title: Trigger points are associated with widespread pressure pain sensitivity in people with tension-type headache.
abstract: Objective To investigate the association between trigger points (TrPs) and widespread pressure pain sensitivity in people with tension-type headache (TTH) and to determine if this association is different between frequent episodic (FETTH) or chronic (CTTH) headache. Design A cross-sectional study. Methods One hundred and fifty-seven individuals (29% male) with TTH participated. Clinical features of headache, i.e., intensity, duration, and frequency, were recorded in a headache diary. Active and latent TrPs were bilaterally explored in the temporalis, masseter, suboccipital, upper trapezius, sternocleidomastoid, and splenius capitis muscles. Pressure pain thresholds (PPT) were assessed over the trigeminal area (i.e., temporalis muscle), extra-trigeminal (i.e., C5/C6 zygapophyseal joint), and two distant pain-free points (i.e., second metacarpal and tibialis anterior muscle). Results Eighty (51%) patients were classified as FETTH, whereas 77 (49%) were classified as CTTH. No differences in the number of either active or latent TrPs (all p > 0.171) or widespread pressure pain sensitivity (all p > 0.351) were observed between FETTH and CTTH groups. The number of active and latent TrPs was significantly and negatively associated with PPTs: The higher the number of active or latent TrPs, the lower the widespread PPT, and the more generalized sensitization. This association was stronger within the FETTH group than the CTTH group. Conclusions This study found that the number of TrPs in head and neck/shoulder muscles was associated with widespread pressure hypersensitivity independently of the frequency of headache.
authors.affiliation: 1 Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos, Alcorcón, Spain.|2 Center for Sensory-Motor Interaction (SMI), Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark.
authors.forename: María
authors.initials: M
authors.lastname: Palacios-Ceña
authors.affiliation: 2 Center for Sensory-Motor Interaction (SMI), Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark.
authors.forename: Kelun
authors.initials: K
authors.lastname: Wang
authors.affiliation: 2 Center for Sensory-Motor Interaction (SMI), Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark.|3 Department of Physical Therapy, University of Siena, Italy.|4 Poliambulatorio Fisiocenter, Collecchio (Parma), Italy.
authors.forename: Matteo
authors.initials: M
authors.lastname: Castaldo
authors.affiliation: 5 Department of Neurology, Hospital Universitario Gregorio Marañón, Madrid, Spain.
authors.forename: Amparo
authors.initials: A
authors.lastname: Guillem-Mesado
authors.affiliation: 6 Department of Neurology, Hospital Rey Juan Carlos, Madrid, Spain.
authors.forename: Carlos
authors.initials: C
authors.lastname: Ordás-Bandera
authors.affiliation: 2 Center for Sensory-Motor Interaction (SMI), Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark.
authors.forename: Lars
authors.initials: L
authors.lastname: Arendt-Nielsen
authors.affiliation: 1 Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos, Alcorcón, Spain.|2 Center for Sensory-Motor Interaction (SMI), Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark.
authors.forename: César
authors.initials: C
authors.lastname: Fernández-de-Las-Peñas
mesh_terms: D000328:Adult; D059333:Central Nervous System Sensitization / Q000502:physiology; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D006930:Hyperalgesia / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D017288:Pain Threshold / Q000502:physiology*; D018781:Tension-Type Headache / Q000503:physiopathology*; D061028:Trigger Points / Q000503:physiopathology*
keywords: Tension-type headache; muscle pain; referred pain; sensitization