Abnormal pain processing in chronic tension-type headache: a high-density EEG brain mapping study

Abstract

Central sensitization caused by prolonged nociceptive input from muscles is considered to play an important role for chronification of tension-type headache. In the present study we used a new high-density EEG brain mapping technique to investigate spatiotemporal aspects of brain activity in response to muscle pain in 19 patients with chronic tension-type headache (CTTH) and 19 healthy, age- and sex-matched controls. Intramuscular electrical stimuli (single and train of five pulses delivered at 2 Hz) were applied to the trapezius muscle and somatosensory evoked potentials were recorded with 128-channel EEG both in- and outside a condition with induced tonic neck/shoulder muscle pain (glutamate injection into the trapezius muscle). Significant reduction in magnitude during and after induced tonic muscle pain was found in controls at the P200 dipole in response to both the first (baseline versus tonic muscle pain: P = 0.001; baseline versus post-tonic muscle pain: P = 0.002) and fifth (baseline versus tonic muscle pain: P = 0.04; baseline versus post-tonic muscle pain: P = 0.04) stimulus in the train. In contrast, there were no differences between the conditions in patients. No consistent difference was found in localization or peak latency of the dipoles. The reduction in magnitude during and after induced tonic muscle pain in controls but not in patients with CTTH may be explained by impaired inhibition of the nociceptive input in these patients. This may be the first evidence that the supraspinal response to muscle pain is abnormal in patients with CTTH.

Pain catastrophizing and cortical responses in amputees with varying levels of phantom limb pain: a high-density EEG brain-mapping study

“…For this purpose, a verbal rating scale (VRS) was used: 0 = no change (in sensation); 1 = barely intense, no pain; 2 = intense, no pain; 3 = fairly intense, but no pain; 4 = slight pain (painthreshold); 5 = mild pain; 6 = moderate pain; 7 = moderate-strong pain; 8 = strong pain; 9 = severe pain; 10 = unbearable pain (Buchgreitz et al 2008). …”

The Role of Muscles in Tension-Type Headache

“…Decreased antinociceptive activity from supraspinal structures (ie, deficient descending inhibition) also may contribute to the increased pain sensitivity in chronic TTH [46,48,51,58,59]. Sandrini et al [48] demonstrated deficient diffuse noxious inhibitory control in chronic TTH, and a recent high-density brain electroencephalogram mapping study found impaired inhibition of nociceptive input in patients with chronic TTH [59].…”

“…Sandrini et al [48] demonstrated deficient diffuse noxious inhibitory control in chronic TTH, and a recent high-density brain electroencephalogram mapping study found impaired inhibition of nociceptive input in patients with chronic TTH [59]. Cathcart et al [51] recently reported deficient inhibition of repeated noxious mechanical stimulation in patients with chronic TTH.…”

Efficacy of Manual and Manipulative Therapy in the Perception of Pain and Cervical Motion in Patients With Tension-Type Headache: A Randomized, Controlled Clinical Trial

“…10 It has been observed that central sensitization caused by prolonged periods of pain may lead to headache chronification. 11 Tension in suboccipital and neck muscles probably involves limitation of movement in the cervical region; and therefore, knowing the range of motion might be useful as a reference for the quality of neck muscles. The perception of pain and its different dimensions (ie, word descriptors for pain in headache) are aspects that should be assessed in patients with headache to better know the pain sensation experienced by the patient, as this can alter their quality of life.…”