Are Neck Flexor
Muscles Involved in
Chronic Tension-Type Headache ?
Denise Schneider , PT , MPT , FAAOMPT , COMT , ATC Doctors of Physical Therapy
Lisle , IL
Tension-type headache , the most common form of headache , is classified as either episodic or chronic . Chronic tension-type headaches are defined as daily or almost daily episodes of headache . These episodes involve a headache occurring on both sides of the head , and the pain is described as pressing or tightening , of mild to moderate intensity . It is not aggravated by routine physical activity , such as walking or climbing stairs . The headache is not accompanied by associated symptoms commonly linked to migraine , such as moderate to severe nausea or vomiting , or heightened sensitivity to light or sound . Individuals who suffer from chronic tension-type headache ( CTTH ) may experience substantial disability and decreased quality of life . To confirm the diagnosis of CTTH , the headaches must occur approximately 15 days a month for at least 3 months . This type of headache lasts hours to days or is constant .
The exact cause of tension-type headache is not known . Previously , this type of headache was consider “ psychogenic ” in nature , due to either anxiety or depression . Recent studies have attributed it to a neurobiological cause . Pain mechanisms , both peripheral ( incidental ) and central , play a role . Peripheral sensitization occurs due to local tissue injury or damage in which pain producing substances are released ; the result is local pain . Prolonged peripheral sensitization can lead to central sensitization as in chronic tension-type headache . In this case , pain is widespread and radiates beyond the original injury or tissue damage . Key indicators of central sensitization are pain that is caused by non-painful stimuli and / or an exaggerated response to pain .
The main findings of tension-type headache are abnormal tenderness of the pericranium , that is the membrane covering the skull . This tenderness can be assessed by manual manipulation of the membrane over the various muscles , including the frontal , masseter , and trapezius . Other findings include decreased neck flexor ( muscle contraction ) strength and endurance , postural abnormalities , and motor control impairments .
In a study by Castien , Blankenstein , and DeHertogh , the authors reported on the possible relationship of pressure pain and isometric ( equivalent ) strength of neck flexor muscles in chronic tension-type headache ( CTTH ). They noted that in patients with CTTH , changes in pressure pain in the neck area are associated with peripheral or central sensitization . They hypothesized that an increase
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