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Mechanisms of Tension-Type Headache and Their Relevance to Management

  • Lars Bendtsen
  • David Bezov
  • Sait Ashina
Reference work entry

Abstract

The tenderness of pericranial myofascial tissues is considerably increased in patients with tension-type headache (TTH). The mechanisms responsible for the increased myofascial pain sensitivity have been extensively studied. Peripheral activation or sensitization of myofascial nociceptors could play a role in causing increased pain sensitivity, but firm evidence for a peripheral abnormality is still lacking. Most likely, peripheral mechanisms are of major importance in subjects with episodic TTH. Numerous studies have demonstrated that the central nervous system is sensitized in patients with chronic TTH. Sensitization of pain pathways in the central nervous system due to prolonged nociceptive stimuli from pericranial myofascial tissues seem to be responsible for the conversion of episodic to chronic TTH. The central sensitization explains why patients with chronic TTH are difficult to treat. This delineates two major targets for future treatment strategies: (a) to identify the source of peripheral nociception in order to prevent the development of central sensitization and thereby the conversion of episodic into chronic TTH and (b) to reduce established central sensitization and facilitate descending inhibition of pain.

Keywords

Central Sensitization Pain Sensitivity Spinal Dorsal Horn Diffuse Noxious Inhibitory Control Increase Muscle Activity 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. Ashina M (2004) Neurobiology of chronic tension-type headache. Cephalalgia 24:161–172PubMedCrossRefGoogle Scholar
  2. Ashina M, Bendtsen L, Jensen R, Lassen LH, Sakai F, Olesen J (1999a) Possible mechanisms of action of nitric oxide synthase inhibitors in chronic tension-type headache. Brain 122:1629–1635PubMedCrossRefGoogle Scholar
  3. Ashina M, Bendtsen L, Jensen R, Sakai F, Olesen J (1999b) Muscle hardness in patients with chronic tension-type headache: relation to actual headache state. Pain 79:201–205PubMedCrossRefGoogle Scholar
  4. Ashina M, Lassen LH, Bendtsen L, Jensen R, Olesen J (1999c) Effect of inhibition of nitric oxide synthase on chronic tension-type headache: a randomised crossover trial. Lancet 353:287–289PubMedCrossRefGoogle Scholar
  5. Ashina M, Bendtsen L, Jensen R, Olesen J (2000) Nitric oxide-induced headache in patients with chronic tension-type headache. Brain 123:1830–1837PubMedCrossRefGoogle Scholar
  6. Ashina M, Stallknecht B, Bendtsen L, Pedersen JF, Galbo H, Dalgaard P, Olesen J (2002) In vivo evidence of altered skeletal muscle blood flow in chronic tension-type headache. Brain 125:320–326PubMedCrossRefGoogle Scholar
  7. Ashina M, Stallknecht B, Bendtsen L, Pedersen J, Schifter S, Galbo H, Olesen J (2003) Tender points are not sites of ongoing inflammation - in vivo evidence in patients with chronic tension-type headache. Cephalalgia 23:109–116PubMedCrossRefGoogle Scholar
  8. Ashina S, Bendtsen L, Ashina M (2005) Pathophysiology of tension-type headache. Curr Pain Headache Rep 9:415–422PubMedCrossRefGoogle Scholar
  9. Ashina S, Bendtsen L, Ashina M, Magerl W, Jensen R (2006) Generalized hyperalgesia in patients with chronic tension-type headache. Cephalalgia 26:940–948PubMedCrossRefGoogle Scholar
  10. Bendtsen L (2000) Central sensitization in tension-type headache – possible pathophysiological mechanisms. Cephalalgia 20:486–508PubMedCrossRefGoogle Scholar
  11. Bendtsen L (2002) Sensitization: its role in primary headache. Curr Opin Investig Drugs 3:449–453PubMedGoogle Scholar
  12. Bendtsen L, Jensen R (2000) Amitriptyline reduces myofascial tenderness in patients with chronic tension-type headache. Cephalalgia 20:603–610PubMedCrossRefGoogle Scholar
  13. Bendtsen L, Jensen R (2006) Tension-type headache: the most common, but also the most neglected, headache disorder. Curr Opin Neurol 19:305–309PubMedGoogle Scholar
  14. Bendtsen L, Jensen R (2009) Tension-type headache. Neurol Clin 27:525–535PubMedCrossRefGoogle Scholar
