Active Trigger Points Are Associated With Anxiety and Widespread Pressure Pain Sensitivity in Women, but not Men, 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.

Research Progress on the Experimental Model and Underlying Mechanistic Studies of Tension-Type Headaches

PURPOSE OF REVIEW

Tension-type headaches (TTH) significantly diminish patients' quality of life and increase absenteeism, thereby imposing a substantial economic burden. Animal models are essential tools for studying disease mechanisms and drug development. However, until now, little focus has been placed on summarizing the animal models of TTH and associated mechanistic studies. This narrative review discusses the current animal models of TTH and related mechanistic studies to provide insights into the pathophysiological mechanisms of and treatments for TTH.

RECENT FINDINGS

The primary method for constructing an animal model of TTH involves injecting a solution of pain relievers, such as adenosine triphosphate, nerve growth factor, or a high concentration of salt solution, into the neck to initiate harmful cervical muscle responses. This model enables the examination of the interaction between peripheral muscles and central sensitization, which is crucial for understanding the pathophysiology of TTH. Mechanistic studies based on this model have investigated the effect of the P2X receptor antagonist, P2X7 receptor blockade, the P2Y1 receptor agonist 2-MESADP, P2Y1 receptor antagonist MRS2179, nitric oxide synthase inhibitors, and acetylsalicylic acid. Despite notable advancements, the current model of TTH has limitations, including surgical complexity and the inability to replicate chronic tension-type headache (CTTH). To gain a more comprehensive understanding and develop more effective treatment methods, future studies should focus on simplifying surgical procedures, examining other predisposing factors, and establishing a model for chronic TTH. This will offer a deeper insight into the pathophysiological mechanism of TTH and pave the way for improved treatment approaches.

Physical Therapy in Tension-Type Headache: A Systematic Review of Randomized Controlled Trials

(1) Objective: The aim of this study is to synthesize the effects of physical therapy on pain, frequency, or duration management in the short, medium, and long term in adult patients diagnosed with Tension-type headache (TTH). (2) Background: Tension-type headache (TTH) is the most common headache with migraine and its pathophysiology and treatment has been discussed for years without reaching a consensus. (3) Methods: A systematic review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The review was registered in PROSPERO (CRD42020175020). The systematic search for clinical trials was performed in the databases PubMed, CINAHL, Cochrane Central Register of Controlled Trials, PEDro, Scopus, SciELO and Dialnet. Articles were selected according to the inclusion and exclusion criteria, regarding the effectiveness of physical therapy interventions on adult patients with TTH published in the last 11 years with a score ≥ 6 in the PEDro Scale (Physiotherapy Evidence Database). (4) Results: In total, 120 articles were identified, of which 15 randomized controlled trials were finally included in order to determine the inclusion criteria. Changes in pain intensity, headache frequency or headache duration of individual studies were described (5) Conclusions: This systematic review shows that there is no standardized physical therapy protocol for the approach to tension headache, although all the techniques studied to date address in one way or another the cranio-cervical-mandibular region. The approach to the cranio-cervical-mandibular region reports significant effects in terms of decreasing the intensity of pain and frequency of headache episodes in the short and medium term. More long-term longitudinal studies are needed.

Masseter muscle contraction and cervical muscle sensitization by nerve growth factor cause mechanical hyperalgesia in masticatory muscle with activation of the trigemino-lateral parabrachial nucleus system in female rats

OBJECTIVE

To establish a new rat model of craniofacial myalgia, and to clarify which central nervous system pathways are activated in the model.

BACKGROUND

Craniofacial myalgia, represented by myogenous temporomandibular disorder and tension-type headache with pericranial tenderness, is more common in female patients. The pain is thought to be a type of multifactorial disorder with several coexisting causes. To our knowledge, there are no models of craniofacial muscle hyperalgesia caused by multiple types of stimuli.

