Skip to main content

Advertisement

SpringerLink
Log in

Central mechanisms in tension-type headaches

  • Published:
Current Pain and Headache Reports Aims and scope Submit manuscript

Abstract

Although tension-type headache is the most frequent primary headache, little is known about its pathophysiology. It is a matter of debate if the pain in tension-type headache originates from myofascial tissues or from central mechanisms in the brain. This article presents a summary of available data on the pathophysiology of tension-type headache and proposes a pathogenic model. From experimental research and clinical studies, it appears that myofascial nociception is important in episodic tension-type headache; however, central mechanisms (ie, central sensitization) are preponderant in the pathophysiology of the chronic form. Understanding the mechanisms of this central sensitization could allow for more efficient prophylactic treatments to emerge.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References and Recommended Reading

  1. Rasmussen BK, Jensen R, Schroll M, et al.: Epidemiology of headache in a general population: a prevalence study. J Clin Epidemiol 1991, 44:1147–1157.

    Article  PubMed  CAS  Google Scholar 

  2. Ad Hoc Committee on Classification of Headache: Classification of Headache. Arch Neurol 1962, 6:13–16.

    Google Scholar 

  3. Headache Classification Committee of the International Headache Society: Classification and diagnostic criteria for headache disorders, cranial, and facial pain. Cephalalgia 1998, 8:29–34.

    Google Scholar 

  4. Jensen R, Rasmussen BK, Pedersen B, et al.: Muscle tenderness and pressure pain thresholds in headache. Pain 1993, 52:193–199.

    Article  PubMed  CAS  Google Scholar 

  5. Jensen R, Rasmussen BK: Muscular disorders in tension-type headache. Cephalalgia 1996, 16:97–103.

    Article  PubMed  CAS  Google Scholar 

  6. Langemark M, Jensen K, Jensen TS, et al.: Pressure pain thresholds and thermal nociceptive thresholds in chronic tensiontype headache. Pain 1989, 38:203–210.

    Article  PubMed  CAS  Google Scholar 

  7. Bendtsen L, Jensen R, Olesen J: Decreased pain detection and tolerance thresholds in chronic tension-type headache. Arch Neurol 1996, 53:373–376.

    PubMed  CAS  Google Scholar 

  8. Bovim G: Cervicogenic headache, migraine, and tension-type headache: pressure-pain threshold measurements. Pain 1992, 51:169–173.

    Article  PubMed  CAS  Google Scholar 

  9. Jensen R, Bendtsen L, Olesen J: Muscular factors are of importance in tension-type headache. Headache 1998, 38:10–17.

    Article  PubMed  CAS  Google Scholar 

  10. Langemark M, Olesen J: Pericranial tenderness in tension headache. Cephalalgia 1987, 7:249–255.

    Article  PubMed  CAS  Google Scholar 

  11. Bendsten L, Jensen R, Jensen NK, Olesen J: Pressure-controlled palpation: a new technique which increases the reliability of manual palpation. Cephalalgia 1995, 15:205–210.

    Article  Google Scholar 

  12. Jensen R: Mechanisms of spontaneous tension-type headaches: an analysis of tenderness, pain thresholds, and EMG. Pain 1995, 64:251–256.

    Article  Google Scholar 

  13. Bendtsen L, Jensen R, Olesen J: Qualitatively altered nociception in chronic myofascial pain. Pain 1996, 65:259–264.

    Article  PubMed  CAS  Google Scholar 

  14. Bendtsen L, Nørregaard J, Jensen R, et al.: Evidence of a qualitatively altered nociception in patients with fibromyalgia. Arthritis Rheum 1997, 40:98–102.

    Article  PubMed  CAS  Google Scholar 

  15. Bendtsen L, Jensen R, Jensen NK, et al.: Muscle palpation with controlled finger pressure: new equipment for the study of tender myofascial tissues. Pain 1994, 59:235–239.

