Abstract
BackgroundMost knowledge on chronic tension-type headache (CTTH) is based on data from selected clinic populations, while data from the general population is sparse. Since pericranial tenderness is found to be the most prominent finding in CTTH, we wanted to explore the relationship between CTTH and pericranial muscle tenderness in a population-based sample.MethodsAn age- and gender-stratified random sample of 30,000 persons aged 30-44 years from the general population received a mailed questionnaire. Those with a self-reported chronic headache were interviewed and examined by neurological residents. The questionnaire response rate was 71% and the interview participation rate was 74%. The International Classification of Headache Disorders II was used. Pericranial muscle tenderness was assessed by a total tenderness score (TTS) involving 8 pairs of muscles and tendon insertions. Cross-sectional data from the Danish general population using the same scoring system were used for comparison.ResultsThe tenderness scores were significantly higher in women than men in all muscle groups. The TTS was significantly higher in those with co-occurrence of migraine compared with those without; 19.3 vs. 16.8, p = 0.02. Those with bilateral CTTH had a significantly higher TTS than those with unilateral CTTH. The TTS decreased significantly with age. People with CTTH had a significantly higher TTS compared to the general population.ConclusionsPeople with CTTH have increased pericranial tenderness. Elevated tenderness scores are associated with co-occurrence of migraine, bilateral headache and low age.Whether the increased muscle tenderness is primary or secondary to the headache should be addressed by future studies.
Highlights
Most knowledge on chronic tension-type headache (CTTH) is based on data from selected clinic populations, while data from the general population is sparse
We found no significant differences in total tenderness score (TTS) between those with chronic migraine and CTTH (21.4 vs. 19.7, p = 0.5)
We found no significant associations between pericranial muscle tenderness and headache pain intensity, headache hours per day, headache frequency per month and years with chronic headache, which is in accordance with a study on college students with CTTH [26], and a recent study of a clinic based sample of CTTH sufferers [6]
Summary
Most knowledge on chronic tension-type headache (CTTH) is based on data from selected clinic populations, while data from the general population is sparse. Pericranial muscle tenderness is found to be the most prominent clinical finding in tension-type headache. It has been postulated that the mechanisms responsible for the increased pericranial tenderness could be peripheral activation or sensitization of myofascial nociceptors. Chronic tension-type headache (CTTH) differs from the episodic form in lack of effect of most treatment strategies. It has been suggested that pericranial muscle tenderness may not reflect abnormalities within the muscle tissue, but rather sensitization of peripheral nociceptors, second order neurons or a dysfunction in higher order supraspinal pain modulation systems [7]. Several therapeutic approaches have been proposed for the treatment of tension-type headache Both behavioral and medical treatment have shown sparse long term effects [11]
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