Skip to main content

Brain Excitability in Tension-Type Headache: a Separate Entity from Migraine?

Current Pain and Headache Reports volume 24, Article number: 82 (2020) Cite this article

Abstract

Purpose of Review

Tension-type headache is often regarded as the “normal” headache due to its high prevalence and mild disability in contrast with migraine. Clinically, both headaches are common comorbidities to each other. To date there has been many studies linked migraine to a brain excitability disorder. This review summarized earlier studies on brain excitability of TTH and discuss if TTH is a separate clinical entity from migraine as suggested by the diagnostic criteria.

Recent Findings

A recent magnetoencephalographic study from our group enrolled patients with “strict-criteria” TTH (i.e., absence of any migraine characteristics and associated symptoms) to compare the somatosensory excitability with patients with migraine and controls. This study provided evidence that TTH and migraine differ in excitability profiles and the measurement of preactivation excitability was able to discriminate TTH from migraine.

Summary

Earlier studies on brain excitability of TTH yielded negative findings or a common change shared with migraine. Future studies using strict diagnostic criteria to avoid the unwanted interference from migraine comorbidity may help decipher the “true” pathophysiology of TTH, which may pave the way to a TTH-specific brain signature and treatment.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

43,34 €

Price includes VAT (Finland)
Tax calculation will be finalised during checkout.

Fig. 1

References

Papers of particular interest, published recently, have been highlighted as: •• Of major importance

  1. Global, regional, and national burden of migraine and tension-type headache, 1990–2016: A systematic analysis for the global burden of disease study 2016. Lancet Neurol. 2018;17(11):954–76.

  2. Headache Classification Committee of the International Headache Society (IHS). The International Classification of Headache Disorders, 3rd edition. Cephalalgia. 2018;38(1):1–211.

    Google Scholar 

  3. Jensen RH. Tension-Type Headache - The Normal and Most Prevalent Headache. Headache. 2018;58(2):339–45.

  4. •• Yu S, Han X. Update of chronic tension-type headache. Curr Pain Headache Rep. 2015;19(1):469 This intensive review summaries the update knowledge on CTTH regarding pathogenesis and therapeutic strategies.

  5. Kaniecki RG. Tension-type headache. Continuum (Minneap Minn). 2012;18(4):823–34.

    Google Scholar 

  6. •• Lai TH, et al. Neural plasticity in common forms of chronic headaches. Neural Plast. 2015;2015:205985 This review provides a narrative overview of the neural plasticity associated with the most common forms of chronic headaches including TTH and migraine.

    PubMed  PubMed Central  Google Scholar 

  7. Rossi P, Vollono C, Valeriani M, Sandrini G. The contribution of clinical neurophysiology to the comprehension of the tension-type headache mechanisms. Clin Neurophysiol. 2011;122(6):1075–85.

    PubMed  Google Scholar 

  8. Sohn JH, Choi HC, Jun AY. Differential patterns of muscle modification in women with episodic and chronic tension-type headache revealed using surface electromyographic analysis. J Electromyogr Kinesiol. 2013;23(1):110–7.

    PubMed  Google Scholar 

  9. Schmidt-Wilcke T, Leinisch E, Straube A, Kämpfe N, Draganski B, Diener HC, et al. Gray matter decrease in patients with chronic tension type headache. Neurology. 2005;65(9):1483–6.

    CAS  PubMed  Google Scholar 

  10. Chen WT, Chou KH, Lee PL, Hsiao FJ, Niddam DM, Lai KL, et al. Comparison of gray matter volume between migraine and “strict-criteria” tension-type headache. J Headache Pain. 2018;19(1):4.

    PubMed  PubMed Central  Google Scholar 

  11. Sandrini G, Proietti Cecchini A, Milanov I, Tassorelli C, Buzzi MG, Nappi G. Electrophysiological evidence for trigeminal neuron sensitization in patients with migraine. Neurosci Lett. 2002;317(3):135–8.

