Trigger Points in the Suboccipital Muscles and Forward Head Posture in Tension-Type Headache
César Fernández-de-las-Peñas, PT; Cristina Alonso-Blanco, PT;
Maria Luz Cuadrado, MD, PhD; Robert D. Gerwin, MD; Juan A. Pareja, MD, PhD
Department of Physical Therapy,
University Rey Juan Carlos,
Madrid, Spain
Objective: To assess the presence of trigger points (TrPs) in the suboccipital muscles and forward head posture (FHP) in subjects with chronic tension-type headache (CTTH) and in healthy subjects, and to evaluate the relationship of TrPs and FHP with headache intensity, duration, and frequency.
Background: Tension-type headache (TTH) is a prototypical headache in which myofascial TrPs in the cervical and pericranial musculature can play an important role.
Design: A blinded, controlled pilot study.
Methods: Twenty CTTH subjects and 20 matched controls without headache participated. TrPs were identified by eliciting referred pain with palpation, and increased referred pain with muscle contraction. Side-view pictures of each subject were taken in sitting and standing positions, in order to assess FHP by measuring the craniovertebral angle. Both measures were taken by a blinded assessor. A headache diary was kept for 4 weeks in order to assess headache intensity, frequency, and duration.
Results: Sixty-five percent (13/20) CTTH subjects showed active TrPs and 35% (7/20) had latent TrPs in the suboccipital muscles. Six (30%) controls also had latent TrPs. Differences in the presence of suboccipital muscle TrPs between both the groups were significant for active TrPs (P< .001) but not for latent TrPs (P> .5). CTTH subjects with active TrPs reported a greater headache intensity and frequency than those with latent TrPs (P< .05). The degree of FHP was greater in CTTH subjects than in controls in both sitting and standing positions (P< .01). Within the CTTH group, there was a negative correlation between the craniovertebral angle and the frequency of headache (rs=-0.6, P< .01, in sitting position; rs=-0.5, P< .05, in standing position). CTTH subjects with active TrPs had a greater FHP than those with latent TrPs, though this difference was not significant.
Conclusions: Suboccipital active TrPs and FHP were associated with CTTH. CCTH subjects with active TrPs reported a greater headache intensity and frequency than those with latent TrPs. The degree of FHP correlated positively with headache duration, headache frequency, and the presence of suboccipital active TrPs.
