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Myofascial Trigger Points Are Very Prevalent in Patients With Chronic Tension-type Headache: A Double-blinded Controlled Study

Couppé, Christian MSc, PT*; Torelli, Paola MD; Fuglsang-Frederiksen, Anders MD, PhD; Andersen, Kjeld Visti MD§; Jensen, Rigmor MD, PhD*

The Clinical Journal of Pain: January 2007 - Volume 23 - Issue 1 - p 23-27
doi: 10.1097/01.ajp.0000210946.34676.7d
Original Articles

Objectives Myofascial pain syndromes due to trigger points (TrPs) are clinical entities, but more evidence is needed to evaluate TrP palpation. Chronic tension-type headache (CTTH) is the most prevalent chronic headache with high socioeconomic costs. The primary aim was to study whether TrP palpation can distinguish patients with headache patients from healthy controls.

Design Double-blinded, controlled design.

Patients Twenty patients with the diagnosis of CTTH, and 20 healthy age-matched and sex-matched control participants.

Results TrP palpation revealed more TrPs in patients (N=17) versus controls (N=6) (P=0.0005). Referred pain was also more frequent in patients (N=17) versus controls (N=9) (P=0.04). Further, TrP palpation also identified a higher pain intensity than at a control point (CtP) in both groups (P=0.0001). Pain intensity at TrPs in patients was higher than in controls (P=0.0010), and CtPs were also more tender in patients than in controls (P=0.0167). For spontaneous electromyographic activity no difference between TrPs versus CtPs within or between groups could be detected.

Conclusions These findings suggest that active TrPs are much more frequent in CTTH than in controls and the number and pain intensity of TrPs may be used to distinguish between the 2 groups. Spontaneous electromyographic activity could not be demonstrated, and the underlying biology of TrPs is still unclear.

*Department of Neurology, Danish Headache Center, University of Copenhagen, Glostrup Hospital

Department of Clinical Neurophysiology, Aarhus University Hospital, Aarhus

§Department of Clinical Neurophysiology, University of Copenhagen, Glostrup Hospital, Denmark

Section of Neurology, Department of Neuroscience, Headache Center, University of Parma, Italy

C. Couppé, MSc, PT, was supported by The Danish Medical Association Research Fund and The Lundbeck Research Fund Grant.

Reprints: Rigmor Jensen, MD, PhD, Department of Neurology, Danish Headache Center, University of Copenhagen, Glostrup Hospital, Glostrup DK-2600, Denmark (e-mail:

Received for publication February 1, 2005; accepted August 1, 2006

© 2007 Lippincott Williams & Wilkins, Inc.