Relationship of active trigger points with related disability and anxiety in people with tension-type headache

The relationship between myofascial trigger points sensitivity, cervical postural abnormality, and clinical tension-type headache parameters

BACKGROUND

Myofascial Trigger Points (MTrPs) play a significant role in the pathogenesis of Tension Type Headache (TTH). Abnormal cranio-cervical posture has been linked to various types of headaches. However, the correlation between MTrPs sensitivity, cervical postural alignment, and clinical measures of headache has not been extensively studied in patients with TTH.

OBJECTIVES

To investigate the relationship between MTrPs sensitivity in cervical and pericranial muscles, cervical postural abnormality, and clinical headache parameters in patients with TTH. Furthermore, to investigate the effect of sex on the examined variables and their association with headache type (episodic vs chronic TTH).

METHODS

A total of 72 patients with TTH of both sexes were enrolled in this study. Headache frequency and disability as clinical measures of headache, pressure pain threshold (PPT) of bilateral upper trapezius (UT) and suboccipital (SUB) muscles, cervical lordosis angle (CA), and anterior head translation (AHT) were measured.

RESULTS

Pericranial MTrPs sensitivity did not demonstrate any correlation with clinical headache parameters or cervical postural abnormality. However, there was a significant correlation between the frequency of headaches and the level of disability (r = 0.32, P < 0.05). In addition, episodic TTH was more prevalent in females who exhibited greater AHT and MTrPs sensitivity of both bilateral UT and right SUB muscles than males.

CONCLUSIONS

There was no correlation found between the frequency of headaches and the level of disability with measures of cervical posture alignment or MTrPs sensitivity in individuals with TTH.. Based on findings, Clinicians should consider sex differences when assessing patients with TTH.

Are Morphometric Alterations of the Deep Neck Muscles Related to Primary Headache Disorders? A Systematic Review

This systematic review aims to summarise the evidence from studies that examined morphometric alterations of the deep neck muscles using diagnostic imaging (ultrasound imaging, magnetic resonance imaging, and computed tomography) in patients diagnosed with primary headache disorders (PHD). No previous reviews have focused on documenting morphometric changes in this population. We searched five databases (up to 12 November 2022) to identify the studies. The risk of bias (RoB) was assessed using the Quality in Prognostic Studies (QUIPS) tool and the overall quality of the evidence was assessed using The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system. A total of 1246 studies were screened and five were finally included; most were at high RoB, and the overall level of confidence in results was very low. Only two studies showed a significant association between morphometric alterations of the deep neck muscles and PHD (p < 0.001); nevertheless, their RoB was high. Contradictory and mixed results were obtained. The overall evidence did not show a clear association between morphometric alterations of the deep neck muscles in patients diagnosed with PHD. However, due to the limited number of studies and low confidence in the evidence, it is necessary to carry out more studies, with higher methodological quality to better answer our question.

Clinical-Epidemiology of Tension-Type Headache among the Medical and Dental Undergraduates of King Khalid University, Abha, Saudi Arabia

Introduction (background): Headache is the primary complaint among students. Headaches mostly have multifactorial causes. The degree of headache severity significantly impacts attitudes, behavior, and academic performance. Objectives: Here, we investigate the demographic epidemiology of tension-type headaches (T.T.H.), and determine the clinical presentation and triggers of the tension-type among headache sufferers. Methods (settings, design): An institutional-based cross-sectional study (descriptive) was conducted on the medical and dental undergraduates at King Khalid University, Abha, Saudi Arabia, from 1 July 2021 to 31 December 2021. Data were gathered using a pre-designed questionnaire. A consecutive sampling method was used in a COVID-19-constrained environment. After preliminary screening of the study population, 460 samples were included. An electronic questionnaire was shared with them, and they were requested to respond. Results: More than half of the participants (258, 56.1%) experienced tension-type headaches, while the remaining 202 (43.9%) never felt a headache. Tension-type headaches manifested as heaviness of the head (44, 17.0%), tightness (126, 48.8%), and dull aching pain (66, 25.7%). Conclusions: T.T.H. is a prevalent condition with a significant impingement on academic work, and psychological health. Tension-type headache sufferers are advised to keep daily diaries to determine triggers, and plan for prevention and treatment progression.

