Objective:

This study investigates whether physically examining the muscles of the head and neck with manual pressure - theMyofascial Exam (MFE) - can provoke and reproduce Persistent Post Traumatic Headache (PPTH) pain phenotypes and discusses the implications of these findings.  

Background:

Pressing head and neck muscles in the Myofascial Examination (MFE) can provoke all pain elements of migraine without aura, chronic migraine, and tension-type headaches.   Persistent Post Traumatic Headache (PPTH) has similar pain phenotypes as these headaches.

Design/Methods:

The author performed an MFE on 29 patients with PPTH. 22/29 were female. The average age was 49.3 years (range 24-72 years). The average time between injury and evaluation was 20.2 months (range 1-168 months). 5/29 had primary headaches (migraine, cluster, or tension-type) before injury. 

Results:

The 29 subjects had the pain phenotypes of migraine in 12, of tension-type headache (TTH) in 16, and of both in 1. The MFE reproduced the subject’s headache pains in 28 of 29 (96.5%). The subject whose headache could not be reproduced by the MFE suffered a skull fracture from his injury. 

Conclusions:

The findings show the MFE can reproduce the pain phenotypes of migraine without aura, chronic migraine, and tension-type headaches. The functional and structural anatomies of migraine without aura and chronic migraine are different from those of PPTH with the same phenotype. Since each can be provoked by the same MFE, the functional or connectivity pathways conducting information from the different cortical and cerebellar areas should be similar to have similar phenotypes. Since the MFE consistently elicits patients’ pain in PPTH, an examiner should query the veracity of the headache pain complaint in an individual patient with headache pain symptoms at the time of the examination if there is no history of skull fracture or coma lasting one or more days.