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01.12.2014 | Research article | Ausgabe 1/2014 Open Access

The Journal of Headache and Pain 1/2014

Pericranial tenderness in chronic tension-type headache: the Akershus population-based study of chronic headache

The Journal of Headache and Pain > Ausgabe 1/2014
Kjersti Aaseth, Ragnhild Berling Grande, Christofer Lundqvist, Michael Bjørn Russell
Wichtige Hinweise

Electronic supplementary material

The online version of this article (doi:10.​1186/​1129-2377-15-58) contains supplementary material, which is available to authorized users.

Competing interests

The authors declare that they have no competing interests.

Authors’ contributions

MBR had the original idea for the study and planned the overall design. KA prepared the initial draft and was the main author of the present manuscript. RBG and KA collected data. CL and MBR was involved in data analysis and interpretation and assisted in preparation of the manuscript. All authors read and approved the manuscript.



Most knowledge on chronic tension-type headache (CTTH) is based on data from selected clinic populations, while data from the general population is sparse. Since pericranial tenderness is found to be the most prominent finding in CTTH, we wanted to explore the relationship between CTTH and pericranial muscle tenderness in a population-based sample.


An age- and gender-stratified random sample of 30,000 persons aged 30-44 years from the general population received a mailed questionnaire. Those with a self-reported chronic headache were interviewed and examined by neurological residents. The questionnaire response rate was 71% and the interview participation rate was 74%. The International Classification of Headache Disorders II was used. Pericranial muscle tenderness was assessed by a total tenderness score (TTS) involving 8 pairs of muscles and tendon insertions. Cross-sectional data from the Danish general population using the same scoring system were used for comparison.


The tenderness scores were significantly higher in women than men in all muscle groups. The TTS was significantly higher in those with co-occurrence of migraine compared with those without; 19.3 vs. 16.8, p = 0.02. Those with bilateral CTTH had a significantly higher TTS than those with unilateral CTTH. The TTS decreased significantly with age. People with CTTH had a significantly higher TTS compared to the general population.


People with CTTH have increased pericranial tenderness. Elevated tenderness scores are associated with co-occurrence of migraine, bilateral headache and low age.
Whether the increased muscle tenderness is primary or secondary to the headache should be addressed by future studies.
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