The importance of the local twitch response during needling interventions in spinal pain associated with myofascial trigger points: a systematic review and meta-analysis

OBJECTIVE

To compare the clinical effects of needling interventions eliciting local twitch responses (LTRs) versus needling without eliciting LTRs when applied to muscle trigger points (TrPs) associated with spinal pain of musculoskeletal origin.

DATABASES AND DATA TREATMENT

Electronic databases were searched for randomized or non-randomized clinical trials where one group received needling intervention where LTRs were elicited and was compared with another group receiving the same intervention without elicitation of LTRs in spinal pain disorders associated with TrPs. Outcomes included pain intensity, pain-related disability, and pressure pain thresholds. The risk of bias (RoB) was assessed using the Cochrane risk of bias tool or ROBINS-I tool, methodological quality was assessed with the PEDro score, and quality of evidence was evaluated using the GRADE approach.

RESULTS

Six trials were included. The application of a needling intervention eliciting LTRs was associated with a significant reduction in pain intensity immediately after treatment (mean difference (MD): -2.03 points, 95% confidence interval (CI): -3.77 to -0.29; standardized MD (SMD): -1.35, 95% CI: -2.32 to -0.38, p = 0.02) when compared to the same needling intervention without elicitation of LTRs. No effect at short-term follow-up (MD: -0.20 points, 95% CI: -1.46 to 1.06, p = 0.75) was observed. No significant differences based on elicitation or non-elicitation of LTRs were found in related disability (SMD: -0.05, 95% CI: -0.41 to 0.30, p = 0.77) or pressure pain thresholds (MD: 23.39 kPa, 95% CI: -13.68 to 60.47, p = 0.22).

DISCUSSION

Low-level evidence suggests an immediate effect of obtaining LTRs during needling interventions on pain intensity, with no significant effects on related disability or pressure pain sensitivity in spinal pain disorders associated with muscle TrPs.

REGISTRATION NUMBER

OSF Registry-https://doi.org/10.17605/OSF.IO/5ZX9N.

The efficacy of acupuncture combined with Bailemian capsule in the treatment of cervical spondylosis accompanied by headache, anxiety, and depression

OBJECTIVE

The present study aimed to investigate the efficacy of using acupuncture combined with Bailemian capsule to treat cervical spondylosis by observing the improvement in the degree of headache, anxiety, and depression suffered by patients.

METHODS

A total of 100 patients with cervical spondylosis of the cervical type were equally divided into a combination group and a control group using the random number table method. The patients in the combination group were treated with acupuncture combined with the oral administration of Bailemian capsule, while those in the control group were only treated with acupuncture. Patient self-assessment was conducted, comprising the visual analogue scale, the self-assessment scale for anxiety, and the self-assessment scale for depression. Before treatment and on the14th and 28th days of treatment, the therapeutic effects of the two treatment modalities on the cervical spondylosis and accompanying headache, anxiety, and depression were analyzed using the Hamilton anxiety scale, the Hamilton depression scale, the Pittsburgh sleep quality inventory, and the Neck Disability Index (%).

RESULTS

There were statistically significant differences between the two groups in all seven indicators at the different treatment time points (p < 0.01). The seven indicators were significantly reduced in both groups on the 14th and 28th days of treatment compared with before the treatment. Moreover, except for the Neck Disability Index results at 14 days, which did not differ between the groups (p = 0.37), all the other indicators were significantly lower in the combination group than in the control group on the 14th and 28th days of treatment (p < 0.01), and at the end of the treatment, the therapeutic effect was significantly better in the combination group than in the control group (p = 0.006).

CONCLUSION

Both acupuncture combined with Bailemian Capsule and acupuncture alone were effective in the treatment of cervical spondylosis, but the combination therapy was better than the acupuncture alone in improving the accompanying negative symptoms of headache, anxiety, and depression.

Osmophobia in primary headache patients: associated symptoms and response to preventive treatments

Background

Osmophobia, is common among primary headaches, with prevalence of migraine.

The study aimed to evaluate prevalence and clinical characteristics of patients with osmophobia in a cohort of primary headache patients selected at a tertiary headache center. The second aim was to verify the possible predicting role of osmophobia in preventive treatment response in a sub cohort of migraine patients.

Methods

This was an observational retrospective cohort study based on data collected in a tertiary headache center.

