Increased pericranial tenderness, decreased pressure pain threshold, and headache clinical parameters in chronic tension-type headache patients

Objective: The aim was to investigate whether increased pericranial tenderness or decreased pressure pain threshold (PPT) was related to headache intensity, duration, and frequency in chronic tension-type headache (CTTH). Methods: Twenty-five CTTH patients and 25 matched controls were studied. A headache diary was kept for 4 weeks to substantiate the diagnosis and record the pain history. Three tenderness (total, cephalic, and neck) scores and PPT at both cephalic and neck points were objectively and blinded assessed. Bodily pain perceived by the patients was assessed with the Short Form-36 questionnaire. Results: CTTH patients showed decreased PPT and increased tenderness as compared with controls (P < 0.001). Negative correlations were found between PPT on each point and their respective tenderness scores. Within the CTTH group, neither increased tenderness nor decreased PPT seemed to directly influence headache intensity, frequency or duration; or vice versa. Discussion: Increased tenderness may predispose the patients to other perpetuating factors in inducing headache attacks. Further research is needed to clearly define the role of pericranial tender tissues or other factors in the genesis and maintenance of CTTH.