Skeletomuscular dysfunctions in primary and secondary headaches: part 1. pathogenesis peculiarities and clinical manifestations: a scientific review

Authors:

Sorokin Yuri Nikolaevich – Grand PhD in Medical sciences (Dr. Med. Sci.), Associate Professor; Professor of the Department of Neurology and Restorative Medicine with a course in Osteopathy, Rostov State Medical University, 29 Nakhichevansky Lane, 344022 Rostov-on-Don, Russian Federation; е-mail: sorokin.yuri@bk.ru; https://orcid.org/0000-0002-9185-4073.

Sorokina Elena Yuryevna – senior lecturer at the Department of Foreign Languages with a Latin course, Rostov State Medical University, 29 Nakhichevansky Lane, 344022 Rostov-on-Don, Russian Federation; e-mail: lenoklug@mail.ru.

Annotation:

The pathogenesis of primary and secondary headaches (HA) is multifactorial, with peripheral and central sensitization mechanisms being of leading importance in the pathophysiology of migraine, tension headache, and cervicogenic HA. Skeletomuscular dysfunctions, myofascial disorders in particular, play a fairly important role in this case and, due to prolonged nociceptive stimulation, cause the development of central sensitization and can provoke the development of HA attack or contribute to the transformation of episodic HA into chronic one. At the same time, central sensitization may cause the formation of myofascial trigger points in pericranial muscles. This ultimately forms a pathologic cycle, when peripheral sensitization supports the central one and vice versa.
Tension headache is likely to be a heterogenous condition, pathogenically and clinically. It may be reflected from myofascial trigger points, may be due to tension of temporal muscles and/or scalp muscles, their tendons and fascia, with the development of local inflammation in the periosteum of skull bones, may result from ischemia of spasmodic muscle or compression of extracranial nerves. During the prolonged course it may be accompanied by intracranial venous dysfunction with difficulty in venous outflow from the cranial cavity.

List of cited literature:

1. Onan D, Younis S, Wellsgatnik WD, Farham F, Andruskevicius S, Abashidze A, Jusupova A, Romanenko Yu, Grosu O, Moldokulova MZ, Mursalova U, Saidkhodjaeva S, Martelletti P, Ashina S. Debate: differences and similarities between tension-type headache and migraine. J Headache Pain. 2023;24:92. https://doi.org/10.1186/s10194-023-01614-0

2. Burstein R, Blake P, Schain A, Perry C. Extracranial origin of headache. Curr Opin Neurol. 2017;30(3):263-271. https://doi.org/10.1097/WC0.0000000000000437

3. Christensen RH, Ashina H, Muhsen Al-Khazali H, Pineda M, Rahmanzadeh R, Hadjikhani N, Granziera C, Ashina M. Cortical inflammation in migraine measured with quantitative magnetic resonance imaging: a Registry for Migraine (REFORM) study. J Headache Pain. 2024;25(Suppl 1):LP018. https://doi. org/10.1186/s10194-024-01793-4

4. Blumenfeld AM, Lipton RB, Silberstein S, Tepper SJ, Charleston L 4th, Landy S, Kuruvilla DE, Manack Adams A. Multimodal Migraine Management and the Pursuit of Migraine Freedom: A Narrative Review. Neurol Ther. 2023;12(5):1533-1551. https://doi. org/10.1007/s40120-023-00529-x

5. Do TP, Heldarskard GF, Kolding LT, Hvedstrup J, Schytz HW. Myofascial trigger points in migraine and tension-type headache. J Headache Pain. 2018;19:84. https://doi.org/10.1186/s10194-018-0913-8

6. Straube A, Forderreuther S, Eren OE. Kopfschmerz vom Spannungstyp. Quo vadis? [Tension type headaches. Quo vadis?] Schmerz. 2020;34:464-475. (In German) https://doi.org/10.1007/s00482-020-00495-5

