Mechanisms of Tension-Type Headache and Their Relevance to Management
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.
KeywordsCentral Sensitization Pain Sensitivity Spinal Dorsal Horn Diffuse Noxious Inhibitory Control Increase Muscle Activity
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