    Article  PubMed  CAS  Google Scholar 

  16. Yu XM, Mense S: Response properties and descending control of rat dorsal horn neurons with deep receptive fields. Neuroscience 1990, 39:823–831.

    Article  PubMed  CAS  Google Scholar 

  17. Wall PD: The presence of ineffective synapses and the circumstances which unmask them. Phil Trans R Soc Lond Biol 1977, 278:361–372.

    CAS  Google Scholar 

  18. Woolf CJ: Evidence for a central component of post-injury pain hypersensitivity. Nature 1983, 15:686–688.

    Article  Google Scholar 

  19. Schoenen J, Bottin D, Hardy F, et al.: Cephalic and extracephalic pressure pain thresholds in chronic tension-type headache. Pain 1991, 47:145–149.

    Article  PubMed  CAS  Google Scholar 

  20. Drummond PD: Scalp tenderness and sensitivity to pain in migraine and tension headache. Headache 1987, 27:45–50.

    Article  PubMed  CAS  Google Scholar 

  21. Petersen KL, Brennum J, Olesen J: Evaluation of pericranial myofascial nociception by pressure algometer: reproducibility and factors of variation. Cephalalgia 1992, 12:33–37.

    Article  PubMed  CAS  Google Scholar 

  22. Langemark M, Olesen J, Poulsen DL, et al.: Clinical characterization of patients with chronic tension headache. Headache 1988, 28:590–596.

    Article  PubMed  CAS  Google Scholar 

  23. Olesen J, Schoenen J: Tension-type headache, cluster headache, and miscellaneous headaches. In The Headaches. Edited by Olesen J, Tfelt-Hansen P, Welch KMA. New York: Raven Press; 1993:493–496.

    Google Scholar 

  24. Kosek E, Ekholm J, Hansson P: Sensory dysfunction in fibromyalgia patients with implications for pathogenic mechanisms. Pain 1996, 68:375–383.

    Article  PubMed  CAS  Google Scholar 

  25. Proietti-Cecchini A, Áfra J, Maertens de Noordhout A, Schoenen J: Modulation of pressure pain thresholds during isometric contraction in patients with chronic tension-type headache and/or generalized myofascial pain compared with healthy volunteers. J Neurology 1997, 48:A258.

    Google Scholar 

  26. Schulte-Mattler WJ, Wieser T, Zierz S: Treatment of tensiontype headache with botulinum toxin: a pilot study. Eur J Res 1999, 26:183–186.

    Google Scholar 

  27. Wheeler AH: Botulinum toxin A: adjunctive therapy for refractory headaches associated with pericranial muscle tension. Headache 1998, 38:468–471.

    Article  PubMed  CAS  Google Scholar 

  28. Schmitt W, Slowey E, Fravi N, et al.: Effect of botulinum toxin A injections in the treatment of chronic tension-type headache: a double-blind, placebo-controlled trial. Headache 2001, 41:658–664.

    Article  PubMed  CAS  Google Scholar 

  29. Rollnik JD, Tanneberger O, Schubert M, et al.: Treatment of tension-type headache with botulinum toxin type A: a doubleblind, placebo-controlled study. Headache 2000, 40:300–305.

    Article  PubMed  CAS  Google Scholar 

  30. Rollnik JD, Karst M, Fink M, et al.: Botulinum toxin type A and EMG: a key to the understanding of chronic tension-type headaches? Headache 2001, 41:985–989.

    Article  PubMed  CAS  Google Scholar 

  31. Godaux E, Desmedt JE: Exteroceptive suppression and motor control of the masseter and temporalis muscles in normal man. Brain Res 1975, 85:447–458.

    Article  PubMed  CAS  Google Scholar 

  32. Schoenen J, Jamart B, Gerard P, et al.: Exteroceptive suppression of temporalis muscle activity in chronic headache. Neurology 1987, 37:1834–1836.

