Exteroceptive suppression of temporalis muscle activity: methodological and physiological aspects

In recent years studies of the suppression of EMG activity in temporalis muscle induced by stimulation in the trigeminal territory have opened new perspectives in headache research. The various methods that have been used in different laboratories are reviewed and some of the physiological modulations of temporalis exteroceptive suppression are described. Among different methods of recording, averaging 10 full-wave rectified EMG responses produces results with acceptable variability and discomfort. In order to obtain maximal responses the intensity of the stimulation should reach at least 20 mA. To avoid habituation of the second temporalis exteroceptive suppression period (ES2), the stimulation frequency has to be at 0.1 Hz or below. The level of voluntary contraction is not a critical variable as long as it reaches 50% of maximum. Some physiological variations of temporalis suppression are well documented. In females, ES2 is shorter during menstruation than at mid-cycle and correlated with the estradiol/progesterone ratio in plasma. Conditioning temporalis ES2 by a preceding peripheral stimulus markedly reduces its duration, which is partly reversible by naloxone. Various pharmacological agents are able to modify temporalis ES2: its duration is increased by 5-HT1 antagonists, but decreased by 5-HT uptake blockers; contradictory results have been obtained with acetylsalicylic acid. These results suggest that inhibitory brain-stem interneurons mediating temporalis ES2 are inhibited by serotonergic afferents, probably from the raphe magnus nucleus, and that the latter receives an excitatory input from the periaqueductal gray matter and other limbic structures, in part via opioid receptors.