Chronic Tension-Type Headache: Muscle Overactivity Versus Deficient Pain Controls

Abstract

Objective: The oscillating school of thought between the peripheral and central mechanisms of pain origin hinders the selection of appropriate therapy for chronic tension-type headache (CTTH). The aim of this study was to assess the role of central and peripheral pain mechanisms together in CTTH. Methods:In the present study, we compared surface electromyography (sEMG) amplitudes and nociceptive flexion thresholds in patients diagnosed with CTTH (n=30) with age-matched healthy controls (n=30). For central pain modulation with spinal and supraspinal influences on nociception, we recorded nociceptive flexion reflex (NFR) by stimulating the sural nerve and observing the biceps femoris muscle response. sEMG was done for the temporalis and trapezius muscles at rest, during mental activity and during maximum voluntary contraction to assess contribution from peripheral pain. Results:We observed a decreased NFR threshold in CTTH patients as compared to healthy controls, suggesting a hyperalgesic state due to central factors. Electromyographic activity of trapezius muscle was increased at rest in CTTH while both temporalis and trapezius showed an overactivity in patients during mental task. Conclusion:Central factors are important in the pathogenesis of CTTH while, peripheral factors, such as stress-related muscle spasm may also contribute to pain state.

Low-Frequency Repetitive Transcranial Magnetic Stimulation for Chronic Tension-Type Headache: A Randomized Controlled Study

“…Similarly, the rTMS group saw a higher and more significant reduction in HIT-6 scores postoperatively, from 63.005.68 to 42.907.09 with p < 0.0001 compared to the sham groups, where HIT-6 scores decreased non-significantly from 59.107.84 to 57.007.54 with p = 0.2189. These results were consistent with the 2019 study by Mattoo et al [5], which was a pilot study. This further supports the fact that the adjuvant use of rTMS to conventional standard care in subjects with CTTH has added advantages concerning nociceptive excitability, muscle overactivity, daily life interference, and pain intensity.…”

“…In maximal voluntary contractions, mental activity, and during rest, EMG was recorded, with each lasting for one minute. Time to fatigue and EMG amplitude were also assessed [5].…”

“…Tricyclics appear to become more effective with time [4]. A recent study done by Mattoo et al in 2019 reported that the literature evidence is limited for chronic tension-type headaches, warranting further studies to assess the efficacy of rTMS use as an adjunct to standard care for managing chronic tension-type headaches [5].…”

Caffeine Induced Cervical Dystonia-a Case Study

“…The occurrence of spasmodic torticollis should not always be co-related with any traumatic injury and can occur due to irregular lifestyle habits and deficits such as improper keyboard techniques, asymmetrical postures with poor gravitational alignment, and rapid repetitive movements [1,2]. Mental stress and tension-type headaches can cause overactivity of the pericranial and cervical muscles, indicating the role of the trapezius muscle [7]. The patient's grim situation can be understood by the unawareness of the previous physician, his consultation, and counselling, who prescribed a combination of non-steroidal antiinflammatory drugs, believing it to be a normal muscle strain.…”