Muscle tenderness in different headache types and its relation to anxiety and depression

Abstract

To assess in patients with migraine and tension type headache, both episodic and chronic, the extent to which muscle tenderness may relate to anxiety and depression, 459 patients with Episodic Migraine (EM, 125), Chronic Migraine (CM, 97), Episodic Tension Type Headache (ETTH, 82), Chronic Tension Type Headache (CTTH, 83), and EM+ETTH (72) were enrolled. For each patient, a psychological assessment on the Axis 1 of the DSM-IV and muscle palpation of pericranial and cervical muscles were carried out. A Pericranial Muscle Tenderness Score (PTS) and a Cervical Muscle Tenderness Score (CTS) were calculated (range 0-3). Logistic and linear regression analyses were employed to assess relations between muscle tenderness, the demographic variables and psychiatric disorders in the different patient groups. Odds ratio for 'male gender' was higher in groups with tension type headache. Only EM patients showed a positive association with increasing age. Anxiety and depression were significantly associated to CM. A significant negative correlation of PTS and CTS was observed in EM patients. In relation to male gender, the PTS was significantly lower in EM, ETTH and CTTH; CTS was significantly lower in EM, CM, and CTTH. Anxiety and, even more, anxiety and depression combined were positively associated to higher PTS and CTS in EM patients. Anxiety and depression were also positively associated to higher CTS in patients with EM+ETTH. In CTTH patients, PTS only was positively associated to anxiety and depression. We conclude that in patients with EM, the presence of anxiety or anxiety and depression combined considerably increases the level of muscle tenderness in the head and, even more, in the neck, and might facilitate the evolution into CM.

Accompanying symptoms and psychiatric comorbidity in migraine and tension-type headache patients

“…In the aforementioned study [9], the cooccurrence of depression and personality changes in women with migraine seemed to negatively influence headache course in the long term. More recently, it was observed that, in patients suffering from EM, anxiety and/or depression was related to a higher level of tenderness of the pericranial muscles and, even more, of the cervical muscles [24]. It was hypothesized that the more elevated muscle tenderness in migraine patients with psychiatric disorders could be one of the factors that may influence the history of migraine and may facilitate its evolution into CM.…”

Anxiety and depression in patients with chronic temporomandibular pain and in controls

“…[19][20][21][22] The role of anxiety is also controversial. The level of anxiety is found to correlate with pain diagnosis 23 and to be positively related to muscle tenderness in migraine patients 24 and patients with facial pain. 25 TMD patients who are more anxious seem to be at greater risk of developing chronic pain.…”

Prevalence, clinical features and potential therapies for fibromyalgia in primary headaches

“…Despite FM patients exhibiting higher depression and anxiety levels, it was anxiety levels that best discriminated patients with diffuse pain among our headache population. [18].Mongini et al found that the presence of anxiety considerably increases the level of muscle tenderness in the head and, even more, in the neck, and as such might facilitate the evolution into chronic headache forms [45]. In this way, anxiety may also facilitate diffuse myofascial pain and FM comorbidity in headache patients presenting with higher pericranial muscle tenderness.…”