METHODS

We injected nerve growth factor into the trapezius muscle of female and male rats and repeatedly stimulated the masseter muscle (MM) electrically for 10 days. We determined the mechanical head-withdrawal threshold of MM and extent of phosphorylated extracellular signal-related kinase 1/2 (pERK) immunoreactivity in various regions of the lower brainstem. We conducted retrograde tract-tracing to determine the projection of mechanosensitive MM-innervating secondary neurons to the lateral parabrachial nucleus. Finally, we administered morphine in rats to determine whether increases of pERK immunoreactivity were dependent on noxious inputs.

RESULTS

In female rats, but not male rats, the mechanical head-withdrawal threshold was decreased significantly from days 9 to 12. The number of pERK-immunoreactive neurons in the brainstem was increased significantly in female rats in the group with both stimuli compared to rats in other groups with a single stimulus. Mechanosensitive MM-innervating neurons in the brainstem projected to the parabrachial nucleus. Morphine administration blocked the increase in the number of pERK-immunoreactive neurons in both the brainstem and parabrachial nucleus.

CONCLUSIONS

We established a model of craniofacial myalgia by combining trapezius and MM stimuli in female rats. We found mechanical hyperalgesia of the MM and activation of the pain pathway from the brainstem to parabrachial nucleus. The model reflects the characteristics of patients with craniofacial myalgia and might be helpful to clarify the pathogenic mechanisms underlying these disorders.

Sex and gender differences in migraines: a narrative review

Introduction

Gender medicine is a new medical approach aimed at the study of the differences between women and men in terms of prevention, diagnosis, and the outcome of all diseases. Migraines are among these. They represent the most common neurological illness; they are most prevalent in adults between 20 and 50 years of age and are three to four times more frequent in woman than in men. Affecting people in working age, migraines are a problem that strongly impacts the psychophysical health and productivity of workers, regardless of the specific job task they have.

Methods

A narrative review was performed, searching for the most relevant articles describing gender differences in people suffering from migraines, and particularly in workers.

Results

Migraine global prevalence is 20.7% in women and 9.7% in men whereas prevalence in Italy is 32.9% for women and only 13.0% for men. This difference is partly explained by hormonal differences, as well as by differences in brain structure, genetic polymorphisms and neuronal pathways. Sex differences may also play a role in the progression from episodic to chronic migraine. In workers, migraines are mostly associated with strenuous physical work in men, whilst migraines triggered by night shifts, lack of sleep, or irregular sleep patterns are more common in women.

Conclusions

To this day, the reasons of sex/gender disparity for migraine are still obscure. However, migraines, chronic migraine in particular, have a negative impact on the lives of all individuals affected by this disease, but particularly in women in which family cares and working activity are often superimposed. Migraine prevention strategies should be planned in workers through the occupational health physician.

A Study on the Relationship between Mental Resilience, Work-Family Conflict, and Anxiety of Nurses in Shandong, China

Based on Freud's personality theory, 839 nurses from 5 public hospitals in Shandong Province were selected by the convenience sampling method. A cross-sectional survey was conducted to investigate the correlation among resilience, work-family conflict (WFC), and anxiety (SAS). The purpose of this study was to explore the relationship among resilience, WFC, and SAS of these nurses and to provide evidence with reducing WFC and SAS for the nurses. The results showed that the total score of resilience, WFC, and SAS was 58.00 ± 18.27, 53.46 ± 13.29, and 49.98 ± 14.73, respectively. There was 47.68% of the nurses that had anxiety, and 10.97% of the nurses had severe anxiety. There were significant differences in the score of SAS among the length of service, self-perceived health status, confidence in nursing professional development, WFC, and resilience (P < 0.05). This study draws the following conclusions: the proportion of anxiety is high, and the level of resilience is lower than the domestic norm. Length of service, self-perceived health status, confidence in nursing professional development, WFC, and resilience were the important influencing factors of anxiety. It is suggested that hospital managers should pay attention to the mental health of nurses, take active intervention measures according to the influencing factors of SAS, improve nurses' psychological resilience, reduce WFC and anxiety, improve nurses' mental health and well-being, and ensure nursing safety.