    PubMed  CAS  Google Scholar 

  33. Schoenen J, Gerard P, De Pasqua V, et al.: Multiple clinical and paraclinical analyses of chronic tension-type headache associated or unassociated with disorder of pericranial muscles. Cephalalgia 1991, 11:135–139.

    Article  PubMed  CAS  Google Scholar 

  34. Göbel H: Schmerzmessung. In Theorie Methodik-Anwenslung bei Kopfschmerz. Stuttgart: Gustav Fischer; 1992:304.

    Google Scholar 

  35. Nakahima K, Takahashi K: Exteroceptive suppression of the masseter temporalis and trapezius muscles produced by mental nerve stimulation in patients with chronic headaches. Cephalalgia 1991, 11:23–28.

    Article  Google Scholar 

  36. Wallasch TM, Reinecke M, Langohr HD: EMG analysis of the late exteroceptive suppression period of temporal muscle activity in episodic and chronic tension-type headaches. Cephalalgia 1991, 11:109–112.

    Article  PubMed  CAS  Google Scholar 

  37. Zwart JA, Sand T: Exteroceptive suppression of temporalis muscle activity: a blind study of tension-type headache, migraine, and cervicogenic headache. Headache 1995, 35:338–343.

    Article  PubMed  CAS  Google Scholar 

  38. Lipchik GL, Holroyd KA, Talbot F, et al.: Pericranial muscle tenderness and exteroceptive suppression of temporalis muscle activity: a blind study of chronic tension-type headache. Headache 1997, 37:368–376.

    Article  PubMed  CAS  Google Scholar 

  39. Bendtsen L, Jensen R, Brennum J, et al.: Exteroceptive suppression of temporal muscle activity is normal in patients with chronic tension-type headache and not related to actual headache state. Cephalalgia 1996, 16:251–256.

    Article  PubMed  CAS  Google Scholar 

  40. Aktekin B, Yaltkaya K, Ozkaynak S, et al.: Recovery cycle of the blink reflex and exteroceptive suppression of temporalis muscle activity in migraine and tension-type headache. Headache 2001, 41:142–149.

    Article  PubMed  CAS  Google Scholar 

  41. Lipchik GL, Holroyd KA, O’Donnell FJ, et al.: Exteroceptive suppression periods and pericranial muscle tenderness in chronic tension-type headache: effects of psychopathology, chronicity, and disability. Cephalalgia 2000, 20:638–646.

    Article  PubMed  CAS  Google Scholar 

  42. Schoenen J, Sianard-Gaiko J, Raubüschl O: Serotonin and temporalis exteroceptive silent periods. In 5-Hydroxytryptamine Mechanisms in Primary Headaches. Edited by Olesen J, Saxena PR. New York: Raven Press; 1992:91–97.

    Google Scholar 

  43. Bendtsen L, Jensen R, Olesen J: Amitriptyline, a combined serotonin and noradrenalin re-uptake inhibitor, reduces exteroceptive suppression of temporal muscle activity in patients with chronic tension-type headache. Electroencephalogr Clin Neurophysiol 1996, 101:418–422.

    PubMed  CAS  Google Scholar 

  44. Göbel H, Hamouz V, Hansen C, et al.: Chronic tension-type headache: amitriptyline reduces clinical headache-duration and experimental pain sensitivity but does not alter pericranial muscle activity readings. Pain 1994, 59:241–249.

    Article  PubMed  Google Scholar 

  45. Schoenen J: Exteroceptive suppression of temporalis muscle activity in patients with chronic headache and in normal volunteers: methodology, clinical and pathophysiologic relevance. Headache 1993, 33:3–17.

    Article  PubMed  CAS  Google Scholar 

  46. Schoenen J, Lenaerts M, Gérard P: Inhibition of temporal second exteroceptive suppression produced by single or longlasting electrical stimuli and noxious thermal stimuli in peripheral limbs: effects of Naloxone. In Tension-type Headache: Classification, Mechanisms, and Treatment. Edited by Olesen J, Schoenen J. New York: Raven Press; 1993:181–185.

