Features of pain syndrome in patients with episodic and chronic tension-type headache

Background. Tension-type headache (TTH) is the most common type of headache. Some studies have shown that muscle tension increases significantly with an increase in the frequency of TTH, muscle tenderness may increase during attacks of headache. It has been suggested that the continuous nociceptive contribution of peripheral myofascial structures can cause central sensitization and, possibly, chronic headache. The aim of this work was to study the peculiarities of pain syndrome in patients with episodic and chronic TTH. Materials and methods. A total of 108 patients (55 men, 53 women) diagnosed with frequent episodic tension-type headache (group I, n = 64) and chronic tension-type headache (group II, n = 44) were examined. Clinical neurological examination, palpation of the pericranial and neck muscles on both sides were carried out, with counting the number of tender pericranial muscles (NTPM) and tender neck muscles (NTNM) for each patient and their average number in the group. The subjective severity of pain was determined using visual analogue scale, McGill pain questionnaire was used to characterize the headache. Results. Data of visual analogue scale in both groups did not differ significantly, pain was moderate with a tendency to be more severe in group II. In both groups, the palpation tenderness of the pericranial and neck muscles on both sides was mainly in the range from mild to moderate, except for the trapezoid and splenius muscle of the head, where the pain was moderate to severe. In group I compared with group II, there was a significant increase in the number of NTPM and NTNM on the left side, NTPM on the right side, and no differences between NTNM in groups I and II were noted. In patients with episodic TTH, the severity of muscle tenderness decreased with age; indicators describing sensory and psycho-emotional characteristics of pain were higher, a positive correlation was found between the pericranial muscle tenderness and the severity and frequency of headaches per month. In patients with chronic TTH, a correlation was found between the severity, the average duration of headache per month, the sensory and psycho-emotional characteristics of pain, which may indicate the involvement of central and peripheral nociceptive mechanisms in the pathogenesis of chronic TTH. Conclusions. The presence of muscle tenderness, sensory and psychoemotional characteristics of pain must be taken into account when planning treatment and rehabilitation strategies that will prevent the progression and chronicity of headache, and contribute to improvement in the quality of life of patients.