Tension-Type Headache: AKA: Tension Headache, Muscle Contraction Headache, Psychomyogenic Headache, Stress Headache, Ordinary Headache, Essential Headache, Idiopathic Headache and Psychogenic Headache.

Tension-Type Headaches are extremely common affecting the majority of the public at some time during their lifetime.  It is commonly associated with Stress or more accurately how patients react to stressful periods. 

There is often considerable cross over between Tension-Type headaches and Medication Overuse Headache.

Tension-Type Headaches can be mild, moderate or severe to very severe and frequently patients refer to them as "my Migraine".  Migraine in Children are often misdiagnosed Tension Type Headaches associated with Myofascial Trigger Points.  Because Migraine pathogenesis is also not well understood there is a great deal of crossover diagnosis.  

This recent study; Eur J Pain. 2018 Feb;22(2):385-392. doi: 10.1002/ejp.1127. Epub 2017 Sep 26.  "CHILDREN WITH MIGRAINE:  PROVOCATION VIA PRESSURE TO MYOFASCIAL TRIGGER POINTS IN THE TRAPZIUS MUSCLE?"  is an excellent example of research which confuses or fails to clarify migraine and tension-type headaches.  The article is excellent looking at headaches from triggerpoints in the Trapezius muscle.  (abstract below at ent of post)

To understand Tension-Type Headaches I believe it  is extremely important to understand and know all of the referral patterns identifies in MPD or Myofascial Pain.  Any physician or dentist is compromised in their quality of care without this knowledge and is likely to  prescribe excessive or inappropriate medications.  

 I believe it is impossible to make a proper diagnosis in many patients until both  active and latent  trigger points have been identified and managed.  This is an essential step in the differential diagnosis and should be completed prior to medication prescriptions for triptans and other medications.

The website www.TriggerPoints.net is an excellent resource for patients and physicians dealing with Tension-Type Headaches and Migraines.  It is taken from the testbook "Myofascial Pain and Dysfunction: A Trigger Point Manual"  

I recommend that my patients buy this book to better understand their pain patterns, how they can prevent myofascial trigger points from forming and how they can improve the pain from these trigger points. 

The precise mechanisms of Tension-type headaches are not well understood.  There are many discussions that differentiate central and peripheral mechanisms.

The first known fact about Tension Headaches (and Migraines) is that they are primarily disorders of the Trigeminal Nervous System and the Trigeminal Vascular System.

There is also no question that the autonomic nervous system plays an enormous role especially the Sympathetic nervous system and the balance between the sympathetic and parasympathetic nervous system.  

Chronic Tension Type Headaches are a serious condition that can severely decrease quality of life and cause considerable disability.  

All patients with Tension-Type headaches of a severe or chronic nature should have the effects of the autonomic nervous system evaluated as part of the diagnostic work-up with a minimally invasive Diagnostic Sphenopalatine (Pterygopalatine) Ganglion Block.   https://www.sphenopalatineganglionblocks.com/managing-chronic-headaches-spg-block-sphenopalatine-ganglion-block/

The use of self-administered Sphenopalatine Ganglion (SPG) Blocks can often have almost immediate relief of even severe pain and sometimes spontaneous remission of the underlying headache with repeated use.

These blocks reset the autonomic nervous system and help with stress response (sympathetic) turning off "Fight or Flight Reflex" and turn on the Parasympathetic Reflex ie "Feed and Breed or Eat and Digest Reflex"

There is an incredible histor of pain relief including a 1930 scientific article by Hiram Byrd on "Sphenopalatine Phenomena" and a 1986 popular book "Miracles on Park Avenue" documenting the practice of Dr Milton Reder who exclusively utilized SPG Blocks to treat patients varied types of pain.

Dr Ho published an extensive review Sphenopalatine Ganglion Blocks and Modulation in a 2017 paper.  https://www.sphenopalatineganglionblocks.com/sphenopalatine-ganglion-block-radiofrequency-ablation-neurostimulation-systematic-review/

The concept of Neuromodulation is extremely important because it helps explain the amazing successes of neuromuscular dentistry in treating and eliminating headaches and migraines.  A basic concept in Neuromuscular Dentistry is utilizing the Myomonitor to relax muslces inervated by Trigeminal and facial nerves to find neuromuscular rest and occlusion which serves to give a healthy reset to the trigeminal nervous system as a patient functions and swallows.

