Travell and simons what causes referred pain series#
In fact, a recent case series has suggested that myofascial TrPs may play an additional role in a subgroup of children with tension-type headache. Although muscle TrPs may be also involved in the development of CTTH in children, the literature on this topic is scarce. In fact, a series of studies reported that the referred pain elicited by active TrPs in suboccipital, upper trapezius, temporalis, superior oblique, and sternocleidomastoid muscles reproduced the head pain pattern in CTTH. In tension type headache, active TrPs are those reproducing pain symptoms similar to those the patients perceive during their headache attacks.ĭifferent studies have demonstrated the relevance of active TrPs in adults with chronic tension type headache (CTTH). Active TrPs are those which both local and referred pain reproduce pain symptoms and the pain is recognized as a usual or familiar pain by the subjects.
From a clinical point of view, TrPs may be active or latent. Myofascial/muscle TrPs are usually defined as the hypersensitive spots in a taut band of a skeletal muscle that elicit a referred distant pain upon examination. Nevertheless, it has been postulated that tension type headache-related pain may be originated, at some extent, from referred pain from muscle trigger points (TrPs) located in head, neck and shoulder muscles. It seems clear that hyper-excitability of peripheral and central nociceptive pain pathways plays an important role in tension type headache, as several studies have demonstrated the presence of pressure pain hyperalgesia in children with tension type headache. Īlthough there has been an increasing interest in the pathogenic mechanisms of tension type headache, the true patho-anatomical mechanisms remain inconclusive. Furthermore, as tension type headache is also problematic for children, this headache needs further study. estimated that about 20% of the children with primary headache need medical therapy. In a recent epidemiological study in Germany, the 6-month prevalence of headaches was 53.2% among children from 7 to 14 years. Different studies have reported an overall prevalence rate for tension type headache ranging from 5.5 to 26% in children between 6 and 12 years old. Tension-type headache is the most common form of headache in both adults and adolescents. Our results showed that the local and referred pains elicited from active TrPs in head, neck and shoulder shared similar pain pattern as spontaneous CTTH in children, supporting a relevant role of active TrPs in CTTH in children. Significant positive correlations between some headache clinical parameters and the size of the referred pain area were found. Significant differences in referred pain areas between groups ( P < 0.001) and muscles ( P < 0.001) were found: the referred pain areas were larger in CTTH children ( P < 0.001), and the referred pain area elicited by suboccipital TrPs was larger than the referred pain from the remaining TrPs ( P < 0.001). Within children with CTTH, a significant positive association between the number of active TrPs and headache duration ( r s = 0.315 P = 0.026) was observed: the greater the number of active TrPs, the longer the duration of headache attack. Active TrPs were only present in children with CTTH ( P < 0.001). The total number of TrPs was significantly greater in children with CTTH as compared to healthy children ( P < 0.001).
The referred pain areas were drawn on anatomical maps, digitalized, and also measured. TrPs were identified with palpation and considered active when local and referred pains reproduce headache pain attacks. Bilateral temporalis, masseter, superior oblique, upper trapezius, sternocleidomastoid, suboccipital, and levator scapula muscles were examined for TrPs by an assessor blinded to the children’s condition. Fifty children (14 boys, 36 girls, mean age: 8 ± 2) with CTTH and 50 age- and sex- matched children participated. Our aim was to describe the referred pain pattern and areas from trigger points (TrPs) in head, neck, and shoulder muscles in children with chronic tension type headache (CTTH).