Differences in cervical musculoskeletal impairment between episodic and chronic tension-type headache

Tension-type headache (TTH) is a headache in which musculoskeletal impairments of the craniocervical region may play an important role in its pathogenesis. We investigated the presence of myofascial, postural and mechanical abnormalities in patients with frequent episodic and chronic tension-type headache (ETTH and CTTH, respectively).

The study population consisted of 36 patients with ETTH, 23 with CTTH and 42 control subjects. Myofascial trigger points (MTrPs) were identified in the upper trapezius, sternocleidomastoid, temporalis and suboccipital muscles. Sagittal C7-tragus angle was measured to evaluate flexor head posture (FHP), and neck mobility was assessed using an inclinometer.

Only active MTrPs were significantly different between the ETTH and CTTH groups (p < .001). Patients with CTTH showed a larger sagittal C7-tragus angle (p = .011), that is, greater FHP and restricted neck mobility for both rotations compared to controls (p < .001). Although active MTrPs were correlated with the frequency and duration of headache, no correlations were observed for FHP or neck mobility.

Active MTrPs in the craniocervical region contribute to triggering or maintenance of TTH and posture or neck mobility may be a result of chronic headache.