Muscle hardness in patients with chronic tension-type headache: relation to actual headache state

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Abstract
L headache and whether hardness is correlated to tenderness. The secondary aim was to compare muscle hardness between patients and healthy controls. Hardness of the trapezius muscle was measured with a hardness meter in 20 patients with chronic tension-type headache and in 20 healthy controls. The patients were examined on 2 days, 1 day with headache and 1 day without headache. Pericranial myofascial tenderness was recorded with manual palpation. In addition, muscle hardness was measured in another five patients out-side headache and in 30 healthy controls. The muscle hardness recorded in patients (n=20) on days with headache, 98±26 kPa/cm, did not differ significantly from the muscle hardness recorded on days without headache, 100±21 kPa/cm, (P=0.62). The muscle hardness was positively correlated to the local tenderness score recorded from the trapezius muscle both on days with headache (R=0.52, P=0.02) and on days without headache (R=0.53, P=0.02). The total tenderness score (TTS) recorded in patients on days with headache, 23±10, was significantly higher than the TTS recorded on days without headache, 15±11, (P=0.0001). There was a significant difference between the TTS recorded in patients without headache, 15±11, and in controls, 4±4, (P=0.002). The muscle hardness was significantly higher in patients on days without headache (n=25), 97±20 kPa/cm, than in controls (n=30), 87±16 kPa/cm (P=0.03). On basis of previous and present results, we suggest that muscle hardness and muscle tenderness are permanently altered in chronic tension-type headache and not only a consequence of actual pain. In addition, the positive correlation between muscle hardness and tenderness supports the common clinical observation that tender muscles are harder than normal muscles....

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