Tension‐Type Headache: Pain, Fatigue, Tension, and EMG Responses to Mental Activation

Twenty patients with tension‐type headache (14 chronic and 6 episodic) and 20 group‐matched controls were selected for this study. They participated in a 1‐hour, complex, two‐choice, reaction‐time test, as well as 5‐minute pretest and 20‐minute posttest periods. Subjects reported any pain in the forehead, temples, neck, and shoulders, as well as any feelings of fatigue and tension during the pretest, and every 10 minutes during the test and posttest by visual analog scales. Superficial electromyography was recorded simultaneously from positions representing the frontal and temporal muscles, neck (mostly splenius), and trapezius muscles. The location of pain corresponded to the position of the electrodes, but extended over a larger area. The test provoked pain in the forehead, neck, and shoulders of patients, ie, pain scores from these regions increased significantly during the test. The pain scores continued to increase posttest. In patients, the EMG response of the trapezius (first 10 minutes of the test) was elevated relative to pretest. In controls, only the frontal muscles showed an EMG test response. Patients showed significantly higher EMG responses than controls in the neck (whole test period) and trapezius (first 10 minutes of the test period).

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