The Myomonitor also acts as a Neuromodulation device of the Sphenopalatine Ganglion.  There is an incredible 50 year safety record of Sphenopalatine Stimulation with the Myomonitor when used by Neuromuscular Dentists.

Understanding how these processes work is important.  It is also important to hear patients stories.  This is a link to over 100 patient videos who have been treated with Neuromuscular Dentistry and SPG Blocks for Tension-Type Headaches, Migraines, TMJ disorders, Myofascial Pain and referred headaches and related sleep disorders.

https://www.youtube.com/channel/UCk9Bfz6pklC7_UluWFHzLrg/videos

PubMed Abstract

Eur J Pain. 2018 Feb;22(2):385-392. doi: 10.1002/ejp.1127. Epub 2017 Sep 26.

Children with migraine: Provocation of headache via pressure to myofascialtrigger points in the trapezius muscle? - A prospective controlled observational study.

Landgraf MN1,2, Biebl JT1,2, Langhagen T1,2, Hannibal I1,2, Eggert T2,3, Vill K1, Gerstl L1, Albers L4, von Kries R4, Straube A2,3, Heinen F1,2.

Author information

Abstract

BACKGROUND:

The objective was to evaluate a supposed clinical interdependency of myofascial trigger points and migraine in children. Such interdependency would support an interaction of spinal and trigeminal afferences in the trigemino-cervical complex as a contributing factor in migraine.

METHODS:

Children ≤18 years with the confirmed diagnosis of migraine were prospectively investigated. Comprehensive data on medical history, clinical neurological and psychological status were gathered. Trigger points in the trapezius muscle were identified by palpation and the threshold of pressure pain at these points was measured. Manual pressure was applied to the trigger points, and the occurrence and duration of induced headache were recorded. At a second consultation (4 weeks after the first), manual pressure with the detected pressure threshold was applied to non-trigger points within the same trapezius muscle (control). Headache and related parameters were again recorded and compared to the results of the first consultation.

RESULTS:

A total of 13 girls and 13 boys with migraine and a median age of 14.5 (Range 6.3-17.8) years took part in the study. Manual pressure to trigger points in the trapezius muscle led to lasting headache after termination of the manual pressure in 13 patients while no patient experienced headache when manual pressure was applied to non-trigger points at the control visit (p < 0.001). Headache was induced significantly more often in children ≥12 years and those with internalizing behavioural disorder.

CONCLUSION:

We found an association between trapezius muscle myofascial trigger points and migraine, which might underline the concept of the trigemino-cervical complex, especially in adolescents.

SIGNIFICANCE:

In children with migraine headache can often be induced by pressure to myofascial trigger points, but not by pressure to non-trigger points in the trapezius muscle. This supports the hypothesis of a trigemino-cervical-complex in the pathophysiology of migraine, which might have implications for innovative therapies in children with migraine.

© 2017 European Pain Federation - EFIC®.

PMID:

 

28952174

 

DOI:

 

10.1002/ejp.1127

Myofascial Pain Syndrome: MPS. A New Nomenclature for Myofascial Pain and Dysfunction: MPD

Myofascial Pain Syndrome: MPS

Relief of chronic Myofascial Pain and Dysfunction at www.ThinkBetterLife.com

Myofascial Pain Syndrome is a ewer term than Myofascial Pain and Dysfunction. It specifically takes Dysfunction out of the disorder which is a major mistake. Myofascial Pain is a disuse / misuse syndrome and is always a type of repetitive strain disorder.

TMJ Disorders, TMD,, Craniofacial Pain, Tension Headaches, Migraines,Cervicalgia and almost all chronic head and neck pain is directly related to Myofascial Pain and Dysfunction, MPD, MPS, Myofascial Pain Syndrome.  

