Muscle Weakness May Contribute to Tension Headaches

Strength training might help prevent tension headaches, or at least reduce their pain, according to a small Danish study.

Researchers found that neck and shoulder muscles were up to 26 percent weaker in people with regular tension headaches, compared to those without. They also saw strength imbalances between sets of muscles that hold the head straight.

“In order to be able to treat tension-type headache patients non-pharmacologically . . . It is very important to work towards a further understanding of muscle-skeletal impact on tension-type headaches,” lead author Bjarne H. Madsen, a physiotherapist at the Danish Headache Center in Glostrup, said by email.

Previous studies have found that muscle strength and weakness were associated with tension-type headaches, Madsen and his colleagues note in the journal Cephalalgia. More work is needed to determine whether the muscle weakness is a cause or effect of this most common type of headache, they write.

People with tension-type headaches may feel like they have a tight band wrapped around their head but with less pain than is felt from cluster headaches or migraines, which tend to strike one side of the head. Cluster headaches are often accompanied by sinus congestion or runny nose, while migraines cause throbbing, moderate-to-severe pain and sometimes nausea and/or vomiting and sensitivity to light and sound.

The study compared 60 adults with tension headaches to 30 healthy individuals. The patients had experienced a headache on eight or more days out of 30, with no more than three migraines.

The participants’ neck extensor muscles were tested when they leaned their heads back. Neck flexor muscles were tested when they bent their heads forward. The strength of the trapezius muscle running down the back of the neck into the shoulder was also tested.

The healthy people in the study had 26 percent stronger neck extension than those with tension-type headaches, but there was only a slight difference between groups in neck flexor strength. As a result, the ratio of extension and flexion strength was 12 percent larger in the healthy comparison group.

Madsen, who is also a doctoral student at the University of Southern Denmark, noted that when neck extension muscles were weaker, flexor muscles were stronger, which could be pulling their heads forward.

The healthy people also had more shoulder strength when they raised each arm out to the side.

Madsen said past studies have suggested that forward leaning head posture and weaker neck extension might be contributing to tension headaches.

“Also, the use of computers, laptops and tablets have increased in recent years and this may increase the time sitting with a protruded head posture,” he said, adding that shoulder strengthening exercises had helped to reduce neck pain in previous studies.

“What is interesting is that there appears to be this mechanical and strength issue in people who have significant tension-type headaches,” said Dr. Merle Diamond, who heads the Diamond Headache Inpatient Unit at Presence Saint Joseph Hospital in Chicago, and was not involved in the study.

Neck pain and tenderness is a frequent complaint among these patients, she said, but doctors have not really understood the mechanism at work.

Diamond said patients with tension headaches are sometimes horseback riders, dental hygienists or physical laborers, whose repetitive motions at work might lead to the muscle problems.

“If you do a repetitive motion or you’re lifting things, you’re going to build certain muscles and not others,” said Diamond, who also heads a Chicago headache clinic not affiliated with the hospital.

Diamond typically suggests that patients work with a physical therapist or trainer to strengthen their core. “I know that’s very trendy but there’s a reason for it, it actually works,” she said. The therapist checks the posture and works on any imbalance, giving individuals exercises to do at home.

While there are analgesics, nerve blocks and trigger point injections that can help with neck problems, Diamond noted that many patients prefer non-drug methods.

“If you work on these different pieces, you can probably limit the amount of exposure you need to get from analgesics,” Diamond said. “It’s great that we have them but having a good physical response doing some of your own work on this can be helpful.”

SOURCE: bit.ly/1EUGI6j Cephalalgia, online April 1, 2015.