Relationship of Active Trigger Points with Related Disability and Anxiety in People with Tension-type Headache

To investigate the differences in the presence of trigger points (TrPs) and their association with headache-related disability and mood disorders in people with frequent episodic tension-type headache (TTH) (FETTH) and chronic TTH (CTTH). One hundred twenty-two individuals with TTH participated. Clinical features of headache (i.e., intensity, duration, and frequency) were recorded on a headache diary. Headache-related disability was assessed with the Headache Disability Inventory, trait and state anxiety levels with State-Trait Anxiety Inventory, and depression with the Hospital Anxiety and Depression Scale. TrPs were bilaterally explored in the temporalis, masseter, suboccipital, upper trapezius, splenius capitis, and sternocleidomastoid muscles. Sixty-two (51%) patients were classified as FETTH, whereas 60 (49%) were classified as CTTH. Individuals with CTTH showed higher burden of headache and depression than FETTH (P < 0.001). Subjects with FETTH showed similar number of TrPs (total number: 5.9 ± 3.1, active TrPs: 4.7 ± 2.5, and latent TrPs: 1.2 ± 1.9) than those with CTTH (total number: 5.7 ± 3.2, active TrPs: 4.2 ± 3.0, and latent TrPs: 1.5 ± 1.8). The number of active TrPs was significantly associated with the burden of headache (r = 0.189; P = 0.037) and trait anxiety (r = 0.273; P = 0.005): the higher the number of active TrPs, the greater the physical burden of headache or the more the trait anxiety level. No association with the depression was observed. The presence of active TrPs in head and neck/shoulder muscles was similar between individuals with FETTH and CTTH and associated with the physical burden of headache and trait anxiety levels independently of the subgroup of TTH.