    CAS  PubMed  Google Scholar 

  12. Shahani BT, Young RR. Human orbicularis oculi reflexes. Neurology. 1972;22(2):149–54.

    CAS  PubMed  Google Scholar 

  13. Ellrich J, Hopf HC. The R3 component of the blink reflex: normative data and application in spinal lesions. Electroencephalogr Clin Neurophysiol. 1996;101(4):349–54.

    CAS  PubMed  Google Scholar 

  14. Rossi B, Risaliti R, Rossi A. The R3 component of the blink reflex in man: a reflex response induced by activation of high threshold cutaneous afferents. Electroencephalogr Clin Neurophysiol. 1989;73(4):334–40.

    CAS  PubMed  Google Scholar 

  15. Aktekin B, Yaltkaya K, Ozkaynak S, Oguz Y. Recovery cycle of the blink reflex and exteroceptive suppression of temporalis muscle activity in migraine and tension-type headache. Headache. 2001;41(2):142–9.

    CAS  PubMed  Google Scholar 

  16. Avramidis T, Bougea A, Hadjigeorgiou G, Thomaides T, Papadimitriou A. Blink reflex habituation in migraine and chronic tension-type headache. Neurol Sci. 2017;38(6):993–8.

    PubMed  Google Scholar 

  17. Avramidis TG, Podikoglou DG, Anastasopoulos IE, Koutroumanidis MA, Papadimitriou AL. Blink reflex in migraine and tension-type headache. Headache. 1998;38(9):691–6.

    CAS  PubMed  Google Scholar 

  18. Sand T, Zwart JA. The blink reflex in chronic tension-type headache, migraine, and cervicogenic headache. Cephalalgia. 1994;14(6):447–50 discussion 394-5.

    CAS  PubMed  Google Scholar 

  19. Sand T, Moll-Nilsen B, Zwart JA. Blink reflex R2 amplitudes in cervicogenic headache, chronic tension-type headache and migraine. Cephalalgia. 2006;26(10):1186–91.

    CAS  PubMed  Google Scholar 

  20. Peddireddy A, Wang K, Svensson P, Arendt-Nielsen L. Blink reflexes in chronic tension-type headache patients and healthy controls. Clin Neurophysiol. 2009;120(9):1711–6.

    PubMed  Google Scholar 

  21. Filatova E, Latysheva N, Kurenkov A. Evidence of persistent central sensitization in chronic headaches: a multi-method study. J Headache Pain. 2008;9(5):295–300.

    PubMed  PubMed Central  Google Scholar 

  22. Milanov I, Bogdanova D. Trigemino-cervical reflex in patients with headache. Cephalalgia. 2003;23(1):35–8.

    CAS  PubMed  Google Scholar 

  23. Nardone R, Tezzon F. The trigemino-cervical reflex in tension-type headache. Eur J Neurol. 2003;10(3):307–12.

    CAS  PubMed  Google Scholar 

  24. de Tommaso M, et al. Photic driving response in primary headache: diagnostic value tested by discriminant analysis and artificial neural network classifiers. Ital J Neurol Sci. 1999;20(1):23–8.

    PubMed  Google Scholar 

  25. Sandrini G, Friberg L, Janig W, Jensen R, Russell D, Sanchez del Rio M, et al. Neurophysiological tests and neuroimaging procedures in non-acute headache: guidelines and recommendations. Eur J Neurol. 2004;11(4):217–24.

    CAS  PubMed  Google Scholar 

  26. Ramirez-Segura R, et al. Visual evoked potentials in children with tension headaches and migraine. Rev Neurol. 1999;29(11):1017–9.

    CAS  PubMed  Google Scholar 

  27. Unay B, Ulas UH, Karaoglu B, Eroglu E, Akin R, Gokcay E. Visual and brainstem auditory evoked potentials in children with headache. Pediatr Int. 2008;50(5):620–3.

    PubMed  Google Scholar 

  28. de Tommaso M, Sciruicchio V, Guido M, Sasanelli G, Puca F. Steady-state visual-evoked potentials in headache: diagnostic value in migraine and tension-type headache patients. Cephalalgia. 1999;19(1):23–6 discussion 1.

    PubMed  Google Scholar 

  29. Wang W, Wang GP, Ding XL, Wang YH. Personality and response to repeated visual stimulation in migraine and tension-type headaches. Cephalalgia. 1999;19(8):718–24 discussion 697-8.