    Google Scholar 

  47. Bendtsen L, Jensen R, Brennum J, et al.: Exteroceptive suppression periods in jaw-closing muscles. Variability and relation to experimental pain and sustained muscle contraction. Cephalalgia 1993, 13:184–191.

    Article  PubMed  CAS  Google Scholar 

  48. Schoenen J, Bendtsen L: Neurophysiology of tension-type headache. In The Headaches. Edited by Olesen J, Tfelt-Hansen P, Welch KMA. Philadelphia: Lippincott Williams & Wilkins; 2000:579–587.

    Google Scholar 

  49. Sand T, Zwart JA: The blink reflex in chronic tension-type headache migraine and cervicogenic headache. Cephalalgia 1994, 14:447–450.

    Article  PubMed  CAS  Google Scholar 

  50. McCall RB, Aghajanian GK: Serotoninergic facilitation of facial motorneuron excitation. Brain Res 1979, 169:11–27.

    Article  PubMed  CAS  Google Scholar 

  51. Cruccu G, Pauletti R, Agostino R, et al.: Masseter inhibitory reflex in movement disorders: Huntington’s chorea, Parkinson’s disease, dystonia, and unilateral masticatory spasm. Electroencephalogr Clin Neurophysiol 1991, 81:24–30.

    Article  PubMed  CAS  Google Scholar 

  52. Puca F, de Tommaso M: Clinical neurophysiology in childhood headache. Cephalalgia 1999, 19:137–146.

    Article  PubMed  CAS  Google Scholar 

  53. Ellrich J, Katsarava Z, Przywara S, Kaube H: Is the R3 component of the human blink reflex nociceptive in origin? Pain 2001, 91:389–395.

    Article  PubMed  CAS  Google Scholar 

  54. Kaube H, Katsarava Z, Käufer T, et al.: A new method to increase nociception specificity of the human blink reflex. Clin Neurophysiol 2000, 111:413–416.

    Article  PubMed  CAS  Google Scholar 

  55. Willer JC, Roby A, Gerard A, et al.: Electrophysiologic evidence for a possible serotoninergic involvement in some endogenous opiate activity in humans. Eur J Pharmacol 1982, 78:117–120.

    Article  PubMed  CAS  Google Scholar 

  56. Willer JC: Nociceptive flexion reflexes as a tool for pain research in man. In Motor Control Mechanisms in Health and Disease. Edited by Desmedt JE. New York: Raven Press; 1983:809–827.

    Google Scholar 

  57. Langemark M, Bach FW, Jensen TS, et al.: Decreased nociceptive flexion reflex threshold in chronic tension-type headache. Arch Neurol 1993, 50:1061–1064.

    PubMed  CAS  Google Scholar 

  58. Garthwaite J, Boulton CL: Nitric oxide signaling in the central nervous system [Review]. Annu Rev Physiol 1995, 57:683–706.

    Article  PubMed  CAS  Google Scholar 

  59. Aley KO, McCarter G, Levine JD: Nitric oxide signaling in pain and nociceptor sensitization in the rat. J Neurosci 1998, 18:7008–7014.

    PubMed  CAS  Google Scholar 

  60. Ashina M, Bendtsen L, Jensen R, et al.: Nitric oxide-induced headache in patients with chronic tension-type headache. Brain 2000, 1123:1830–1837.

    Article  Google Scholar 

  61. Storer RJ, Goadsby PJ: Trigeminovascular nociceptive transmission involves N-methyl-D-aspartate and non-N-methyl-D-aspartate glutamate receptors. Neuroscience 1999, 90:1371–1376.

    Article  PubMed  CAS  Google Scholar 

  62. Mao J, Price DD, Zhu J, et al.: The inhibition of nitric oxideactivated poly (ADP-ribose) synthetase attenuates transynaptic alteration of spinal cord dorsal horn neurons and neuropathic pain in the rat. Pain 1997, 72:355–366.