  15. Bendtsen L, Jensen R, Olesen J (1996a) Decreased pain detection and tolerance thresholds in chronic tension-type headache. Arch Neurol 53:373–376PubMedGoogle Scholar
  16. Bendtsen L, Jensen R, Olesen J (1996b) Qualitatively altered nociception in chronic myofascial pain. Pain 65:259–264PubMedCrossRefGoogle Scholar
  17. Bendtsen L, Evers S, Linde M, Mitsikostas DD, Sandrini G, Schoenen J (2009) EFNS guideline on the treatment of tension-type headache – Report of an EFNS task force. Eur J Neurol 17:1318–1325Google Scholar
  18. Bovim G (1992) Cervicogenic headache, migraine, and tension-type headache. Pressure-pain threshold measurements. Pain 51:169–173PubMedCrossRefGoogle Scholar
  19. Buchgreitz L, Lyngberg AC, Bendtsen L, Jensen R (2006) Frequency of headache is related to sensitization: a population study. Pain 123:19–27PubMedCrossRefGoogle Scholar
  20. Buchgreitz L, Lyngberg A, Bendtsen L, Jensen R (2007) Increased prevalence of tension-type headache over a 12-year period is related to increased pain sensitivity. A population study. Cephalalgia 27:145–152PubMedCrossRefGoogle Scholar
  21. Buchgreitz L, Egsgaard LL, Jensen R, Arendt-Nielsen L, Bendtsen L (2008a) Abnormal pain processing in chronic tension-type headache: a high-density EEG brain mapping study. Brain 131:3232–3238PubMedCrossRefGoogle Scholar
  22. Buchgreitz L, Lyngberg AC, Bendtsen L, Jensen R (2008b) Increased pain sensitivity is not a risk factor but a consequence of frequent headache: a population-based follow-up study. Pain 137:623–630PubMedCrossRefGoogle Scholar
  23. Cathcart S, Winefield AH, Lushington K, Rolan P (2010a) Noxious inhibition of temporal summation is impaired in chronic tension-type headache. Headache 50(3):403–412PubMedCrossRefGoogle Scholar
  24. Cathcart S, Petkov J, Winefield AH, Lushington K, Rolan P (2010b) Central mechanisms of stress-induced headache. Cephalalgia 30(3):285–295PubMedGoogle Scholar
  25. Christensen M, Bendtsen L, Ashina M, Jensen R (2005) Experimental induction of muscle tenderness and headache in tension-type headache patients. Cephalalgia 25:1061–1067PubMedCrossRefGoogle Scholar
  26. Coderre TJ, Katz J, Vaccarino AL, Melzack R (1993) Contribution of central neuroplasticity to pathological pain: review of clinical and experimental evidence. Pain 52:259–285PubMedCrossRefGoogle Scholar
  27. Fernandez-de-Las-Penas C, Alonso-Blanco C, Cuadrado ML, Gerwin RD, Pareja JA (2006a) Myofascial trigger points and their relationship to headache clinical parameters in chronic tension-type headache. Headache 46:1264–1272PubMedCrossRefGoogle Scholar
  28. Fernandez-de-Las-Penas C, Alonso-Blanco C, Cuadrado ML, Gerwin RD, Pareja JA (2006b) Trigger points in the suboccipital muscles and forward head posture in tension-type headache. Headache 46:454–460PubMedCrossRefGoogle Scholar
  29. Fernandez-de-Las-Penas C, Cuadrado ML, Arendt-Nielsen L, Ge HY, Pareja JA (2007a) Increased pericranial tenderness, decreased pressure pain threshold, and headache clinical parameters in chronic tension-type headache patients. Clin J Pain 23:346–352PubMedCrossRefGoogle Scholar
  30. Fernandez-de-Las-Penas C, Cuadrado ML, Arendt-Nielsen L, Simons DG, Pareja JA (2007b) Myofascial trigger points and sensitization: an updated pain model for tension-type headache. Cephalalgia 27:383–393PubMedCrossRefGoogle Scholar
  31. Fernandez-de-Las-Penas C, Cuadrado ML, Pareja JA (2007c) Myofascial trigger points, neck mobility, and forward head posture in episodic tension-type headache. Headache 47(5):662–672PubMedCrossRefGoogle Scholar
  32. Fumal A, Schoenen J (2008) Tension-type headache: current research and clinical management. Lancet Neurol 7:70–83PubMedCrossRefGoogle Scholar
  33. Göbel H, Weigle L, Kropp P, Soyka D (1992) Pain sensitivity and pain reactivity of pericranial muscles in migraine and tension-type headache. Cephalalgia 12:142–151PubMedCrossRefGoogle Scholar
  34. Heckman BD, Holroyd KA (2006) Tension-type headache and psychiatric comorbidity. Curr Pain Headache Rep 10:439–447PubMedCrossRefGoogle Scholar
