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Pericranial muscle hardness in tension-type headache
A non-invasive measurement method and its clinical application

Fumihiko Sakai, Shinichiro Ebihara, Minoru Akiyama, Muneyuki Horikawa
DOI: http://dx.doi.org/10.1093/brain/118.2.523 523-531 First published online: 1 April 1995


Using a new method to measure the hardness of pericranial muscles, the role of muscle factors in tension-type headache was evaluated. In 223 normal healthy subjects, the hardness of trapezius muscles was 82±15 kPa/cm (mean±SD). The muscle hardness in women, 92±17 kPa/cm, was significantly greater than that in men, 74±14 kPa/cm (P < 0.01). Trapezius muscles were significantly harder than paraspinal posterior neck muscles measured at the level of the fifth cervical vertebra (71±13 kPa/cm; n = 26) but a significant correlation in muscle hardness did exist between these two muscle groups (r = 0.89, P < 0.001). Muscle hardness did not show a significant correlation with advancing age, blood pressure or subjective feeling of stiffness in the shoulder. A significant correlation was noted between the muscle hardness measured by the present method and the stiffness scores evaluated by manual palpation. In patients with tensiontype headache (n = 60), the hardness of trapezius muscles, 114±24 kPa/cm (mean±SD), was significantly greater than that in normal subjects (P < 0.01). Twenty-six patients (43% of the total) showed significantly high values which exceeded the mean±2 SD (113 kPa/cm) of the normal value, while the remaining patients (57%) constituted a high normal group. The hardness of posterior neck muscles measured in 27 patients (99±21 kPa/cm) was also significantly greater than that in normal subjects (P < 0.01). There was no significant difference in muscle hardness between episodic tension-type headache and chronic tension-type headache. Trapezius muscles were significantly harder in patients who had a feeling of severe or painful stiffness in their shoulder muscles than in patients whose stiffness feeling was moderate or absent. Muscle hardness was reduced in patients who displayed clinical improvement. Our data indicated that the muscle factor plays a significant role in the pathophysiological mechanism of tension-type headache which is probably multifactorial.

  • tension-type headache
  • muscle hardness
  • trapezius muscle
  • muscle relaxant

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