Active Trigger Points Are Associated With Anxiety and Widespread Pressure Pain Sensitivity in Women, but not Men, With Tension Type Headache

BACKGROUND: A better understanding of gender differences can assist clinicians in further developing therapeutic programs in tension type headache (TTH). OBJECTIVE: To evaluate gender differences in the presence of trigger points (TrPs) in the head, neck, and shoulder muscles and their relationship with headache features, pressure pain sensitivity, and anxiety in people with TTH. METHODS: Two hundred and ten (59 men, 151 women) patients with TTH participated. TrPs were bilaterally explored in the temporalis, masseter, suboccipital, upper trapezius, splenius capitis, and sternocleidomastoid muscles. Headache features were collected using a 4-week headache diary. Trait and state anxiety levels were assessed using the State-Trait Anxiety Inventory. Pressure pain thresholds (PPTs) over the temporalis, C5/C6 joint, second metacarpal, and tibialis anterior were assessed. RESULTS: Women with TTH exhibited a significantly higher number of total (P = 0.027) and active (P = 0.030), but similar number of latent (P = 0.461), TrPs than men with TTH. Active TrPs in the temporalis, suboccipital, and splenius capitis muscles were the most prevalent in both men and women with TTH. The number of active TrPs was associated with anxiety levels (r = 0.217; P = 0.045) in women, but not in men (P = 0.453): the higher the number of active TrPs, the more the trait levels of anxiety. Women exhibited lower PPTs than men (all, P < 0.001). In men, the number of active, but not latent, TrPs was negatively associated with localized PPTs (all, P < 0.05), whereas in women, the number of active and latent TrPs was negatively associated with PPTs in all points (all, P < 0.01): the higher the number of TrPs, the lower the widespread PPTs. CONCLUSIONS: This study described gender differences in the presence of TrPs in TTH. Women with TTH showed lower PPTs than men. The association between TrPs, anxiety levels, and pressure pain hyperalgesia seems to be more pronounced in women than in men with TTH