Morphology of muscular function in chronic tension-type headache: a pilot study

Chronic pain has been thought to induce muscular changes in chronic tension-type headache (CTTH) patients. As the knowledge of muscular responses in CTTH is inconsistent, we decided to introduce new electromyogram signal shape descriptors. We also wanted to compare the discriminatory power of proposed indices with classical measures to establish their potential to act as markers for CTTH. Thirty-eight headache patients with twenty healthy volunteers were recruited. Twenty patients had CTTH, while 18 had migraine without aura. Surface electromyogram data were recorded from right sternocleidomastoid and left temporalis muscles during rest and in a headache-free situation. Besides conventional root mean square (RMS) and median frequency (MDF), two morphological-based indices, skewness and kurtosis, were proposed to quantify the shape variations of signal distribution. Results demonstrated that the skewness outperformed RMS and MDF in terms of discriminatory power (p < 0.00). Kurtosis values for both muscles differed considerably among study groups (p < 0.04). RMS for both muscles was noticeably higher in CTTH group (p < 0.00). Regarding MDF, migraineurs revealed highest (p < 0.05), while CTTH patients represented the lowest values. Skewness was the most relevant predictor for headache diagnosis, especially in temporalis muscle (migraine, odds ratio = 21.1, p = 0.01; Ctension-type headache, odds ratio = 78.8, p = 0.00). There are detectable distinct muscular responses in chronic headache sufferers. This finding could be due to adaptation to muscle underuse or sustained contraction, leading to impaired recruitment and muscle fiber-type conversion with dominant type I fibers in CTTH.