Sex-Based Differences in Pressure Pain Thresholds of Myofascial Trigger Points in Cervical and Cranial Muscles in Tension-Type Headache: A Cross-Sectional Study

Abstract

Background: Tension-type headache (TTH) is the most prevalent primary headache. Pressure pain thresholds (PPTs) reflect the pressure pain sensitivity of the tissues. Women with TTH have showed greater pressure hypersensitivity in some muscles compared to men. The aim of this study was to compare the PPTs from myofascial trigger points in cervical and cranial muscles which might contribute to headaches between men and women with TTH. Methods: An observational and correlation cross-sectional study was performed. PPTs were evaluated bilaterally and compared between men and women in the following muscles: upper trapezius, splenius capitis and cervicis, semispinalis, rectus capitis posterior major, obliquus capitis superior and inferior, occipitofrontalis posterior and anterior, temporalis, masseter, clavicular and sternal head of sternocleidomastoid, zygomaticus major, and levator scapulae. The mean PPT was calculated as well. Results: Significant differences showing lower PPTs in women compared to men were found in the mean PPT (p = 0.000) and in all the points except in the left clavicular head of the sternocleidomastoid (p = 0.093) and in the left masseter (p = 0.069). Conclusions: Lower PPTs from myofascial trigger points in cervical and cranial muscles, which might contribute to headaches, were observed in women compared to men with TTH. The mean PPT was also lower in women than in men, suggesting the need for gender-specific approaches in the treatment of TTH.

Keywords

• tension-type headache
• dry needling
• active myofascial trigger points
• neurologic manifestations
• muscle tenderness
• referred pain