Table 2 Tension-type headache and myofascial trigger points
From: Myofascial trigger points in migraine and tension-type headache
First author (year) | Blinding | Participants | Mean age (range) | Gender | Timing of recordings | Methods | Muscles | Main findings |
|---|---|---|---|---|---|---|---|---|
Alonso-Blanco (2011) [62] | None | 20 CTTH adult patients 20 CTTH adolescent patients | 41 (18–47) 8 (6–12) | 10 M, 10F 10 M, 10F | Interictally | MTrP diagnosis as described by Simons et al. [19] | Temporalis, suboccipital, sternocleidomastoid, and upper trapezius | • The number of active MTrPs were higher in adults versus children. • Referred pain elicited from active MTrPs shared similar pain patterns as spontaneous CTTH in both groups. No significant association between the number of active MTrPs and headache parameters. |
Couppé (2007) [67] | Double-blinded | 20 CTTH patients 20 CTRLs | 37.5 (33.3–41.6) | Not reported | Ictally | MTrP diagnosis as described by Simons et al. [19] EMG examination at a MTrP and a control point in the same subject. | Upper trapezius | • The number of active MTrPs were higher in patients versus controls • No difference in electromyographic activity between MTrPs versus control points. |
Fernández-de-las-Peñas (2011) [63] | Examiner blinded to diagnosis | 50 CTTH patients 50 CTRLs | 8 (6–12) | 14 M, 36F | Interictally | MTrP diagnosis as described by Simons et al. [19]. | Temporalis, superior oblique, masseter, suboccipital, sternocleidomastoid, levator scapulae, and upper trapezius | • Active MTrPs were only found in patients. • In the CTTH patients, the number of active TrPs correlated with the duration of a headache attack. • The local and referred pains elicited from active MTrPs shared similar pain pattern as spontaneous CTTH. |
Fernández-de-las-Peñas (2009) [68] | None | 40 CTTH | 40 (20–57) | 40F | Interictally < 4 on a 11 NRS | MTrP diagnosis was performed following the criteria described by Simons et al. [19] and Gerwin et al. [89] PPT was assessed using an algometer. | Temporalis (9 landmarks total, 3 each respectively in the anterior, medial and posterior part) | • The analysis of variance did not detect significant differences in the referred pain pattern between active MTrPs. • The topographical pressure pain sensitivity maps showed the distinct distribution of the MTrPs indicated by locations with low PPTs. |
Fernández-de-las-Peñas (2007) [69] | Examiner blinded to diagnosis | 15 ETTH 15 CTRLs | 39 ± 17 (20–70) 37 ± 12 (21–70) | 3 M, 12F 4 M, 11F | Interictally | MTrP diagnosis as described by Simons et al. [19] and Gerwin et al. [89] FHP was noted both seated and standing. | Temporalis, sternocleidomastoid, and upper trapezius | • Active MTrPs in the affected muscles were only found within the ETTH group. • MTrPs were not related to any clinical variable concerning the intensity and the temporal profile of headache. |
Fernández-de-las-Peñas (2007) [70] | Examiner blinded to diagnosis | 20 CTTH 20 CTRLs | 36 (18–56) 35 (20–56) | 11 M, 9F 13 M, 7F | < 4 cm on a 10 cm VAS | MTrP diagnosis as described by Simons et al. [19] and by Gerwin et al. [89] PPT was assessed using an algometer. | Upper trapezius | • CTTH subjects with active MTrPs showed greater headache intensity, and duration than those with latent TrPs. • Patients with bilateral MTrPs reported a greater headache intensity and duration than those with unilateral TrPs. • CCTH subjects showed a decreased PPT compared to controls. |
Fernández-de-las-Peñas (2007) [66] | Examiner blinded to diagnosis | 30 CTTH 30 CTRLs | 39 ± 16 (18–65) 39 ± 12 (19–65) | 9 M, 21F 9 M, 21F | < 4 cm on a 10 cm VAS | MTrP diagnosis as described by Simons et al. [19] and by Gerwin et al. [89] | Temporalis | • Referred pain was evoked in 87 and 54% on the dominant and non-dominant sides in CTTH patients, which was significantly higher than in controls (10% vs. 17%, respectively). • CTTH patients with active MTrPs in either right or left temporalis muscle showed longer headache duration than those with latent MTrPs. • CTTH patients showed significantly lower pressure pain threshold when compared with controls. |
