The association between myofascial trigger-points in the masseter muscle group and episodic tension-type headaches, in the Waterberg District

Headache is a common complaint in society and is related to personal, biomechanical and socioeconomic circumstances. In current literature trigger-points (TrPs) in the majority of the muscles of the face and neck contributing to tension-type headache (TTH) have been evaluated, except the TrPs of the masseter muscles. The aim of this studyis to determine the association between myofascial (TrPs) in the masseter muscle group and episodic tension-type headache (ETTH). Fourteen subjects with ETTH were matched with same sex and same age subjects not suffering from headache acting as the control group. The diagnostic criteria as described by Simons and Travel (1999) were used in the objective tests to diagnose the TrPs in the masseter muscles. Subjective tests included a disability questionnaire, National stress awareness day stress questionnaire, (NSAD stress questionnaire), a precipitating and aggravating factors questionnaire. Active TrPs were found in 92.86% of ETTH group and 7.14% had latent TrPs. Within the control group 7.14% had active TrPs, 14.29% latent TrPs and 78.37% had no TrPs.Differences in the presence of masseter TrPs between the ETTH and control group were significant with p-value <0.001. All the questions asked in the headache disability questionnaire evaluating headache frequency, intensity and severity were significantwith p-value<0.005. The NSAD stress questionnaire revealed statistical significant values for questions pertaining to muscular aches and pains and subjectively subjects claimed that theyfelt tension at work. The precipitating questionnaire showed that physical activity, stress / tension and reading were significant precipitating factors for developing a tension-type headache. The aggravating questionnaire only showed light as an aggravating factor. Stress and tension had 100% “yes”answers in the ETTH group.Weather as an aggravating factor had 100% “no” answersfrom the control group.Physical activity, driving and noise had relative high percentages of “yes”answers from the ETTH group and higher probability scores for being an aggravating factor whencomparing the ETTH and control group, but were not found to be statistically significant. Myofascial TrPs in the masseter muscle group contribute to the origin and or maintenance of ETTH.