Presence of widespread pain predicts comorbidities and treatment response in temporomandibular disorders patients

OBJECTIVES

Investigate the presence of widespread pain in a well-defined TMD group and analyze its interrelationship with various comorbidities. Also, longitudinally seek the difference in treatment response according to the presence of widespread pain.

SUBJECTS AND METHODS

The observational study involved 45 female TMD patients in their 20s. Patients were grouped into localized and widespread pain groups based on the widespread pain index (WPI ≥ 4). Clinical characteristics and levels of comorbidities were analyzed through physical examination and validated questionnaires. Differences between the groups and the power of pre-treatment WPI in predicting pre-treatment comorbidities and post-treatment pain level improvement were statistically analyzed.

RESULTS

Patients with widespread pain showed higher somatization and anxiety levels. SF-36 scores were significantly lower and more patients complained of gastrointestinal symptoms. Conventional treatment significantly reduced pain intensity in both groups but less in the widespread pain group. WPI showed significant chances to predict patients showing improvement in pain levels with treatment with a cutoff value of 4. WPI was also effective in differentiating patients that showed a higher level of somatization.

CONCLUSION

Widespread pain index could be effectively applied in differentiating those with a higher level of psychological distress and predicting TMD treatment response with further investigations into its reliability.

Recent advancements in tension-type headache: a narrative review

INTRODUCTION

Tension-type headache (TTH) is the most common primary headache disorder with a prevalence of up to 78% in general population and huge expenses in terms of health service. Despite its high incidence and impact on life's quality the knowledge on the pathophysiology and efficacious treatment of TTH was still limited.

AREAS COVERED

In recent years, a series of studies highlighted the heterogeneous nature of this pathology that seems to be determined by a complex interaction between genetic, environmental, and neuromuscular factors, which result in nociceptive system activation. In this setting, alongside the simple analgesic therapies used during the acute attack, a series of therapeutic options based on newly acquired experiences have taken hold.

EXPERT REVIEW

Not having a single substrate or a typical site of pathophysiology, TTH must be analyzed in a global and multidisciplinary way. Herein, we perform a narrative review of the most recent advancement stimulating the concept of this disease as the tip of the iceberg of a more complex individual malaise secondary to different alterations. Strategies based solely on symptomatic drugs should therefore be avoided by experienced personnel and treatment should aim at taking charge of the patient considering the processes behind this complex pathology.

Current perspectives on sex differences in tension-type headache

INTRODUCTION

Clinical and experimental evidence supports the presence of several gender differences in the pain experience.

AREAS COVERED

The current paper discusses biological, psychological, emotional, and social differences according to gender and their relevance to TTH. Gender differences have also been observed in men and women with tension-type headache and they should be considered by clinicians managing this condition. It appears that multimodal treatment approaches lead to better outcomes in people with tension-type headache; however, management of tension-type headache should consider these potential gender differences. Different studies have observed the presence of complex interactions between tension-type headache, emotional stress, sleep, and burden and that these interactions are different between men and women.

EXPERT OPINION

Based on current results, the authors hypothesize that treatment of men with tension-type headache should focus on the improvement of sleep quality and the level of depression whereas treatment of women with TTH should focus on nociceptive mechanisms and emotional/stressful factors. Future trials should investigate the proposed hypotheses.

The role of social support and emotional exhaustion in the association between work-family conflict and anxiety symptoms among female medical staff: a moderated mediation model

BACKGROUND

Limited work has been done to explain how work-family conflict is related to anxiety symptoms and the roles of emotional exhaustion and social support may play.

METHODS

Based on a sample of 764 female nurses and physicians, a model was tested in which emotional exhaustion served as a mediator and social support was regarded as a moderator between work-family conflict and anxiety symptoms.

RESULTS

This current study supported a moderated mediation model where the relationship between work-family conflict and anxiety symptoms via emotional exhaustion was weakest for female medical staff who reported high levels of social support.

CONCLUSIONS

This study contribute to providing an understanding of how and when work-family conflict affects anxiety symptoms. The results implicate a wide range of interventions aimed at promoting mental wellbeing among female medical staff for policymakers and individuals.