    Article  PubMed  CAS  Google Scholar 

  63. Ashina M, Bendtsen L, Jensen R, et al.: Possible mechanisms of action of nitric oxide synthase inhibitors in chronic tensiontype headache. Brain 1999, 122:1629–1635. A nice study that demonstrates the important role of nitric oxide in tension-type headache. It opened a new avenue for research, and suggested that central sensitization can be modulated by treatment with nitric oxide synthase inhibitors.

    Article  PubMed  Google Scholar 

  64. Ashina M, Lassen LH, Bendtsen L, et al.: Effect of inhibition of nitric oxide synthase on chronic tension-type headache. Lancet 1999, 353:287–289.

    Article  PubMed  CAS  Google Scholar 

  65. Ashina M, Bendtsen L, Jensen R, et al.: Plasma levels of calcitonin gene-related peptide in chronic tension-type headache. Cephalalgia 2000, 20(63):292.

    Google Scholar 

  66. Woolf CJ, Doubell TP: The pathophysiology of chronic painincreased sensitivity to low threshold a beta-fiber inputs. Curr Opin Neurobiol 1994, 4:525–534.

    Article  PubMed  CAS  Google Scholar 

  67. Coderre TJ, Katz J, Vaccarino AL, et al.: Contribution of central neuroplasticity to pathological pain: review of clinical and experimental evidence. Pain 1993, 52:259–285.

    Article  PubMed  CAS  Google Scholar 

  68. Woolf CJ, Thompson SW: The induction and maintenance of central sensitization is dependent on N-methyl-D-aspartic acid receptor activation; implications for the treatment of postinjury pain hypersensitivity states. Pain 1991, 44:293–299.

    Article  PubMed  CAS  Google Scholar 

  69. Bendtsen L: Central sensitization in tension-type headache: possible pathophysiologic mechanisms. Cephalalgia 2000, 20:486–508. A good review of the pathophysiology of tension-type headache, concluding that the main problem in chronic tension-type headache is central sensitization that results from prolonged nociceptive inputs from pericranial myofascial tissues. This mechanism is of major importance for the conversion of episodic into chronic tension-type headache.

    Article  PubMed  CAS  Google Scholar 

  70. Nakano T, Shimomura T, Takahashi K, et al.: Platelet substance P and 5-hydroxytryptamine in migraine and tension-type headache. Headache 1993, 33:528–532.

    Article  PubMed  CAS  Google Scholar 

  71. Mazzotta G, Sarchielli P, Gaggioli A, et al.: Study of pressure pain and cellular concentration of neurotransmitters related to nociception in episodic tension-type headache patients. Headache 1997, 37:565–571.

    Article  PubMed  CAS  Google Scholar 

  72. Ashina M, Bendtsen L, Jensen R, et al.: Plasma levels of substance P, neuropeptide Y, and vasoactive intestinal polypeptide in patients with chronic tension-type headache. Pain 1999, 83:541–547.

    Article  PubMed  CAS  Google Scholar 

  73. Sacerdote P, Rubboli F, Locatelli L, et al.: Pharmacologic modulation of neuropeptides in peripheral mononuclear cells. J Neuroimmunol 1991, 32:35–41.

    Article  PubMed  CAS  Google Scholar 

  74. Schoenen J: Exteroceptive suppression of temporalis muscle activity: methodologic and physiologic aspects. Cephalalgia 1993, 13:3–10.

    Article  PubMed  CAS  Google Scholar 

  75. Bendtsen L, Jensen R, Hindberg I, et al.: Serotonin metabolism in chronic tension-type headache. Cephalalgia 1997, 17:843–848.

    Article  PubMed  CAS  Google Scholar 

  76. Shimomura T, Takahashi K: Alteration of platelet serotonin in patient with chronic tension-type headache during cold pressor test. Headache 1990, 30:581–583.

