Abstract
Our aim was to describe the referred pain pattern and areas from trigger points (TrPs) in head, neck, and shoulder muscles in children with chronic tension type headache (CTTH). Fifty children (14 boys, 36 girls, mean age: 8 ± 2) with CTTH and 50 age- and sex- matched children participated. Bilateral temporalis, masseter, superior oblique, upper trapezius, sternocleidomastoid, suboccipital, and levator scapula muscles were examined for TrPs by an assessor blinded to the children’s condition. TrPs were identified with palpation and considered active when local and referred pains reproduce headache pain attacks. The referred pain areas were drawn on anatomical maps, digitalized, and also measured. The total number of TrPs was significantly greater in children with CTTH as compared to healthy children (P < 0.001). Active TrPs were only present in children with CTTH (P < 0.001). Within children with CTTH, a significant positive association between the number of active TrPs and headache duration (r s = 0.315; P = 0.026) was observed: the greater the number of active TrPs, the longer the duration of headache attack. Significant differences in referred pain areas between groups (P < 0.001) and muscles (P < 0.001) were found: the referred pain areas were larger in CTTH children (P < 0.001), and the referred pain area elicited by suboccipital TrPs was larger than the referred pain from the remaining TrPs (P < 0.001). Significant positive correlations between some headache clinical parameters and the size of the referred pain area were found. Our results showed that the local and referred pains elicited from active TrPs in head, neck and shoulder shared similar pain pattern as spontaneous CTTH in children, supporting a relevant role of active TrPs in CTTH in children.
Highlights
Tension-type headache is the most common form of headache in both adults [1] and adolescents [2]
The current controlled and blinded study showed the existence of multiple active trigger points (TrPs) in head and neck-shoulder muscles in children with chronic tension type headache (CTTH)
The current controlled and blinded study showed the existence of multiple active TrPs in head, neck and shoulder musculature in children with CTTH
Summary
Tension-type headache is the most common form of headache in both adults [1] and adolescents [2]. J Headache Pain (2011) 12:35–43 studies have reported an overall prevalence rate for tension type headache ranging from 5.5 to 26% in children between 6 and 12 years old [3,4,5,6]. In a recent epidemiological study in Germany, the 6-month prevalence of headaches was 53.2% among children from 7 to 14 years [7]. Lewis et al [8] estimated that about 20% of the children with primary headache need medical therapy. As tension type headache is problematic for children, this headache needs further study [9, 10]. It seems clear that hyper-excitability of peripheral and central nociceptive pain pathways plays an important role in tension type headache [12], as several studies have demonstrated the presence of pressure pain hyperalgesia in children with tension type headache [13,14,15]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
