Musculoskeletal physical outcome measures in individuals with tension-type headache: a scoping review

Cephalalgia. 2013 Dec;33(16):1319-36. doi: 10.1177/0333102413492913. Epub 2013 Jun 26.


Introduction: Individuals with tension-type headache (TTH), in addition to headache pain, typically suffer from pericranial muscle tenderness and increased cervical muscle tone. Physical and physiological outcomes related to musculoskeletal function, however, are not commonly assessed in clinical studies and not systematically proposed as outcome measures in headache-related practice guidelines.

Objectives: To review which musculoskeletal outcomes are used in the clinical assessment of patients with TTH and which are associated with headache pain and related dysfunction.

Methods: Literature searches were performed in MEDLINE, PubMed, the Cochrane databases and EMBASE using terms relating to musculoskeletal physical outcomes in TTH.

Results: Twenty-six studies met selection criteria. Physiological outcomes typically reported in laboratory studies were trigger points, pressure pain threshold, range of motion and tenderness. A greater number of trigger points and lower pressure pain threshold were reported in patients with episodic TTH in comparison with healthy subjects. Individuals with chronic TTH, when compared with non-headache controls, consistently showed a greater number of trigger points, a lower value of pressure pain threshold and a more severe forward head posture.

Conclusion: Musculoskeletal outcomes, such as trigger points, pressure pain threshold and forward head posture should inform TTH pathophysiology, diagnosis and interdisciplinary patient care.

Keywords: Primary headache; pain; pericranial; spine.

Publication types

  • Review

MeSH terms

  • Humans
  • Myofascial Pain Syndromes / complications*
  • Myofascial Pain Syndromes / diagnosis*
  • Tension-Type Headache / complications*
  • Tension-Type Headache / diagnosis*