Muscle Triggers as a Possible Source of Pain in a Subgroup of Tension-type Headache Patients?

Arendt-Nielsen, Lars; Castaldo, Matteo; Mechelli, Filippo; Fernández‐de‐las‐Peñas, César

doi:10.1097/ajp.0000000000000318

Cited by 27 publications

(18 citation statements)

References 90 publications

(113 reference statements)

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“…This raises the question whether neck tenderness is an indicator for distinct subtypes of migraine: patients with neck pain as a simple symptom prior or during the attack without any identifiable changes in the periphery, and patients where the neck plays a crucial role either as a trigger or as a perpetuator for migraine attacks. The second group, if untreated, could be susceptible to ongoing nociceptive input from the neck, which activates the trigeminocervical system and subsequently leads to more frequent headache attacks, eventually contributing to the transition from episodic to chronic headache [ 16 , 17 ]. Although these statements were originally related to tension-type headache, considering the partially related pathobiology, this might also be true for migraine.…”

Section: Discussionmentioning

confidence: 99%

Stratifying migraine patients based on dynamic pain provocation over the upper cervical spine

Luedtke

May

2017

J Headache Pain

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BackgroundMigraine patients usually report a high prevalence of neck pain preceding or during the migraine attack. A recent investigation of musculoskeletal dysfunctions in migraine patients concluded that neck pain is not simply a symptom of the migraine attack but corresponds to identifiable muscle and joint alterations. Particularly pain provocation using palpation of the joints in the upper cervical spine was significantly more prevalent in patients with migraine than in headache-free participants.MethodsOne hundred seventy-nine migraineurs (diagnosed according to IHS classification criteria version III beta) and 73 age- and gender-matched healthy controls were examined by a physiotherapist blinded towards the diagnosis, using a palpation technique over the upper cervical spine. The palpation combined oscillating movements and sustained pressure.FindingsUsing simple palpation of the upper cervical spine, migraine patients can be stratified into three groups: painfree (11%), local pain only (42%), and pain referred to the head during sustained pressure (47%). Combining both test components (palpation and sustained pressure) has a high sensitivity and specificity for migraine.ConclusionsThe response to palpation of the upper cervical spine may indicate migraine subtypes. The presence of musculoskeletal dysfunctions of the upper cervical spine should be identified and treated to avoid ongoing nociceptive input into the trigeminocervical complex.Trial registrationGerman Clinical Trial Register DRKS-ID: DRKS00009622.

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Section: Discussionmentioning

confidence: 99%

Stratifying migraine patients based on dynamic pain provocation over the upper cervical spine

Luedtke

May

2017

J Headache Pain

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“…Active TrPs are those provoking spontaneous symptoms and the elicited referred pain reproduces the symptom experienced by the patient [1]. It has been reported that active TrPs reproduce the symptoms experienced by individuals experiencing mechanical neck pain [2], lateral epicondylitis [3], PM R 9 (2017) [1208][1209][1210][1211][1212][1213][1214][1215][1216] www.pmrjournal.org whiplash [4], tension-type headache [5,6], fibromyalgia [7,8], temporomandibular pain [9], or shoulder pain [10,11]. Several therapeutic approaches are proposed for the management of myofascial pain including the growing trend of TrP dry needling (TrP-DN) [12].…”

Section: Introductionmentioning

confidence: 99%

Effects of Low‐Load Exercise on Postneedling‐Induced Pain After Dry Needling of Active Trigger Point in Individuals With Subacromial Pain Syndrome

Salom‐Moreno

Jiménez-Gómez

Gómez-Ahufinger

et al. 2017

PM&R

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Background The application of dry needling usually is associated with postneedling‐induced pain. A postneedling intervention to reduce this adverse event is needed. Objective To determine the effectiveness of low‐load exercise on reducing postneedling‐induced pain after dry needling of active trigger points (TrPs) in the infraspinatus muscle in subacromial pain syndrome. Design A 72‐hour follow‐up, single‐blind randomized controlled trial. Setting Urban hospitals. Participants Individuals with subacromial pain syndrome (n = 90, 52% female, mean age: 35 ± 13 years) with active TrPs in the infraspinatus muscle. Interventions All individuals received dry needling into the infraspinatus active TrP. Then, they were divided randomly into an experimental group, which received a single bout of low‐load exercise of shoulder muscles; a placebo group, which received inactive ultrasound for 10 minutes; and a control group, which did not receive any intervention. Outcome Measures Numerical Pain Rating Scale (0‐10 point) was administered postneedling, immediately postintervention (2 minutes), and 24, 48, and 72 hours after needling. Shoulder pain (Numerical Pain Rating Scale, 0‐10) and disability (Disabilities of the Arm, Shoulder and Hand; Shoulder Pain and Disability Index) were assessed before and 72 hour after needling. Results The 5 × 3 analysis of covariance showed that the exercise group demonstrated a larger decrease in postneedling‐induced pain immediately after (P = .001), 24 hours (P = .001), and 48 hours after (P = .006) than placebo or control groups. No differences were found at 72 hours (P = .03). Similar improvements in shoulder pain (P < .001) and related disability (Disabilities of the Arm, Shoulder and Hand: P < .001; Shoulder Pain and Disability Index: P < .001) were observed 72 hours after needling, irrespective of the treatment group. Conclusions Low‐load exercise was effective for reducing postneedling‐induced pain on active TrPs in the infraspinatus muscle 24 and 48 hours after needling. The application of a postneedling intervention did not influence short‐term pain and disability changes. Level of Evidence I

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“…Current research into the pathogenesis of TTH focuses on the role of muscle tissues (Arendt-Nielsen et al, 2016) and facilitation of nociceptive pain processing (de Tommaso and Fern andez-de-las-Peñas, 2016). It has been argued that TTH has a muscle component (Bendtsen and Fern andez-de-las-Peñas, 2011) and that sensitization processes play an important role in the transition from acute to chronic TTH (Yu and Han, 2015).…”

Section: Introductionmentioning

confidence: 99%

Assessment of deep dynamic mechanical sensitivity in individuals with tension‐type headache: The dynamic pressure algometry

Palacios‐Ceña

Wang

Castaldo

et al. 2017

European Journal of Pain

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The current study found that dynamic pressure algometry in the temporalis muscle was associated with widespread pressure pain sensitivity in individuals with tension-type headache. The association was independent of the frequency of headaches. Assessing deep static and dynamic somatic tissue pain sensitivity may provide new opportunities for differentiated diagnostics and possibly a tool for assessing treatment effects.

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Muscle Triggers as a Possible Source of Pain in a Subgroup of Tension-type Headache Patients?

Cited by 27 publications

References 90 publications

Stratifying migraine patients based on dynamic pain provocation over the upper cervical spine

Stratifying migraine patients based on dynamic pain provocation over the upper cervical spine

Effects of Low‐Load Exercise on Postneedling‐Induced Pain After Dry Needling of Active Trigger Point in Individuals With Subacromial Pain Syndrome

Assessment of deep dynamic mechanical sensitivity in individuals with tension‐type headache: The dynamic pressure algometry

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