Total tenderness score and pressure pain thresholds in persistent post-traumatic headache attributed to mild traumatic brain injury
Abstract Objective To investigate whether persistent post-traumatic headache attributed to mild traumatic brain injury (TBI) is associated with more pronounced pericranial tenderness and lower pressure pain thresholds (PPTs) in the head and neck region, compared with healthy controls. Methods Patien...
| Main Authors: | , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2022-08-01
|
| Series: | The Journal of Headache and Pain |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s10194-022-01457-1 |
| _version_ | 1798042457509724160 |
|---|---|
| author | Håkan Ashina Haidar Muhsen Al-Khazali Afrim Iljazi Sait Ashina Faisal Mohammad Amin Henrik Winther Schytz |
| author_facet | Håkan Ashina Haidar Muhsen Al-Khazali Afrim Iljazi Sait Ashina Faisal Mohammad Amin Henrik Winther Schytz |
| author_sort | Håkan Ashina |
| collection | DOAJ |
| description | Abstract Objective To investigate whether persistent post-traumatic headache attributed to mild traumatic brain injury (TBI) is associated with more pronounced pericranial tenderness and lower pressure pain thresholds (PPTs) in the head and neck region, compared with healthy controls. Methods Patients with persistent post-traumatic headache (n = 100) and age- and gender-matched healthy controls (n = 100) were included between July 2018 and June 2019. Total tenderness score (TTS) was used to assess pericranial tenderness by bilateral manual palpation in eight muscles or tendon insertions. Summation was then used to calculate a TTS from 0 to 48 based on individual right- and left-sided scores; higher TTS score indicated more pronounced pericranial tenderness. PPTs were examined in m. temporalis and m. trapezius (upper and middle part) using an electronic pressure algometer that applies increasing blunt pressure at a constant rate. Results The TTS score was higher in patients with persistent post-traumatic headache (median, 21; IQR, 12–31), compared with healthy controls (median, 10; IQR, 6–17; P < .001). PPTs were lower in patients with persistent post-traumatic headache than in controls in both the left-sided m. temporalis (mean ± SD, 157.5 ± 59.9 vs. 201.1 ± 65.2; P < .001) and right-sided m. temporalis (mean ± SD, 159.5 ± 63.8 vs. 212.3 ± 61.9; P < .001). Furthermore, patients with persistent post-traumatic headache also had lower left- and right-sided PPTs in the upper as well as middle part of m. trapezius, compared with healthy controls; all P values were .05 or less. Conclusions Among patients with persistent post-traumatic headache, pericranial tenderness was more pronounced and PPTs in the head and neck region were lower than in healthy controls free of headache and mild TBI. Further research is needed to better understand the involvement of pericranial myofascial nociceptors in the disease mechanisms underlying post-traumatic headache. |
| first_indexed | 2024-04-11T22:35:49Z |
| format | Article |
| id | doaj.art-71b8e4448d6c4c42a5d97517cf10dec8 |
| institution | Directory Open Access Journal |
| issn | 1129-2369 1129-2377 |
| language | English |
| last_indexed | 2024-04-11T22:35:49Z |
| publishDate | 2022-08-01 |
| publisher | BMC |
| record_format | Article |
| series | The Journal of Headache and Pain |
| spelling | doaj.art-71b8e4448d6c4c42a5d97517cf10dec82022-12-22T03:59:13ZengBMCThe Journal of Headache and Pain1129-23691129-23772022-08-012311810.1186/s10194-022-01457-1Total tenderness score and pressure pain thresholds in persistent post-traumatic headache attributed to mild traumatic brain injuryHåkan Ashina0Haidar Muhsen Al-Khazali1Afrim Iljazi2Sait Ashina3Faisal Mohammad Amin4Henrik Winther Schytz5Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical SchoolDanish Headache Center, Department of Neurology, Rigshospitalet, Faculty of Health and Medical Sciences, University of CopenhagenDanish Headache Center, Department of Neurology, Rigshospitalet, Faculty of Health and Medical Sciences, University of CopenhagenBIDMC Comprehensive Headache Center, Departments of Neurology and Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical SchoolDanish Headache Center, Department of Neurology, Rigshospitalet, Faculty of Health and Medical Sciences, University of CopenhagenDanish Headache Center, Department of