We selected patients aged 18–65 years, diagnosed as migraine without aura (MO), migraine with aura (MA) or Chronic Migraine (CM), Tension-Type Headache (TTH); and Cluster Headache (CH). We also selected a sub-cohort of migraine patients who were prescribed preventive treatment, according to Italian Guidelines, visited after 3 months follow up.

Patients were considered osmophobic, if reported this symptom in at least the 20% of headache episodes. Other considered variables were: headache frequeny, the migraine disability assessment (MIDAS), Allodynia Symptom Checklist, Self-rating Depression scale, Self-rating Anxiety scale, Pain intensity evaluated by Numerical Rating Scale-NRS- form 0 to 10.

Results

The 37,9% of patients reported osmophobia (444 patients with osmophobia, 726 without osmophobia).

Osmophobia prevailed in patients with the different migraine subtypes, and was absent in patients with episodic tension type headache and cluster headache (chi square 68.7 DF 7 p < 0.0001). Headache patients with osmophobia, presented with longer hedache duration (F 4.91 p 0.027; more severe anxiety (F 7.56 0.007), depression (F 5.3 p 0.019), allodynia (F 6 p 0.014), headache intensity (F 8.67 p 0.003). Tension type headache patients with osmophobia (n° 21), presented with more frequent headache and anxiety. A total of 711 migraine patients was visited after 3 months treatment. The change of main migraine features was similar between patients with and without osmophobia.

Conclusions

While the present study confirmed prevalence of osmophobia in migraine patients, it also indicated its presence among chronic tension type headache cases, marking those with chronic headache and anxiety.

Osmophobia was associated to symptoms of central sensitization, as allodynia. It was not relevant to predict migraine evolution after first line preventive approach.

Supplementary Information

The online version contains supplementary material available at 10.1186/s10194-021-01327-2.

Mapping Assessments Instruments for Headache Disorders against the ICF Biopsychosocial Model of Health and Disability

Headache disorders have a strong impact on sufferers’ lives. However, the “content” of assessment instruments addressing concepts, such as disability and quality of life (QoL), has not comprehensively been addressed. We searched SCOPUS for research papers in which outcome measures were used in adult populations of patients with migraine, tension-type headache (TTH), and cluster headache (CH). The content of single instruments was then mapped against the International Classification of Functioning, Disability, and Health. A total of 150 papers and 26 instruments were included: 15 addressed disability or impact, two addressed work-related difficulties, and nine addressed QoL. Few instruments were commonly used across the conditions and covered domains of functioning were impact on daily life activities, homework, school, and work-related tasks, leisure time, informal and family relations, pain, emotional difficulties, energy level, and impulse control. Most of the research is based on instruments that were developed for migraine, which is critical for CH, and the impact of headache disorders on work-related activities is poorly acknowledged. Further research is needed to expand the scope of headaches impact on daily life activities, and on environmental factors relevant to headache disorders to raise knowledge on the less represented areas, e.g., TTH impact.

Neuroticism Traits and Anxiety Symptoms are Exhibited in Athletes With Chronic Gastrocnemius Myofascial Pain Syndrome

San-Antolín, M, Rodríguez-Sanz, D, Becerro-de-Bengoa-Vallejo, R, Losa-Iglesias, ME, Martínez-Jiménez, EM, López-López, D, and Calvo-Lobo, C. Neuroticism traits and anxiety symptoms are exhibited in athletes with chronic gastrocnemius myofascial pain syndrome. J Strength Cond Res 34(12): 3377-3385, 2020-Common psychological factors, such as anxiety or neurotic personality traits, seem to be associated with pain suffered by athletes. Gastrocnemius muscles present a high prevalence for injury in athletes. These muscles are a region in which myofascial pain syndrome (MPS) frequently develops. Myofascial pain syndrome is characterized by the presence of active myofascial trigger points (MTrPs). This study compared different personality and anxiety symptoms between athletes with and without active MTrPs in the gastrocnemius. A case-control study was conducted in an outpatient clinic. Athletes who performed moderate or vigorous physical activity according to the International Physical Activity Questionnaire were included. Fifty paired-matched athletes with and without active MTrPs in their gastrocnemius muscles (n = 25 in each group) were recruited. Different personality traits (neuroticism, extraversion, psychoticism, and sincerity) and anxiety (state and trait) were evaluated by the Eysenck Personality Questionnaire and State-Trait Anxiety Inventory, respectively. Statistically significant differences (p < 0.01) with an effect size from moderate to large (d = 0.75-1.29) were found for greater neuroticism and sincerity traits in addition to state and trait anxiety in athletes with gastrocnemius MPS compared with healthy controls. In conclusion, athletes with gastrocnemius active MTrPs exhibited higher neuroticism and anxiety symptoms compared with healthy athletes. Mental health may play a key role in athletes with myofascial pain, and future studies should be performed to determine whether neuroticism-related and anxiety-related psychological care could be a key intervention in athletes with gastrocnemius active MTrPs to improve athletic performance and rehabilitation or prevent injuries.