Fernández-de-las-Peñas (2006) [71] | Examiner blinded to diagnosis | 10 ETTH 10 CTRLs | 35 ± 15 (18–66) 34 ± 13 (18–66) | 2 M, 8F 3 M, 7F | Interictally | MTrP diagnosis as described by Simons et al. [19] and by Gerwin et al. [89] | Suboccipital | • In the ETTH group, 60% showed active MTrPs; 40% showed latent trigger points. In the ETTH group, headache intensity, frequency and duration did not differ depending on whether the MTrPs were active or latent. |
Fernández-de-las-Peñas (2006) [72] | Examiner blinded to diagnosis | 25 CTTH 25 CTRLs | 40 ± 16 (18–72) 38 ± 9 (18–73) | 8 M, 17F 9 M, 16F | < 4 cm on a 10 cm VAS | MTrP diagnosis was performed following the criteria described by Simons et al. [19] and by Gerwin et al. [89] FHP was noted both seated and standing. | Temporalis, sternocleidomastoid, and upper trapezius | • Active MTrPs were only found in CTTH patients. • There was significant association between the presence of active MTrPs and headache intensity and duration. |
Fernández-de-las-Peñas (2006) [65] | Examiner blinded to diagnosis | 20 CTTH 20 CTRLs | 38 ± 18 (18–70) 35 ± 10 (20–68) | 9 M, 11F 12 M, 8F | Pain intensity < 4 on a 10 cm VAS | MTrP diagnosis was performed following the criteria described by Simons et al. [19] and by Gerwin et al. [89] FHP was noted both seated and standing. | Suboccipital | • Active MTrPs were only found in CTTH patients. • CTTH patients with active MTrPs reported greater headache intensity and frequency than those with latent. • A craniovertebral smaller angle was positively correlated with increased headache frequency and negatively correlated with headache duration. |
Fernández-de-las-Peñas (2005) [64] | Examiner blinded to diagnosis | 15 CCTH 15 ETTH 15 CTRLs | 37 ± 16 38 ± 14 38 ± 14 Range not reported | 5 M, 10F 4 M, 11F 5 M, 10F | CTTH: Pain intensity < 4 cm on a 10 cm VAS TTH: Interictally | MTrP diagnosis was performed following the criteria described by Simons et al. [19] and by Gerwin et al. [89] | Superior oblique | • 86% CTTH patients and 60% ETTH patients reported referred pain from MTrPs. • The pain was perceived as a deep ache located at the retro-orbital region – sometimes extending to the supraorbital region or the homo-lateral forehead. • Pain intensity was greater in CTTH patients than in ETTH patients. |
Harden (2009) [73] | Double-blinded | 23 CTTH with active cervical MTrPs (12 in active group, 11 in placebo group) | 49.6 in active group 40.8 in placebo group Range not reported | 7 M, 5F 7 M, 4F | Not reported | Patients received i.m. injections of botulinum toxin A or isotonic saline (placebo) in MTrPs. 25 units dose pr. MTrP, but no more than 100 units in total pr. patient (maximum four trigger points treated pr. patient). | Sternocleidomastoid, trapezius, and splenius capitis (which overlies involved cervical muscle groups: semispinalis capitis, longissimus capitis, recti capitis posterior and obliquus capitis superior) | • Patients in the active group reported greater reductions in headache frequency during the first part of the study, but these effects dissipated by week 12. |
Karadas (2013) [74] | Double-blinded | 48 CTTH with active MTrPs (24 in active group, 24 in placebo group). | 40.4 ± 12 in active group 40.7 ± 13.2 in placebo group Range not reported | 4 M, 20F 5 M, 19F | Not reported | Patients received i.m. injections with 0.5% lidocaine or 0.9% NaCl (placebo) to the trigger points of the muscles innervated by C1-C3 and the trigeminal nerve, exit point of the fifth cranial nerve and around the superior cervical ganglion. | Muscles innervated by C1-C3 and the trigeminal nerve, exit point of the fifth cranial nerve and around the superior cervical ganglion | • Patients in the active group reported significantly greater reductions in headache frequency and intensity. |