    CAS  PubMed  Google Scholar 

  30. Coppola G, Pierelli F, Schoenen J. Habituation and migraine. Neurobiol Learn Mem. 2009;92(2):249–59.

    PubMed  Google Scholar 

  31. Garcia-Larrea L, Frot M, Valeriani M. Brain generators of laser-evoked potentials: from dipoles to functional significance. Neurophysiol Clin. 2003;33(6):279–92.

    CAS  PubMed  Google Scholar 

  32. de Tommaso M, Libro G, Guido M, Sciruicchio V, Losito L, Puca F. Heat pain thresholds and cerebral event-related potentials following painful CO2 laser stimulation in chronic tension-type headache. Pain. 2003;104(1–2):111–9.

    PubMed  Google Scholar 

  33. Valeriani M, de Tommaso M, Restuccia D, le Pera D, Guido M, Iannetti DG, et al. Reduced habituation to experimental pain in migraine patients: a CO(2) laser evoked potential study. Pain. 2003;105(1–2):57–64.

    CAS  PubMed  Google Scholar 

  34. de Tommaso M, Shevel E, Pecoraro C, Sardaro M, Losito L, Lamberti P, et al. Topographic analysis of laser evoked potentials in chronic tension-type headache: correlations with clinical features. Int J Psychophysiol. 2006;62(1):38–45.

    PubMed  Google Scholar 

  35. Andersen S, Petersen MW, Svendsen AS, Gazerani P. Pressure pain thresholds assessed over temporalis, masseter, and frontalis muscles in healthy individuals, patients with tension-type headache, and those with migraine-a systematic review. Pain. 2015;156(8):1409–23.

    PubMed  Google Scholar 

  36. Buchgreitz L, Egsgaard LL, Jensen R, Arendt-Nielsen L, Bendtsen L. Abnormal pain processing in chronic tension-type headache: a high-density EEG brain mapping study. Brain. 2008;131(Pt 12):3232–8.

    CAS  PubMed  Google Scholar 

  37. Maertens de Noordhout A, et al. Contingent negative variation in headache. Ann Neurol. 1986;19(1):78–80.

    CAS  PubMed  Google Scholar 

  38. Bender S, Weisbrod M, Resch F, Oelkers-Ax R. Stereotyped topography of different elevated contingent negative variation components in children with migraine without aura points towards a subcortical dysfunction. Pain. 2007;127(3):221–33.

    PubMed  Google Scholar 

  39. Bender S, Weisbrod M, Just U, Pfüller U, Parzer P, Resch F, et al. Lack of age-dependent development of the contingent negative variation (CNV) in migraine children? Cephalalgia. 2002;22(2):132–6.

    CAS  PubMed  Google Scholar 

  40. Besken E, Pothmann R, Sartory G. Contingent negative variation in childhood migraine. Cephalalgia. 1993;13(1):42–3.

    CAS  PubMed  Google Scholar 

  41. Demirci S, Savas S. The auditory event related potentials in episodic and chronic pain sufferers. Eur J Pain. 2002;6(3):239–44.

    PubMed  Google Scholar 

  42. Mazzotta G, Alberti A, Santucci A, Gallai V. The event-related potential P300 during headache-free period and spontaneous attack in adult headache sufferers. Headache. 1995;35(4):210–5.

    CAS  PubMed  Google Scholar 

  43. Chen W, Shen X, Liu X, Luo B, Liu Y, Yu R, et al. Passive paradigm single-tone elicited ERPs in tension-type headaches and migraine. Cephalalgia. 2007;27(2):139–44.

    CAS  PubMed  Google Scholar 

  44. de Tommaso M, Ambrosini A, Brighina F, Coppola G, Perrotta A, Pierelli F, et al. Altered processing of sensory stimuli in patients with migraine. Nat Rev Neurol. 2014;10(3):144–55.

    PubMed  Google Scholar 

  45. Rocca MA, Messina R, Colombo B, Falini A, Comi G, Filippi M. Structural brain MRI abnormalities in pediatric patients with migraine. J Neurol. 2014;261(2):350–7.

