Deep Cervical Muscles and Functionality in Patients with Chronic Tension-Type Headache: An Observational Study.

Chronic tension-type headache (TTH) is the type of headache with the highest prevalence. The involvement of musculoskeletal structures in TTH is supported by evidence in the scientific literature. Among these, deep cervical muscle strength appears to be related to the function of the cervical spine and the clinical characteristics of TTH. This study aimed to correlate anatomical, functional, and psychological variables in patients with TTH. An observational descriptive study was carried out with 22 participants diagnosed with TTH for at least six months. The characteristics of headaches, including ultrasound-based deep neck flexor and extensor muscle thickness, range of motion (ROM), and pressure pain threshold (PPT), were recorded. We also conducted the Pain Vigilance and Awareness Questionnaire (PVAQ) and the Craniocervical Flexion Test (CCFT). Moderate-large negative correlations were found between the PVAQ and the muscle thickness of right deep flexors contracted (r = -0.52; = 0.01), left multifidus contracted (r = -0.44; = 0.04), right multifidus at rest (r = -0.48; = 0.02), and right multifidus contracted (r = -0.45; = 0.04). Moderate-large positive correlations were found between the CCFT score and the left cervical rotation ROM (r = 0.53; = 0.01), right cervical rotation ROM (r = 0.48; = 0.03), muscle thickness of left multifidus contracted (r = 0.50; = 0.02), and muscle thickness of right multifidus at rest (r = 0.51; = 0.02). The muscle thickness of the contracted right deep cervical flexors showed a moderate negative correlation with headache intensity (r = -0.464; = 0.03). No correlations were found between PPT and the rest of the variables analyzed. In patients with TTH, a higher thickness of deep cervical muscles was associated with higher ROM and higher scores in the CCFT. In turn, the thickness of deep cervical muscles showed negative correlations with pain hypervigilance and headache intensity. These results contribute to a better understanding of the physical and psychosocial factors contributing to the development of TTH, which is useful for implementing appropriate prevention and treatment measures.