7. Ashina S, Mitsikostas DD, Lee MJ, Yamani N, Wang Sh.-J, Messina R, Ashina H, Buse DC, Pozo-Rosich P, Jensen RH, Diener H.-Ch, Lipton RB. Tension-type headache. Nat Rev Dis Primers. 2021;7(1):24. https:// doi.org/10.1038/s41572-021-00257-2

8. Fernandez-de-Las-Penas C, Florencio LL, Plaza-Manzano G, Arias-Buria JL. Clinical Reasoning Behind Non-Pharmacological Interventions for the Management of Headaches: A Narrative Literature Review. Int J Environ Res Public Health. 2020;17(11):4126. https://doi.org/10.3390/ ijerph17114126

9. Headache Classification Committee of the International Headache Society. The international classification of headache disorders: 3rd edition. Cephalalgia. 2018;38(1):1-211. https://doi. org/10.1177/0333102417738202

10. Fernandez-de-Las-Penas C, Plaza-Manzano G, Navarro-Santana MJ, Olesen J, Jensen RH, Bendtsen L. Evidence of localized and widespread pressure pain hypersensitivity in patients with tension-type headache: A systematic review and meta-analysis. Cephalalgia. 2021;41(2):256-273. https://doi. org/10.1177/0333102420958384

11. Fernandez-de-las-Penas C. Myofascial Head Pain. Curr Pain Headache Rep. 2015;19:28. https://doi. org/10.1007/s11916-015-0503-2

12. Steel SJ, Robertson CE, Whealy MA. Current understanding of the pathophysiology and approach to tension-type headache. Curr Neurol Neurosci Rep. 2021;21:56. https://doi.org/10.1007/ s11910-021-01138-7

13. Gevirtz R. The Role of the Autonomic Nervous System in Headache: Biomarkers and Treatment. Curr Pain Headache Rep. 2022;26:767-774. https://doi. org/10.1007/s11916-022-01079-x

14. Castien RF, van der Wouden JC, De Hertogh W. Pressure pain thresholds over the cranio-cervical region in headache: a systematic review and metaanalysis. J Headache Pain. 2018;19:9. https://doi. org/10.1186/s10194-018-0833-7

15. Bendtsen L. Central Sensitization in Tension-Type Headache – Possible Pathophysiological Mechanisms. Cephalalgia. 2000;20(5):486-508. https://doi. org/10.1046/j.1468-2982.2000.00070.x

16. Sjaastad O. Tension-type headache: one or more headaches? Funct Neurol. 2011;26(3):165-70. PMID: 22152438; PMCID: PMC3814554. https://pmc.ncbi. nlm.nih.gov/articles/PMC3814554/

17. Simons DG, Travell JG, Simons LS. Myofascial Pain and Dysfunction: The Trigger Point Manual, vol. 1, 2nd edition. Williams & Wilkins, Baltimore, MD. 1999;1664.

18. Алексеев В.В., Шехтер А.И., Скоробогатых К.В., Шашкова Е.В. Головные боли при интракраниальной венозной дисфункции // Боль. – 2008. – Т. 3 № 20. – С. 15-21.

19. Alekseev V.V., Shexter A.I., Skorobogaty’x K.V, Shashkova E.V. Golovny’e boli pri intrakranial’noj venoznoj disfunkcii [Alekseev VV, Shekhter AI, Skorobogatykh KV, Shashkova EV Headaches with intracranial venous dysfunction]. Bol’ [Pain]. 2008;3(20):15-21. https:// painrussia.ru/pdf/web/viewer.html?file=/russian-Journal-of-Pain/03%2008.pdf (In Russian).