    PubMed  Google Scholar 

  46. Kim JH, Suh SI, Seol HY, Oh K, Seo WK, Yu SW, et al. Regional grey matter changes in patients with migraine: a voxel-based morphometry study. Cephalalgia. 2008;28(6):598–604.

    CAS  PubMed  Google Scholar 

  47. Vargas BB. Tension-type headache and migraine: two points on a continuum? Curr Pain Headache Rep. 2008;12(6):433–6.

    PubMed  Google Scholar 

  48. Lipton RB, Cady RK, Stewart WF, Wilks K, Hall C. Diagnostic lessons from the spectrum study. Neurology. 2002;58(9 Suppl 6):S27–31.

    CAS  PubMed  Google Scholar 

  49. Chen WT, Hsiao FJ, Ko YC, Liu HY, Wang PN, Fuh JL, et al. Comparison of somatosensory cortex excitability between migraine and "strict-criteria" tension-type headache: a magnetoencephalographic study. Pain. 2018;159(4):793–803.

    PubMed  Google Scholar 

  50. Hämäläinen M, Hari R, Ilmoniemi RJ, Knuutila J, Lounasmaa OV. Magnetoencephalography—theory, instrumentation, and application to noninvasive studies of the working human brain. Rev Mod Phys. 1993;65:413–97.

    Google Scholar 

  51. Dissanayake DW, Mason R, Marsden CA. Sensory gating, cannabinoids and schizophrenia. Neuropharmacology. 2013;67:66–77.

    CAS  PubMed  Google Scholar 

  52. Hsiao FJ, Wang SJ, Lin YY, Fuh JL, Ko YC, Wang PN, et al. Somatosensory gating is altered and associated with migraine chronification: a magnetoencephalographic study. Cephalalgia. 2018;38(4):744–53.

    PubMed  Google Scholar 

  53. Vuralli D, et al. Somatosensory temporal discrimination remains intact in tension-type headache whereas it is disrupted in migraine attacks. Cephalalgia. 2016:333102416677050.

Download references

Funding

The authors disclose receipt of the following financial support for the research, authorship, and article publication: Ministry of Science and Technology of Taiwan (MOST 107-2314-B-075-015-MY2-2 to WT Chen, 108-2321-B-010-001 and 108-2321-B-010-014-MY2 to SJ Wang, and 107-2221-E-010-007 and 108-2221-E-010-004 to FJ Hsiao) and Taipei-Veterans General Hospital (V108C-129 and V107C-091 to WT Chen). This work was supported by the Brain Research Center, National Yang-Ming University from The Featured Areas Research Center Program within the framework of the Higher Education Sprout Project by the Ministry of Education in Taiwan.

Author information

Affiliations

  1. Brain Research Center, National Yang-Ming University, Taipei, Taiwan

    Wei-Ta Chen, Fu-Jung Hsiao & Shuu-Jiun Wang

  2. School of Medicine, National Yang-Ming University, Taipei, Taiwan

    Wei-Ta Chen & Shuu-Jiun Wang

  3. Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, No. 201, Sec. 2 Shih-Pai Rd, Taipei, Taiwan

    Wei-Ta Chen & Shuu-Jiun Wang

Authors
  1. Wei-Ta Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Fu-Jung Hsiao
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Shuu-Jiun Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Wei-Ta Chen.

Ethics declarations

Conflict of Interest

Wei-Ta Chen, Fu-Jung Hsiao, and Shuu-Jiun Wang declare no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Disclaimer

The funders had no role in the study design, data collection and analysis, decision to publish, or manuscript preparation.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This article is part of the Topical Collection on Chronic Daily Headache

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Chen, WT., Hsiao, FJ. & Wang, SJ. Brain Excitability in Tension-Type Headache: a Separate Entity from Migraine?. Curr Pain Headache Rep 24, 82 (2020). https://doi.org/10.1007/s11916-020-00916-1

Download citation

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s11916-020-00916-1

Keywords

  • Tension-type headache (TTH)
  • Migraine
  • Neurophysiology
  • Brain excitability
  • Somatosensory gating
  • Magnetoencephalography (MEG)