Total tenderness score and pressure pain thresholds in persistent post-traumatic headache attributed to mild traumatic brain injury

Abstract

Objective To investigate whether persistent post-traumatic headache attributed to mild traumatic brain injury (TBI) is associated with more pronounced pericranial tenderness and lower pressure pain thresholds (PPTs) in the head and neck region, compared with healthy controls. Methods Patients with persistent post-traumatic headache (n = 100) and age- and gender-matched healthy controls (n = 100) were included between July 2018 and June 2019. Total tenderness score (TTS) was used to assess pericranial tenderness by bilateral manual palpation in eight muscles or tendon insertions. Summation was then used to calculate a TTS from 0 to 48 based on individual right- and left-sided scores; higher TTS score indicated more pronounced pericranial tenderness. PPTs were examined in m. temporalis and m. trapezius (upper and middle part) using an electronic pressure algometer that applies increasing blunt pressure at a constant rate. Results The TTS score was higher in patients with persistent post-traumatic headache (median, 21; IQR, 12–31), compared with healthy controls (median, 10; IQR, 6–17; P < .001). PPTs were lower in patients with persistent post-traumatic headache than in controls in both the left-sided m. temporalis (mean ± SD, 157.5 ± 59.9 vs. 201.1 ± 65.2; P < .001) and right-sided m. temporalis (mean ± SD, 159.5 ± 63.8 vs. 212.3 ± 61.9; P < .001). Furthermore, patients with persistent post-traumatic headache also had lower left- and right-sided PPTs in the upper as well as middle part of m. trapezius, compared with healthy controls; all P values were .05 or less. Conclusions Among patients with persistent post-traumatic headache, pericranial tenderness was more pronounced and PPTs in the head and neck region were lower than in healthy controls free of headache and mild TBI. Further research is needed to better understand the involvement of pericranial myofascial nociceptors in the disease mechanisms underlying post-traumatic headache.

Sensory hypersensitivities are associated with post‐traumatic headache‐related disability

“…Beyond the scope of the ARMR questionnaires, peri-cranial tenderness and pressure pain thresholds may also reflect altered nociceptive thresholds in patients who develop persistent PTH following mTBI. 34 While clear PTH-specific patterns of somatosensory dysfunction have yet to emerge, 35 our findings support the overall theme that hypersensitivity is present across multiple sensory modalities in PTH and contributes to post-TBI symptom burden.…”

“…This prior work has led to the proposed notion that allodynia may be more “PTH‐specific” than other features, when clinically differentiating post‐concussive headache from other nontraumatic headaches, though evidence is mixed 33 and the characteristics of the ARMR dataset prohibited direct examination of this factor (discussed further below). Beyond the scope of the ARMR questionnaires, peri‐cranial tenderness and pressure pain thresholds may also reflect altered nociceptive thresholds in patients who develop persistent PTH following mTBI 34 . While clear PTH‐specific patterns of somatosensory dysfunction have yet to emerge, 35 our findings support the overall theme that hypersensitivity is present across multiple sensory modalities in PTH and contributes to post‐TBI symptom burden.…”

“…Participants who responded "yes" to items 21, 22, and 26, or "no" to item 22 but "yes" to items 21 and 24 were assigned a PTH categorization for our analysis. Additional Headache Features II questionnaire items (27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37) were also used to ascertain TBI history and characteristics (see Supplemental Material for complete questionnaire item details).…”

Posttraumatic Headache

“…Studies have demonstrated evidence for thermal and mechanical sensitization among those with posttraumatic headache 29 . For example, there is greater pericranial tenderness and reduced pressure pain thresholds in the head and neck regions among those with persistent posttraumatic headache 30 . This sensitized state can be exacerbated by exposing individuals to bright light, which may be evidence for atypical multisensory integration in those with posttraumatic headache 19 .…”

Evaluating Headache and Facial Pain in a Headache Diagnostic Laboratory: Experiences from the Danish Headache Center

“…Decreased pain thresholds in post-traumatic headache had been shown in a few studies [ 20 , 21 ], but a demonstration of this had not been done with a large cohort. A recent study compared 100 patients with persistent post-traumatic headache after a mild TBI with 100 healthy age- and gender-matched controls [ 22 ]. The tenderness of the pericranial muscles and pressure pain thresholds at m. temporalis and m. trapezius (upper and middle part) were examined in both groups.…”