  35. Hubbard DR, Berkoff GM (1993) Myofascial trigger points show spontaneous needle EMG activity. Spine 18:1803–1807PubMedCrossRefGoogle Scholar
  36. Janke EA, Holroyd KA, Romanek K (2004) Depression increases onset of tension-type headache following laboratory stress. Pain 111:230–238PubMedCrossRefGoogle Scholar
  37. Jensen R (1996) Mechanisms of spontaneous tension-type headaches: an analysis of tenderness, pain thresholds and EMG. Pain 64:251–256PubMedCrossRefGoogle Scholar
  38. Jensen R (1999) Pathophysiological mechanisms of tension-type headache: a review of epidemiological and experimental studies. Cephalalgia 19:602–621PubMedCrossRefGoogle Scholar
  39. Jensen R, Becker WJ (2005) Symptomatology of episodic tension-type headaches. In: Olesen J, Goadsby PJ, Ramadan N, Tfelt-Hansen P, Welch KM (eds) The headaches. Lippincott Williams & Wilkins, Philadelphia, pp 685–692Google Scholar
  40. Jensen R, Olesen J (1996) Initiating mechanisms of experimentally induced tension-type headache. Cephalalgia 16:175–182PubMedCrossRefGoogle Scholar
  41. Jensen R, Rasmussen BK, Pedersen B, Olesen J (1993) Muscle tenderness and pressure pain thresholds in headache. A population study. Pain 52:193–199PubMedCrossRefGoogle Scholar
  42. Jensen R, Bendtsen L, Olesen J (1998) Muscular factors are of importance in tension-type headache. Headache 38:10–17PubMedCrossRefGoogle Scholar
  43. Langemark M, Olesen J (1987) Pericranial tenderness in tension headache. A blind, controlled study. Cephalalgia 7:249–255PubMedCrossRefGoogle Scholar
  44. Langemark M, Jensen K, Jensen TS, Olesen J (1989) Pressure pain thresholds and thermal nociceptive thresholds in chronic tension-type headache. Pain 38:203–210PubMedCrossRefGoogle Scholar
  45. Langemark M, Bach FW, Jensen TS, Olesen J (1993) Decreased nociceptive flexion reflex threshold in chronic tension-type headache. Arch Neurol 50:1061–1064PubMedGoogle Scholar
  46. Lindelof K, Ellrich J, Jensen R, Bendtsen L (2009) Central pain processing in chronic tension-type headache. Clin Neurophysiol 120:1364–1370PubMedCrossRefGoogle Scholar
  47. Lipchik GL, Holroyd KA, O'Donnell FJ, Cordingley GE, Waller S, Labus J, Davis MK, French DJ (2000) Exteroceptive suppression periods and pericranial muscle tenderness in chronic tension-type headache: effects of psychopathology, chronicity and disability. Cephalalgia 20:638–646PubMedGoogle Scholar
  48. Lyngberg AC, Rasmussen BK, Jorgensen T, Jensen R (2005a) Has the prevalence of migraine and tension-type headache changed over a 12-year period? A Danish population survey. Eur J Epidemiol 20:243–249PubMedCrossRefGoogle Scholar
  49. Lyngberg AC, Rasmussen BK, Jorgensen T, Jensen R (2005b) Incidence of primary headache: a Danish epidemiologic follow-up study. Am J Epidemiol 161:1066–1073PubMedCrossRefGoogle Scholar
  50. Makowska A, Panfil C, Ellrich J (2005a) Long-term potentiation of orofacial sensorimotor processing by noxious input from the semispinal neck muscle in mice. Cephalalgia 25:109–116PubMedCrossRefGoogle Scholar
  51. Makowska A, Panfil C, Ellrich J (2005b) Nerve growth factor injection into semispinal neck muscle evokes sustained facilitation of the jaw-opening reflex in anesthetized mice – possible implications for tension-type headache. Exp Neurol 191:301–309PubMedCrossRefGoogle Scholar
  52. Makowska A, Panfil C, Ellrich J (2006) ATP induces sustained facilitation of craniofacial nociception through P2X receptors on neck muscle nociceptors in mice. Cephalalgia 26:697–706PubMedCrossRefGoogle Scholar
  53. Mathew NT (2006) Tension-type headache. Curr Neurol Neurosci Rep 6:100–105PubMedCrossRefGoogle Scholar
  54. Meller ST, Gebhart GF (1993) Nitric oxide (NO) and nociceptive processing in the spinal cord. Pain 52:127–136PubMedCrossRefGoogle Scholar
  55. Mense S (1993) Nociception from skeletal muscle in relation to clinical muscle pain. Pain 54:241–289PubMedCrossRefGoogle Scholar
  56. Mense S, Simons DG, Hoheisel U, Quenzer B (2003) Lesions of rat skeletal muscle after local block of acetylcholinesterase and neuromuscular stimulation. J Appl Physiol 94:2494–2501PubMedCrossRefGoogle Scholar
