{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,29]],"date-time":"2025-10-29T18:40:39Z","timestamp":1761763239555,"version":"build-2065373602"},"reference-count":22,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2025,10,27]],"date-time":"2025-10-27T00:00:00Z","timestamp":1761523200000},"content-version":"vor","delay-in-days":26,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Euro J of Neurology"],"published-print":{"date-parts":[[2025,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Tension\u2010type headache (TTH) is one of the most prevalent headache disorders worldwide, yet its underlying pathophysiological mechanisms remain poorly understood. Previous research suggests a potential link between myofascial factors, such as trapezius muscle stiffness, and headache severity. This study investigates the association between upper trapezius muscle stiffness and headache severity in patients with TTH.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a cross\u2010sectional analysis of 203 patients diagnosed with TTH, evaluating muscle stiffness using a portable muscle hardness meter and headache severity using the Headache Impact Test\u20106 (HIT\u20106) and Migraine Disability Assessment Scale (MIDAS). Logistic regression analysis was performed to identify correlations between muscle stiffness and headache severity, adjusting for age, sex, and other clinical variables.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The mean muscle stiffness values were 32.5\u2009\u00b1\u20095.8 on the left and 31.3\u2009\u00b1\u20095.6 on the right. HIT\u20106 scores positively correlated with muscle stiffness (\n                      <jats:italic>\u03b2<\/jats:italic>\n                      \u2009=\u20090.148), chronic TTH (\n                      <jats:italic>\u03b2<\/jats:italic>\n                      \u2009=\u20090.304), and age (\n                      <jats:italic>\u03b2<\/jats:italic>\n                      \u2009=\u2009\u22120.203). Significant clinical symptoms associated with headache severity included weakness (\n                      <jats:italic>\u03b2<\/jats:italic>\n                      \u2009=\u20090.154) and a heavy eyelid sensation (\n                      <jats:italic>\u03b2<\/jats:italic>\n                      \u2009=\u20090.154). However, shoulder stiffness and neck pain were not significantly associated with headache severity. Triggers such as stress and weather changes were also identified as significant predictors of headache severity.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Increased trapezius muscle stiffness positively correlates with greater headache severity in TTH patients. Weakness and heavy eyelid sensation may serve as important clinical indicators of headache severity, offering potential insights for improved diagnosis and management.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/ene.70393","type":"journal-article","created":{"date-parts":[[2025,10,27]],"date-time":"2025-10-27T07:29:43Z","timestamp":1761550183000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Association Between Trapezius Muscle Stiffness and Headache Severity in Patients With Tension\u2010Type Headache"],"prefix":"10.1111","volume":"32","author":[{"given":"Daisuke","family":"Shimada","sequence":"first","affiliation":[{"name":"Department of Neurosurgery Koyama Memorial Hospital  Ibaraki Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9224-9767","authenticated-orcid":false,"given":"Eiichi","family":"Ishikawa","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Institute of Medicine University of Tsukuba  Ibaraki Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Takuya","family":"Kawai","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery Koyama Memorial Hospital  Ibaraki Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yoichi","family":"Harada","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery Mito Brain Heart Center  Ibaraki Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Toru","family":"Hatayama","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery Mito Brain Heart Center  Ibaraki 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Neurosurgery Iijima Clinic  Ibaraki Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yuta","family":"Sasaki","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery Koyama Memorial Hospital  Ibaraki Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Satoru","family":"Miyawaki","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Faculty of Medicine The University of Tokyo  Tokyo 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