    Article  PubMed  CAS  Google Scholar 

  77. Shulka R, Shanker K, Nag D, et al.: Serotonin in tension headache. J Neurol Neurosurg Psychiatry 1987, 50:1682–1684.

    Article  Google Scholar 

  78. Leira R, Castillo J, Martinez F, et al.: Platelet rich plasma serotonin levels in tension-type headache and depression. Cephalalgia 1993, 13:346–348.

    Article  PubMed  CAS  Google Scholar 

  79. Jensen R, Hindberg I: Plasma serotonin increase during episodes of tension-type headache. Cephalalgia 1994, 14:219–222.

    Article  PubMed  CAS  Google Scholar 

  80. Langemark M, Bach FW, Ekman R, et al.: Increased cerebrospinal fluid met-enkephalin immunoreactivity in patients with chronic tension-type headache. Pain 1995, 63:103–107.

    Article  PubMed  CAS  Google Scholar 

  81. Bach F, Langemark M, Secher NH, et al.: Plasma and cerebrospinal fluid b-endorphin in chronic tension-type headache. Pain 1992, 51:163–168.

    Article  PubMed  CAS  Google Scholar 

  82. Bendtsen L, Jensen R: Amitriptyline reduces myofascial tenderness in patients with chronic tension-type headache. Cephalalgia 2000, 20:603–610.

    Article  PubMed  CAS  Google Scholar 

  83. Eisenach JC, Gebhart GF: Intrathecal amitriptyline acts as an N-methyl-D-aspartate receptor antagonist in the presence of inflammatory hyperalgesia in rats. Anesthesiology 1995, 83:1046–1054.

    Article  PubMed  CAS  Google Scholar 

  84. Su X, Gebhart GF: Effects of tricyclic antidepressants on mechanosensitive pelvic nerve afferent fibers innervating the rat colon. Pain 1998, 76:105–114.

    Article  PubMed  CAS  Google Scholar 

  85. Di Piero V, Bruti G, Venturi P, et al.: Aminergic tone correlates of migraine and tension-type headache: a study using the tridimensional personality questionnaire. Headache 2001, 41:63–71.

    Article  PubMed  Google Scholar 

  86. Langemark M, Olesen J: Sulpiride and paroxetine in the treatment of chronic tension-type headache: an explanatory double-blind trial. Headache 1994, 34:20–24.

    Article  PubMed  CAS  Google Scholar 

  87. Olesen J: Clinical and pathophysiologic observations in migraine and tension-type headache explained by integration of vascular, supraspinal, and myofascial inputs. Pain 1991, 46:125–132.

    Article  PubMed  CAS  Google Scholar 

  88. Russell MB, Ostergaard S, Bendtsen, et al.: Familial occurrence of chronic tension-type headache. Cephalalgia 1999, 19:207–210.

    Article  PubMed  CAS  Google Scholar 

  89. Lamour Y, Guilbaud G, Willer JC: Altered properties and laminar distribution of neuronal responses to peripheral stimulation in the SmI cortex of the arthritic rat. Brain Res 1983, 22:183–187.

    Article  Google Scholar 

  90. Wall PD, Devor M: The Effect of peripheral nerve injury on dorsal root potentials and on transmission of afferent signals into the spinal cord. Brain Res 1981, 23:95–111.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. University Department of Neurology, CHR de la Citadelle, Boulevard du XIIème de ligne 1, 4000, Liège, Belgium

    M. Vandenheede MD & Jean Schoenen MD, PhD

Authors
  1. M. Vandenheede MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jean Schoenen MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Vandenheede, M., Schoenen, J. Central mechanisms in tension-type headaches. Current Science Inc 6, 392–400 (2002). https://doi.org/10.1007/s11916-002-0082-x

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11916-002-0082-x

Keywords

Search

Navigation