  57. Merskey H (1994) Pain and psychological medicine. In: Wall PD, Melzack R (eds) Textbook of pain. Churchill Livingstone, Edinburgh, pp 903–920Google Scholar
  58. Milanov I, Bogdanova D (2004) Pain and tension-type headache: a review of the possible pathophysiological mechanisms. J Headache Pain 5:4–11CrossRefGoogle Scholar
  59. Mork H, Ashina M, Bendtsen L, Olesen J, Jensen R (2003) Induction of prolonged tenderness in patients with tension-type headache by means of a new experimental model of myofascial pain. Eur J Neurol 10:249–256PubMedCrossRefGoogle Scholar
  60. Mork H, Ashina M, Bendtsen L, Olesen J, Jensen R (2004) Possible mechanisms of pain perception in patients with episodic tension-type headache. A new experimental model of myofascial pain. Cephalalgia 24:466–475PubMedCrossRefGoogle Scholar
  61. Newham DJ, Edwards RHT, Mills KR (1994) Skeletal muscle pain. In: Wall PD, Melzack R (eds) Textbook of pain. Churchill Livingstone, Edinburgh, pp 423–440Google Scholar
  62. Østergaard S, Russell MB, Bendtsen L, Olesen J (1997) Comparison of first degree relatives and spouses of people with chronic tension headache. BMJ 12:1092–1093Google Scholar
  63. Panfil C, Makowska A, Ellrich J (2006) Brainstem and cervical spinal cord Fos immunoreactivity evoked by nerve growth factor injection into neck muscles in mice. Cephalalgia 26:128–135PubMedCrossRefGoogle Scholar
  64. Pielsticker A, Haag G, Zaudig M, Lautenbacher S (2005) Impairment of pain inhibition in chronic tension-type headache. Pain 118:215–223PubMedCrossRefGoogle Scholar
  65. Russell MB, Iselius L, Olesen J (1998) Inheritance of chronic tension-type headache investigated by complex segregation analysis. Hum Genet 102:138–140PubMedCrossRefGoogle Scholar
  66. Sandrini G, Rossi P, Milanov I, Serrao M, Cecchini AP, Nappi G (2006) Abnormal modulatory influence of diffuse noxious inhibitory controls in migraine and chronic tension-type headache patients. Cephalalgia 26:782–789PubMedCrossRefGoogle Scholar
  67. Sarchielli P, Alberti A, Floridi A, Gallai V (2002) L-Arginine/nitric oxide pathway in chronic tension-type headache: relation with serotonin content and secretion and glutamate content. J Neurol Sci 198:9–15PubMedCrossRefGoogle Scholar
  68. Schmidt-Hansen PT, Svensson P, Jensen TS, Graven-Nielsen T, Bach FW (2006) Patterns of experimentally induced pain in pericranial muscles. Cephalalgia 26:568–577PubMedCrossRefGoogle Scholar
  69. Schmidt-Hansen PT, Svensson P, Bendtsen L, Graven-Nielsen T, Bach FW (2007) Increased muscle pain sensitivity in patients with tension-type headache. Pain 129:113–121PubMedCrossRefGoogle Scholar
  70. Schmidt-Wilcke T, Leinisch E, Straube A, Kampfe N, Draganski B, Diener HC, Bogdahn U, May A (2005) Gray matter decrease in patients with chronic tension type headache. Neurology 65:1483–1486PubMedCrossRefGoogle Scholar
  71. Schoenen J, Bottin D, Hardy F, Gerard P (1991) Cephalic and extracephalic pressure pain thresholds in chronic tension-type headache. Pain 47:145–149PubMedCrossRefGoogle Scholar
  72. Schwartz BS, Stewart WF, Lipton RB (1997) Lost workdays and decreased work effectiveness associated with headache in the workplace. J Occup Environ Med 39:320–327PubMedCrossRefGoogle Scholar
  73. Simons DG, Mense S (1998) Understanding and measurement of muscle tone as related to clinical muscle pain. Pain 75:1–17PubMedCrossRefGoogle Scholar
  74. Treede RD, Meyer RA, Raja SN, Campbell JN (1992) Peripheral and central mechanisms of cutaneous hyperalgesia. Prog Neurobiol 38:397–421PubMedCrossRefGoogle Scholar
  75. Vandenheede M, Schoenen J (2002) Central mechanisms in tension-type headaches. Curr Pain Headache Rep 6:392–400PubMedCrossRefGoogle Scholar

Copyright information

© Lifting The Burden 2011

Authors and Affiliations

  1. 1.Danish Headache Centre and Department of NeurologyGlostrup Hospital, University of CopenhagenGlostrupDenmark
  2. 2.Department of NeurologyAlbert Einstein College of Medicine, Montefiore Medical CenterBronxUSA

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