Lattes (2009) [75] | None | 27 CTTH | Approximately 46 (18–80) | 7 M, 20F | Not reported | I.m. injections with gonyautoxin in 10 landmarks considered as MTrPs. EMG examination before and after injections. | Occipitalis and trapezius | • Responders (70%) had an average of 8,1 weeks free of pain following treatment. • The EMG recorded immediately after injection in all cases showed that the hyperactivity in the trapezius muscle was completely abolished. |
Moraska (2017) [76] | Single-blind | 34 CTTH 28 ETTH Massage: 13 CTTH 7 ETTH Placebo: 11 CTTH 10 ETTH Wait-list 10 CTTH 11ETTH | 31.2 ± 11.3 34.4 ± 10.7 33.0 ± 9.0 | 7 M, 55F 1 M, 19F 2 M, 19F 4 M, 17F | Not reported | Individuals with ETTH or CTTH were randomized to receive 12 twice-weekly 45-min massage or sham ultrasound sessions or wait-list control. Massage focused on MTrPs. PPT was assessed using an algometer. MTrP diagnosis was performed following the criteria described by Simons et al. [19] | Suboccipital and upper trapezius | • PPT increased across the study timeframe in all four muscle sites tested for massage, but not sham ultrasound or wait-list groups. |
Moraska (2015) [77] | Single-blind | 30 CTTH 26 ETTH | 32.1 ± 12 in active group 34.7 ± 11 in placebo group Range not reported | 8 M, 48F (2 M, 15F in active group; 2 M, 17F in placebo group; 4 M, 16F in wait-list group) | Not reported | 56 patients with TTH were randomized to receive 12 massage or placebo (detuned ultrasound) sessions over 6 weeks, or to wait-list. Massage focused on MTrPs in cervical musculature. PPT was assessed using an algometer. MTrP diagnosis was performed following the criteria described by Simons et al. [19] | Suboccipital, sternocleidomastoid, and upper trapezius | • Headache frequency fell in both the massage and the placebo group. • PPT improved in the massage group. |
Palacios-Ceña (2016) [78] | Examiner blinded to diagnosis | 77 CTTH 80 ETTH | 46 (42–50) 47 (43–51) | 46 M, 111F | Interictally | MTrP diagnosis was performed following the criteria described by Simons et al. [19] PPT was assessed over the trigeminal area, extra-trigeminal area and two distant pain free points using an algometer. | Temporalis, masseter, suboccipital, sternocleidomastoid, splenius capitis, and upper trapezius | • No difference in number of MTrPs and PPT in the two groups. • There was a significant negative correlation between the number of trigger points (active or latent) and PPT. |
Romero-Morales (2017) [79] | None | 60 ETTH 60 CTRLs | 38,30 ± 10,05 34 ± 8,20 Range not reported | 24 M, 32F 27 M, 33F | Not reported | MTrP diagnosis was performed following the criteria described by Simons et al. [19] PPT was assessed using an algometer. | Temporalis and upper trapezius | Minimum clinical differences in PPT between TTH and CTRLs were • Right upper trapezius; 0,85 kg/cm2 • Left upper trapezius; 0;76 kg/cm2 • Right temporalis; 0;16 kg/cm2 • Left temporals; 0,17 kg/cm2 |
Sohn (2012) [80] | Examiner blinded to diagnosis | 23 CTTH 36 ETTH 42 CTRLs | 53.43 ± 16.97 51.11 ± 14.42 51.69 ± 16.18 Range not reported | 2 M, 21F 7 M, 29F 8 M, 34F | Headache intensity < 3 on a 10 cm VAS | MTrP diagnosis was performed following the criteria described by Simons et al. [19] and by Gerwin et al. [89] FHP was used to evaluate posture abnormalities. Measurement of neck mobility was used to evaluate mechanical abnormalities. | Temporalis, suboccipital, sternocleidomastoid, and upper trapezius | • The number of active MTrPs was significantly greater in CTTH subjects than in ETTH subjects. • The number of active MTrPs were correlated with the frequency and duration of headache. • No correlations were observed for FHP or neck mobility. |