Referred pain maps of myofascial trigger points in tension type headache

Cescon, Corrado and Barbero, Marco and Zuin, Piera and Falla, Deborah and Palacios-Ceña, María and Arendt-Nielsen, Lars and Fernández-de-las-Peñas, César (2019) Referred pain maps of myofascial trigger points in tension type headache. UNSPECIFIED. In: WCPT2019 Proceedings World Confederation for Physical Therapy Congress, 2019, May 10th-13th, Geneva, Switzerland.

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Background: Myofascial trigger points (MTrPs) in the head and neck muscles are frequently found in people with tension type headache (TTH). Recent findings suggest that MTrPs are implicated in the etiology of tension type headache and constitute a peripheral source of nociception that can induce central sensitization. Referred pain from MTrPs can be spontaneous or elicited by palpation and can contribute to the clinical manifestation of tension type headache. Nevertheless, specific refereed pain maps from MTrP in people with TTH are not available. Purpose: To describe the referred pain pattern of MTrPs in persons with TTH. Furthermore, the mean extent of referred pain from each MTrPs was compared with pain complains of these patients. Methods: One hundred and thirteen persons with TTH were enrolled in the study. Pain drawings of their usual pain and referred pain elicited by palpation of MTrPs were completed using four different paper body charts of the head and neck region (i.e. frontal view, dorsal view, right view, left view). The following muscles were examined to identify MTrPs: Masseter, Sternocleidomastoid, Suboccipitalis, Splenius Capitis, Temporalis, Upper Trapezius. Participants were instructed to color, using a pencil, every part of the body chart where they perceived pain, independently from the type and the severity of pain. The body charts were presented to the patients on A4 sheets. Subsequently, all pain drawings on the paper body charts were copied onto a digital body chart by two trained operators using an image analysis software. Pain extent for each patient was reported as the sum of the pixels in each view of the head and expressed as the percentage of the total chart area. Pain frequency maps were also generated for the four different body charts of the head to illustrate where pain was most frequently perceived by the participants by superimposing all the pain drawings produced on the same body chart. Results: The mean pain extent for usual pain was 12.4% of the total head and neck area, with a slight but not significant prevalence of pain in the posterior aspect of the head. The prevalence of MTrPs was 31% for Masseter, 48% for Sternocleidomastoid, 50% for Suboccipitalis, 46% for Splenius capitis, 77% for Temporalis, and 44% for Upper Trapezius. The mean extent of referred pain was 2.9%, 4.0%, 6.9%, 5.7%, 4.9% and 5.4% respectively for the aforementioned MTrPs, ranging from 22% to 54% of the extent of the usual pain. The generated pain frequency maps of MTrP showed a common referral zone for each muscle. Conclusion(s): Pain frequency maps of the pain elicited from MTrPs showed that referred pain was localized in specific areas of the neck and head region in people with TTH. The identified pain pattern was similar to the one originally reported by Travell and Simons in (1983). Referred pain from MTrPs appears to contribute to pain symptoms of patients with TTH. Implications: Clinicians can use the pain frequency maps of MTrPs generated in this study for the evaluation of patients with head and neck complains.

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