Amazing Videos of Pain Relief from Migraines, TMJ, TMD, MPD, MPS, Fibromyalgia, Myofascial Pain Syndrome and Myofacial Pain and Dydfunction.

https://www.youtube.com/channel/UCk9Bfz6pklC7_UluWFHzLrg

Visit Dr Shapira's website to learn more and schedule an appointment.
www.ThinkBetterLife.com

 This type of change is designed to allow drug therapy instead of addressing underlying issues. It is part of an unfortunate swing in medicine to avoid cause and effect, corrrective actions, physical therapy, exercise, manual therapy and instead look at treatment with pharmaceuticals

90-95% of all pain is Myofascial Pain or pain coming from muscles and fascia. Dr Janet Travell wrote the book Myofascial Pain and Dysfunction: A Trigger Point Manual.

This youtube video is of a Fibromyalgia patient condemned by medicine to a life of constant pain. This diagnosis is faulty to say the least.
https://www.youtube.com/watch?v=A5xUFtuZe_Y
This patient has "Recovered" from fibromyalgia or never had fibromyalgia or the definition and signs and symptoms of fibromyalgia are a faulty system of diagnosis leading to faulty treatment.

Myofascial pain results from injury and chronic misuse of muscles. Repetiitive strain injury is the primary cause of SPG. Dysfunction or improper function is an essential issue in understanding these problems.

Myofascial pain is often mispronounced as Myofacial pain.

Fibromyalgia is a questionable diagnosis. How chronic MPD and Fibromyalgia are related is hotly contested. MPD patients recover and Fibromyalgia patients do not. Fibromyalgia can best be treated as systemic MPD but treating with the medical model leads to the medication model. This is a model that says recovery is not possible. I suggest treating all patients with a goal of complete remission initially. Treatment designed to promote healthy physiology is always better than treatment with medication to cover up symptoms.

Myofascial pain and Dysfunction (MPD) is a common, painful disorder that is responsible for many, if not the majority of pain clinic visits. MPD can affect any skeletal muscles in the body. Skeletal muscle accounts for approximately 50% of body weight, and there are approximately 400 muscles in the body. MP is responsible for many cases of chronic musculoskeletal pain and the diagnosis is commonly missed.

Mayo Clinic says about MPD "Myofascial pain syndrome is a chronic pain disorder. In myofascial pain syndrome, pressure on sensitive points in your muscles (trigger points) causes pain in seemingly unrelated parts of your body. This is called referred pain from muscle trigger points.."

Mayo clinic's description is actually and over-simplification. It is a result of distorted function that leads to formation of taut bands within the muscles. These are mediated through muscle spindles. The trigger points are areas of low EMG located in the taut band capable of causing pain referral to distant sites.

The term "Myofascial pain syndrome" leaves out the idea of Dysfunction. It is easy to move to medical management of functional problems when the dysfunction is discounted. MPD Typically occurs after a muscle has been contracted repetitively in an awkward manner. This can be caused by repetitive motions used in jobs or hobbies or by stress-related muscle tension. Tere is an enormous difference between healthy and unhealthy repetitive motions.

While nearly everyone has experienced muscle tension pain, the discomfort associated with myofascial pain and dysfunction syndrome persists or worsens over time if underlying issues are not corrected.. Treatment options for myofascial pain syndrome include physical therapy and trigger point injections. Pain medications and relaxation techniques also can help.

When patients also have TMJ disorders function becomes paramount.

MP can cause local or referred pain, tightness, tenderness, popping and clicking, stiffness and limitation of movement, autonomic phenomena, local twitch response (LTR) in the affected muscle, and muscle weakness without atrophy. Trigger points (TrPs), which cause referred pain in characteristic areas for specific muscles, restricted range of motion (ROM), and a visible or palpable LTR to local stimulation, are classic signs of MP. Over 70% of TrPs correspond to acupuncture points used to treat pain.[1]

An active TrP is an area that refers pain to a remote area in a defined pattern when local stimulation is applied. Satellite TrPs appear in response to a primary, active TrP and usually disappear after the primary TrP has been inactivated. Latent TrPs cause stiffness and limitation of ROM but no pain. Frequently, they are found in asymptomatic individuals.

Although MP and fibromyalgia have some overlapping features, they are separate entities; fibromyalgia is a widespread pain problem, not a regional condition caused by specific TrPs.

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