
estimated that about 20% of the children with primary headache need medical therapy. In a recent epidemiological study in Germany, the 6-month prevalence of headaches was 53.2% among children from 7 to 14 years.

Different studies have reported an overall prevalence rate for tension type headache ranging from 5.5 to 26% in children between 6 and 12 years old. Tension-type headache is the most common form of headache in both adults and adolescents. Our results showed that the local and referred pains elicited from active TrPs in head, neck and shoulder shared similar pain pattern as spontaneous CTTH in children, supporting a relevant role of active TrPs in CTTH in children. Significant positive correlations between some headache clinical parameters and the size of the referred pain area were found. Significant differences in referred pain areas between groups ( P < 0.001) and muscles ( P < 0.001) were found: the referred pain areas were larger in CTTH children ( P < 0.001), and the referred pain area elicited by suboccipital TrPs was larger than the referred pain from the remaining TrPs ( P < 0.001). Within children with CTTH, a significant positive association between the number of active TrPs and headache duration ( r s = 0.315 P = 0.026) was observed: the greater the number of active TrPs, the longer the duration of headache attack. Active TrPs were only present in children with CTTH ( P < 0.001). The total number of TrPs was significantly greater in children with CTTH as compared to healthy children ( P < 0.001).

The referred pain areas were drawn on anatomical maps, digitalized, and also measured. TrPs were identified with palpation and considered active when local and referred pains reproduce headache pain attacks. Bilateral temporalis, masseter, superior oblique, upper trapezius, sternocleidomastoid, suboccipital, and levator scapula muscles were examined for TrPs by an assessor blinded to the children’s condition. Fifty children (14 boys, 36 girls, mean age: 8 ± 2) with CTTH and 50 age- and sex- matched children participated. You couldn't ask for a better reference to transform your massage practice, into a truly therapeutic, and healing massage practice, for the relief of pain and muscular tension, and impingement.Our aim was to describe the referred pain pattern and areas from trigger points (TrPs) in head, neck, and shoulder muscles in children with chronic tension type headache (CTTH). He recommended this book, and says he still uses it frequently for reference.


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