The number of active trigger points is associated with sensory and emotional aspects of health-related quality of life in tension type headache

Abstract

Abstract Aims Some evidence supports that referred pain elicited by active trigger points (TrPs) reproduces some features of tension type headache (TTH). Our aim was to investigate the association between the number of active TrPs and health-related quality of life TTH. Methods Patients with TTH diagnosed by experienced neurologists according to the last International Headache Classification (ICHD-III) were included. Exclusion criteria included other primary headaches, medication overuse headache, whiplash injury or fibromyalgia. TrPs were bilaterally explored within the masseter, temporalis, trapezius, sternocleidomastoid, splenius capitis, and suboccipital. Health-related quality of life was assessed with the SF-36 questionnaire including 8 domains: physical functioning, physical role, bodily pain, general health, vitality, social functioning, role-emotional, and mental health. Higher scores represent better quality of life. Spearman correlation coefficients were used to determine correlations between the active TrPs and SF-36. Results Two hundred and two patients (mean age: 45±12 years) with a headache frequency of 17±7 days/month participated. Each patient with TTH exhibited 4.7±2.9 active TrPs. The number of active TrPs showed moderate weak negative associations with bodily pain (r s: −0.216; P =0.002), emotional role (r s: -0.185; P = 0.008) and vitality (r s: –0.161; P = 0.02), but not with the remaining domains: the higher the number of active TrPs, the worse the emotional role and vitality and the higher the pain interference with daily life. These results were similar in both frequent episodic and chronic TTH. Conclusions The number of active TrPs was associated with sensory and emotional aspects of quality of life in a cohort of subjects with TTH.