Pericranial Muscle Tenderness and Exteroceptive Suppression of Temporalis Muscle Activity: A Blind Study of Chronic Tension‐Type Headache

Abstract

The aim of the present study was to examine the ability of pericranial muscle tenderness and the second exteroceptive suppression period to distinguish chronic tension-type headache sufferers, migraine sufferers, and controls in a young adult population utilizing a blind design. The second exteroceptive suppression periods were assessed using the methodology recommended by the European Headache Federation and were scored with an automated computer software program designed in our laboratory to provide reliable, standardized, and precise quantification of exteroceptive suppression periods and eliminate any influence of experimenter bias that may occur with manual scoring. Our sample consisted of 45 subjects diagnosed according to IHS criteria: 25 with chronic tension-type headache and 20 with migraine without aura. Twenty-three headache-free controls were recruited. Consistent with our previous findings, abnormalities in pericranial muscle tenderness, but not in the second exteroceptive suppression period distinguished chronic tension-type headache sufferers from controls. The chronic tension headache sufferers exhibited the highest pericranial muscle tenderness and the control group exhibited the lowest tenderness (P < .001). Pericranial muscle tenderness was quite successful in distinguishing recurrent headache sufferers from controls, but failed to distinguish chronic tension-type headache sufferers from migraineurs. Our findings raise the possibility that pericranial muscle tenderness is present early in the development of chronic tension-type headache and migraine without aura, and thus might contribute to the etiology of headache disorders. Our findings also indicate that a shortened second exteroceptive suppression period is not a reliable marker for chronic tension-type headache in young adults.

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

“…The pathophysiological background of the association between some symptoms and headache is difficult to clarify. Regarding oral parafunctions, we may hypothesize the possible role of muscular tenderness as a common mechanism involved in the complex pathophysiology of tension-type headache and in the expression of this symptom [19][20][21][22][23].…”

Neurophysiological assessment of craniofacial pain

“…Several studies confirmed this finding [63,64] while others did not [65,66]. The shortening of ES2 is probably related to the duration of illness, thus being more common in patients suffering from chronic rather than episodic headache [65,66].…”

A computer program for automated scoring of exteroceptive suppression periods

“…Normally, perioral electrical stimulation during voluntary jaw occlusion elicits two successive suppression periods (ES I & ES2). Although a series of studies have confirmed an attenuated or absent ES2 in chronic tension headache subjects relative to headache-free controls (Nakashima & Takahashi, 1991;Paulus, Raubiichl, Straube, & Schoenen, 1991;Schoenen, Jamart, Gerard, Lenarduzzi, & Delwaide, 1987), there have also been negative findings (Bendtsen, Jensen, Brennum, Arendt-Nielsen, & Olesen, 1996;Lipchik et al, 1996;Lipchik, Holroyd, Talbot, & Greer, 1997;Zwart & Support for this research was provided by an Academic Challenge Award from the State of Ohio. Please note that a new stand-alone version of the program has been recently developed using visual basic.…”

“…Sand, 1995). Because stimulation parameters used to elicit the ES response (e.g., frequency, intensity, and duration of stimulation) and the procedures for quantifying the resultant suppression periods have varied widely across studies from different laboratories (Bendtsen, Jensen, Brennum, Arendt-Nielson, & Olesen, 1993Lipchik et al, 1996;Lipchik et al, 1997;Nakashima & Takahashi, 1991;Paulus et al, 1991;Schoenen et al, 1987;Wallasch, Niemann, Kropp, & Weinshiitz, 1993;Zwart & Sand, 1995), findings often cannot be directly compared across studies.…”