Total tenderness score and pressure pain thresholds in persistent post-traumatic headache attributed to mild traumatic brain injury

Håkan Ashina, Haidar Muhsen Al-Khazali, Afrim Iljazi, Sait Ashina, Faisal Mohammad Amin, Henrik Winther Schytz, Håkan Ashina, Haidar Muhsen Al-Khazali, Afrim Iljazi, Sait Ashina, Faisal Mohammad Amin, Henrik Winther Schytz

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.

Keywords: Concussion; Head trauma; Pathophysiology; Quantitative sensory testing.

Conflict of interest statement

The authors declared the following potential conflicts of interest with respect to the research, authorship and/or publication of this article: S.A. has been a consultant, speaker, or scientific adviser for Allergan, Amgen, Eli Lilly, Novartis, Promius, Satsuma, Supernus, and Theranica, outside of the submitted work. F.M.A. has been a consultant, speaker, or scientific adviser for Eli Lilly, Lundbeck, Novartis, and Teva, outside of the submitted work. H.W.S. has been a consultant, speaker, or scientific adviser for Novartis, Eli Lilly, Lundbeck, Abbvie, and Teva, outside of the submitted work. All other authors declare no competing interests.

© 2022. The Author(s).

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