters in chronic tension-type headache. Headache. 2006 Sep;46(8):1264-72.
Tension-type headache is a headache in which myofascial trigger points in head and neck muscles might play an important etiologic role.
The objective of this study was to assess the presence of Trigger Points in several head and neck muscles in subjects with Chronic Tension-type headache and in healthy subjects; and to evaluate the relationship of these Trigger Points with forward head posture, headache intensity, duration, and frequency.
This was a blinded, controlled, pilot study, with twenty-five chronic tension-type headache subjects and 25 matched controls without headache.
Trigger Points in bilateral upper trapezius, sternocleidomastoids, and temporalis muscles were identified according to Simons et al's diagnostic criteria: tenderness in a hyperirritable spot within a palpable taut band, local twitch response elicited by snapping palpation, and elicited referred pain with palpation.
A Trigger Point was considered active if the subject recognized the evoked referred pain as familiar headache.
If the evoked referred pain was not recognized as familiar headache, the Trigger Point was considered as latent.
Side-view pictures of each subject were taken in both sitting and standing positions in order to assess Forward Head Posture by measuring the cranio-vertebral angle.
Both measurements were made by a blinded assessor. A headache diary was kept for 4 weeks in order to assess headache intensity, frequency, and duration.
RESULTS:
- The mean number of Trigger Points on each Chronic Tension-type headache subject was 3.9 of which 1.9 were active, and 1.9 were latent.
- Control subjects only exhibited latent Trigger Points.
- There was a significant difference between the Chronic Tension-type headache group and the controls for active Trigger Points, but not for latent.
- Differences in the distribution of active and latent Trigger Points within each muscle were also significant for all the analyzed muscles.
- Chronic Tension-type headache subjects with active Trigger Points in the right upper trapezius muscle or left sternocleidomastoid muscle showed a greater headache intensity and duration, but not headache frequency, compared to those with latent Trigger Points.
- Active Trigger Points in the right temporalis muscle were associated with longer headache duration.
- Active Trigger Points in the left temporalis muscle were associated with greater headache intensity.
- Chronic Tension-type headace subjects with active Trigger Points in the analyzed muscles had a greater Forward Head Posture than those with latent Trigger Points in both sitting and standing positions.
CONCLUSIONS:
Active Trigger Points in upper trapezius, sternocleidomastoid, and temporalis muscles were associated with Chronic Tension-type headaches.
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