Referred Pain from Myofascial Trigger Points in Head and Neck-shoulder Muscles Reproduces Head Pain Features in Children With Chronic Tension type Headache

Referred Pain from Myofascial Trigger Points in Head and
Neck-shoulder Muscles Reproduces Head Pain Features
in Children With Chronic Tension type Headache

César Fernández-de-las-Peñas, Daniel M. Fernández-Mayoralas, Ricardo Ortega-Santiago, Silvia Ambite-Quesada, Domingo Palacios-Ceña and Juan A. Pareja

Tension-type headache is the most common form of headache in both adults [1] and adolescents. [2] Different studies have reported an overall prevalence rate for tension type headache ranging from 5.5 to 26% in children between 6 and 12 years old. [3–6] In a recent epidemiological study in Germany, the 6–month prevalence of headaches was 53.2% among children from 7 to 14 years. [7] In fact, Lewis et al. [8] estimated that about 20% of the children with primary headache need medical therapy. Furthermore, as tension type headache is also problematic for children, this headache needs further study. [9, 10]

Although there has been an increasing interest in the pathogenic mechanisms of tension type headache, the true patho-anatomical mechanisms remain inconclusive. [11] It seems clear that hyper-excitability of peripheral and central nociceptive pain pathways plays an important role in tension type headache [12], as several studies have demonstrated the presence of pressure pain hyperalgesia in children with tension type headache. [13–15]

Nevertheless, it has been postulated that tension type headache-related pain may be originated, at some extent, from referred pain from muscle trigger points (TrPs) located in head, neck and shoulder muscles. [16, 17] Myofascial/muscle TrPs are usually defined as the hypersensitive spots in a taut band of a skeletal muscle that elicit a referred distant pain upon examination. [18] From a clinical point of view, TrPs may be active or latent. Active TrPs are those which both local and referred pain reproduce pain symptoms and the pain is recognized as a usual or familiar pain by the subjects. In tension type headache, active TrPs are those reproducing pain symptoms similar to those the patients perceive during their headache attacks.

Different studies have demonstrated the relevance of active TrPs in adults with chronic tension type headache (CTTH). [19] In fact, a series of studies reported that the referred pain elicited by active TrPs in suboccipital [20], upper trapezius [21], temporalis [22], superior oblique [23], and sternocleidomastoid [24] muscles reproduced the head pain pattern in CTTH. Although muscle TrPs may be also involved in the development of CTTH in children, the literature on this topic is scarce. In fact, a recent case series has suggested that myofascial TrPs may play an additional role in a subgroup of children with tension-type headache. [25] This study showed that treatment targeted at inactivating TrPs may be effective for reducing the intensity, duration, and frequency of headache in children with tension type headache. However, this was a non-controlled study which only included nine girls. [25]

To the best of the authors’ knowledge; no previous study has investigated the referred pain areas of myofascial TrPs in children with CTTH in a systematically way. Our aims were to examine the presence of myofascial TrPs in head, neck, and shoulder muscles in children with CTTH and healthy controls and to compare the referred pain patterns and size of the areas in relation to clinical features of CTTH pain.

Source:  Chiro. org