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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