20. Fernandez De Las Penas C, Cuadrado ML, Gerwin RD, Pareja JA. Referred pain from the trochlear region in tension-type headache: A myofascial trigger point from the superior oblique muscle. Headache. 2005;45:731-737. https://doi.org/10.1111/j.1526-4610.2005.05140.x

21. Fernandez-de-las-Penas C, Cuadrado ML, Gerwin RD, Pareja JA. Referred Pain Elicited by Manual Exploration of the Lateral Rectus Muscle in Chronic Tension-Type Headache. Pain Medicine. 2009;10(1):43-48. https:// doi.org/10.1111/j.1526-4637.2008.00416.x

22. Fernandez-de-Las-Penas C, Ge HY, Alonso-Blanco C, Gonzalez-Iglesias J, Arendt-Nielsen L. Referred pain areas of active myofascial trigger points in head, neck, and shoulder muscles, in chronic tension type headache. J Bodyw Mov Ther. 2010;14(4):391-396. https://doi.org/10.1016/j.jbmt.2009.06.008

23. Seong JW, Kwon DR. A proposal for a new headache classification system for general practitioners.Med. Hypotheses. 2020;143:110103. https://doi. org/10.1016/j.mehy.2020.110103

24. Амелин А.В. Шея и головная боль // Consilium Medicum. 2016;18(9):103-109. Amelin A.V. Sheia i golovnaia bol [Amelin AV. Neck and headache. Consilium Medicum. 2016;18(9):103-109.]. https://consilium.orscience.ru/2075-1753/article/ view/94642/78377 (In Russian).

25. Сорокин Ю.Н. Место цервикогенной головной боли в Международной классификации головной боли. Междунар. неврол. журн. – 2016. – Т. 7. -№ 85. – С. 105-111. Sorokin Iu.N. Mesto tservikogennoi golovnoi boli v Mezhdunarodnoi klassifikatsii golovnoi boli. Mezhdunarodnyi nevrologicheskii zhurnal [Sorokin YuN. The place of a cervicogenic headache in the International Classification of Headache Disorders. Intern. Neurol. J. 2016;7(85):105-111]. https://doi. org/10.22141/2224-0713.7.85.2016.86924 (In Russian).

26. Lefel N, van Suijlekom H, Cohen SPC, Kallewaard JW, Van Zundert J. 11. Cervicogenic headache and occipital neuralgia. Pain Pract. 2025;25( 1):e 13405. https://doi. org/10.1111/papr.13405

27. Cote P, Yu H, Shearer HM, Randhawa K, Wong JJ, Mior S, Ameis A, Carroll LJ, Nordin M, Varatharajan S, Sutton D, Southerst D, Jacobs C, Stupar M, Taylor-Vaisey A, Gross DP, Brison RJ, Paulden M, Ammendolia C, Cassidy JD, Loisel P, Marshall S, Bohay RN, Stapleton J, Lacerte M. Non-pharmacological management of persistent headaches associated with neck pain: A clinical practice guideline from the Ontario protocol for traffic injury management (OPTIMa) collaboration. Eur J Pain. 2019;23(6):1051-1070. https://doi.org/10.1002/ejp.1374

28. Govind J, Bogduk N. Sources of Cervicogenic Headache Among the Upper Cervical Synovial Joints. Pain Med. 2022;23(6):1059-1065. https://doi.org/10.1093/pm/pnaa469

29. Kuhn WF, Kuhn SC, Gilberstadt H. Occipital neuralgias: clinical recognition of a complicated headache. A case series and literature review. J Orofac Pain. 1997;11(2):158-165. PMID: 10332322. https:// pubmed.ncbi.nlm.nih.gov/10332322/

30. Guyuron B, Bonetti ЫА, Caretto AA. Comprehensive Criteria for Differential Diagnosis and a Surgical Management Algorithm for Occipital Neuralgia and Migraine Headaches. JPRAS Open. 2023;39:212-216. https://doi.org/10.1016/j.jpra.2023.12.002

31. Saad M, Manzanera Esteve IV, Evans AG, Karagoz H, Kesayan T, Brooks-Horrar K, Sengupta S, Robison R, Johnson B, Dortch R, Thayer WP, Assi P, Gfrerer L, Kassis S. Preoperative visualization of the greater occipital nerve with magnetic resonance imaging in candidates for occipital nerve decompression for headaches. Sci Rep. 2024;14(1):15248. https://doi. org/10.1038/s41598-024-65334-4