Myofascial pain syndrome and trigger points: evaluation and treatment in patients with musculoskeletal pain

PURPOSE OF REVIEW

Myofascial pain syndrome is a chronic pain condition characterized by the presence of myofascial trigger point, a hyperirritable painful spot involving a limited number of muscle fibers. The literature suggest that myofascial trigger points should be considered peripheral pain generators and this critical review will summarize recent findings concerning the clinical evaluation and the treatment of myofascial trigger points.

RECENT FINDINGS

The clinical features of myofascial trigger points and their contribution to the patient pain and disability have been detailed in several recent studies, which support the clinical relevance of the condition. Recent studies reported that manual palpation to identify MTrPs has good reliability, although some limitations are intrinsic to the diagnostic criteria. During the last decade, a plethora of treatments have been proposed and positive effects on pain and function demonstrated.

SUMMARY

The myofascial trigger point phenomenon has good face validity and is clinically relevant. Clinicians are encouraged to consider the contribution of myofascial trigger points to the patient's pain and disability through a careful medical history and a specific manual examination. Patients with myofascial trigger points will benefit from a multimodal treatment plan including dry needling and manual therapy techniques. Internal and external validity of research within the field must be improved.

Trigger point dry needling for the treatment of myofascial pain syndrome: current perspectives within a pain neuroscience paradigm

Myofascial pain syndrome is a pain condition characterized by the presence of trigger points. Current evidence, mostly experimental studies, clearly supports a role of trigger points on peripheral and central sensitization since they are able to contribute to sensitization of peripheral nociceptors, spinal dorsal horn neurons, and the brainstem. Several interventions are proposed for treating trigger points, dry needling being one of the most commonly used by clinicians. There is no consensus on the clinical application of trigger point dry needling: some authors propose that local twitch responses should be elicited during the needling intervention to be effective, whereas others do not. The application of trigger point dry needling is able to reduce the excitability of the central nervous system by reducing peripheral nociception associated to the trigger point, by reducing dorsal horn neuron activity, and by modulating pain-related brainstem areas. However, the effects are mainly observed in the short-term, and effect sizes are moderateto small. Therefore, the current review proposes that the application of trigger point dry needling should be integrated into current pain neuroscience paradigm by combining its application with pain neuroscience education, graded exercise and manual therapy. Additionally, patient’s expectations, beliefs, previous experiences and patient–clinician interaction should be considered when integrating trigger point dry needling into a comprehensive treatment approach.

Cervical musculoskeletal dysfunction in headache: How should it be defined?

Neck pain commonly accompanies migraine and tension-type headache, but the literature is divided on whether this neck pain is a headache symptom or is associated with cervical musculoskeletal dysfunction. Clarification is essential for hypotheses on the pathogenesis of these headaches and their variants and for decisions on suitability of local neck treatments, both from research and clinical practice perspectives. Reasons for disparate findings could relate to participant selection in headache studies and/or the bases on which decisions on the presence of cervical musculoskeletal dysfunction are reached. Propositions towards gaining a clearer picture of migraine and tension-type headache related neck pain include first, stricter inclusion criteria and reporting of headache characteristics of study participants. Second, reliance on pain sensitivity or the presence of neck tenderness/trigger points as measures be discarded, as they are not uniquely tied to a musculoskeletal disorder. Instead, place reliance on tests of musculoskeletal (dys)function. Third, the values and interpretation of single measures or tests of impairment/dysfunctions can be non-informative and do not reflect the presentation of cervical musculoskeletal disorders. Rather, a typical presentation includes at a fundamental level, interrelated changes in cervical movement, segmental joint and muscle function. We advocate that these measures be adopted as the core set of related measures to define cervical musculoskeletal dysfunction in headache. This does not deter inclusion of other measures of interest or qualification.