Neurology, Rigshospitalet, Faculty of Health and Medical Sciences, University of CopenhagenAbstract Objective To investigate whether persistent post-traumatic headache attributed to mild traumatic brain injury (TBI) is associated with more pronounced pericranial tenderness and lower pressure pain thresholds (PPTs) in the head and neck region, compared with healthy controls. Methods Patients with persistent post-traumatic headache (n = 100) and age- and gender-matched healthy controls (n = 100) were included between July 2018 and June 2019. Total tenderness score (TTS) was used to assess pericranial tenderness by bilateral manual palpation in eight muscles or tendon insertions. Summation was then used to calculate a TTS from 0 to 48 based on individual right- and left-sided scores; higher TTS score indicated more pronounced pericranial tenderness. PPTs were examined in m. temporalis and m. trapezius (upper and middle part) using an electronic pressure algometer that applies increasing blunt pressure at a constant rate. Results The TTS score was higher in patients with persistent post-traumatic headache (median, 21; IQR, 12–31), compared with healthy controls (median, 10; IQR, 6–17; P < .001). PPTs were lower in patients with persistent post-traumatic headache than in controls in both the left-sided m. temporalis (mean ± SD, 157.5 ± 59.9 vs. 201.1 ± 65.2; P < .001) and right-sided m. temporalis (mean ± SD, 159.5 ± 63.8 vs. 212.3 ± 61.9; P < .001). Furthermore, patients with persistent post-traumatic headache also had lower left- and right-sided PPTs in the upper as well as middle part of m. trapezius, compared with healthy controls; all P values were .05 or less. Conclusions Among patients with persistent post-traumatic headache, pericranial tenderness was more pronounced and PPTs in the head and neck region were lower than in healthy controls free of headache and mild TBI. Further research is needed to better understand the involvement of pericranial myofascial nociceptors in the disease mechanisms underlying post-traumatic headache.https://doi.org/10.1186/s10194-022-01457-1Quantitative sensory testingConcussionHead traumaPathophysiology |
| spellingShingle | Håkan Ashina Haidar Muhsen Al-Khazali Afrim Iljazi Sait Ashina Faisal Mohammad Amin Henrik Winther Schytz Total tenderness score and pressure pain thresholds in persistent post-traumatic headache attributed to mild traumatic brain injury The Journal of Headache and Pain Quantitative sensory testing Concussion Head trauma Pathophysiology |
| title | Total tenderness score and pressure pain thresholds in persistent post-traumatic headache attributed to mild traumatic brain injury |
| title_full | Total tenderness score and pressure pain thresholds in persistent post-traumatic headache attributed to mild traumatic brain injury |
| title_fullStr | Total tenderness score and pressure pain thresholds in persistent post-traumatic headache attributed to mild traumatic brain injury |
| title_full_unstemmed | Total tenderness score and pressure pain thresholds in persistent post-traumatic headache attributed to mild traumatic brain injury |
| title_short | Total tenderness score and pressure pain thresholds in persistent post-traumatic headache attributed to mild traumatic brain injury |
| title_sort | total tenderness score and pressure pain thresholds in persistent post traumatic headache attributed to mild traumatic brain injury |
| topic | Quantitative sensory testing Concussion Head trauma Pathophysiology |
| url | https://doi.org/10.1186/s10194-022-01457-1 |
| work_keys_str_mv | AT hakanashina totaltendernessscoreandpressurepainthresholdsinpersistentposttraumaticheadacheattributedtomildtraumaticbraininjury AT haidarmuhsenalkhazali totaltendernessscoreandpressurepainthresholdsinpersistentposttraumaticheadacheattributedtomildtraumaticbraininjury AT afrimiljazi totaltendernessscoreandpressurepainthresholdsinpersistentposttraumaticheadacheattributedtomildtraumaticbraininjury AT saitashina totaltendernessscoreandpressurepainthresholdsinpersistentposttraumaticheadacheattributedtomildtraumaticbraininjury AT faisalmohammadamin totaltendernessscoreandpressurepainthresholdsinpersistentposttraumaticheadacheattributedtomildtraumaticbraininjury AT henrikwintherschytz totaltendernessscoreandpressurepainthresholdsinpersistentposttraumaticheadacheattributedtomildtraumaticbraininjury |