{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T22:50:36Z","timestamp":1789685436715,"version":"4.0.1"},"reference-count":22,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2006,1,26]],"date-time":"2006-01-26T00:00:00Z","timestamp":1138233600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Headache"],"published-print":{"date-parts":[[2006,3]]},"abstract":"<jats:p>Objective.\u2014To assess the presence of trigger points (TrPs) in the suboccipital muscles and forward head posture (FHP) in subjects with chronic tension\u2010type headache (CTTH) and in healthy subjects, and to evaluate the relationship of TrPs and FHP with headache intensity, duration, and frequency.<\/jats:p>\n                  <jats:p>Background.\u2014Tension\u2010type headache (TTH) is a prototypical headache in which myofascial TrPs in the cervical and pericranial musculature can play an important role.<\/jats:p>\n                  <jats:p>Design.\u2014A blinded, controlled pilot study.<\/jats:p>\n                  <jats:p>Methods.\u2014Twenty CTTH subjects and 20 matched controls without headache participated. TrPs were identified by eliciting referred pain with palpation, and increased referred pain with muscle contraction. Side\u2010view pictures of each subject were taken in sitting and standing positions, in order to assess FHP by measuring the craniovertebral angle. Both measures were taken by a blinded assessor. A headache diary was kept for 4 weeks in order to assess headache intensity, frequency, and duration.<\/jats:p>\n                  <jats:p>\n                    Results.\u2014Sixty\u2010five percent (13\/20) CTTH subjects showed active TrPs and 35% (7\/20) had latent TrPs in the suboccipital muscles. Six (30%) controls also had latent TrPs. Differences in the presence of suboccipital muscle TrPs between both the groups were significant for active TrPs (\n                    <jats:italic>P<\/jats:italic>\n                    &lt; .001) but not for latent TrPs (\n                    <jats:italic>P<\/jats:italic>\n                    &gt; .5). CTTH subjects with active TrPs reported a greater headache intensity and frequency than those with latent TrPs (\n                    <jats:italic>P<\/jats:italic>\n                    &lt; .05). The degree of FHP was greater in CTTH subjects than in controls in both sitting and standing positions (\n                    <jats:italic>P<\/jats:italic>\n                    &lt; .01). Within the CTTH group, there was a negative correlation between the craniovertebral angle and the frequency of headache (r\n                    <jats:sub>s<\/jats:sub>\n                    =\u22120.6,\n                    <jats:italic>P<\/jats:italic>\n                    &lt; .01, in sitting position; r\n                    <jats:sub>s<\/jats:sub>\n                    =\u22120.5,\n                    <jats:italic>P<\/jats:italic>\n                    &lt; .05, in standing position). CTTH subjects with active TrPs had a greater FHP than those with latent TrPs, though this difference was not significant.\n                  <\/jats:p>\n                  <jats:p>Conclusions.\u2014Suboccipital active TrPs and FHP were associated with CTTH. CCTH subjects with active TrPs reported a greater headache intensity and frequency than those with latent TrPs. The degree of FHP correlated positively with headache duration, headache frequency, and the presence of suboccipital active TrPs.<\/jats:p>","DOI":"10.1111\/j.1526-4610.2006.00288.x","type":"journal-article","created":{"date-parts":[[2006,1,26]],"date-time":"2006-01-26T04:41:26Z","timestamp":1138250486000},"page":"454-460","source":"Crossref","is-referenced-by-count":208,"title":["Trigger Points in the Suboccipital Muscles and Forward Head Posture in Tension\u2010Type Headache"],"prefix":"10.1111","volume":"46","author":[{"given":"C\u00e9sar","family":"Fern\u00e1ndez\u2010de\u2010las\u2010Pe\u00f1as","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cristina","family":"Alonso\u2010Blanco","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria Luz","family":"Cuadrado","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert D.","family":"Gerwin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juan A.","family":"Pareja","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2006,1,26]]},"reference":[{"key":"e_1_2_6_2_2","doi-asserted-by":"publisher","DOI":"10.1046\/j.1468-2982.2000.00070.x"},{"key":"e_1_2_6_3_2","first-page":"1","volume-title":"Clinical Mastery in the Treatment of Myofascial Pain","author":"Gerwin R","year":"2005"},{"key":"e_1_2_6_4_2","doi-asserted-by":"publisher","DOI":"10.1046\/j.1468-2982.1999.019006602.x"},{"key":"e_1_2_6_5_2","volume-title":"Myofascial pain and dysfunction: the trigger point manual","author":"Simons DG","year":"1999"},{"issue":"1","key":"e_1_2_6_6_2","first-page":"9","article-title":"The International Classification of Headache Disorders","volume":"24","author":"IHS: Headache Classification Subcommittee of the International Headache Society","year":"2004","journal-title":"Cephalalgia"},{"issue":"7","key":"e_1_2_6_7_2","first-page":"29","article-title":"Classification and diagnostic criteria for headache disorders, cranial neuralgias and facial pain, 1st ed","volume":"8","author":"IHS: Headache Classification Committee of the International Headache Society","year":"1988","journal-title":"Cephalalgia"},{"key":"e_1_2_6_8_2","doi-asserted-by":"publisher","DOI":"10.1046\/j.1526-4610.1997.3706368.x"},{"key":"e_1_2_6_9_2","doi-asserted-by":"publisher","DOI":"10.1046\/j.1468-2982.1996.1603175.x"},{"key":"e_1_2_6_10_2","doi-asserted-by":"publisher","DOI":"10.2519\/jospt.1995.21.5.287"},{"key":"e_1_2_6_11_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.math.2005.04.007"},{"key":"e_1_2_6_12_2","doi-asserted-by":"publisher","DOI":"10.1046\/j.1526-4610.1999.3901021.x"},{"issue":"9","key":"e_1_2_6_13_2","first-page":"75","article-title":"Adverse tension in cranial dura mater and myofascial trigger points in suboccipital muscles in patients with episodic tension type headache","volume":"12","author":"Fern\u00e1ndez\u2010de\u2010las\u2010Pe\u00f1as C","year":"2004","journal-title":"J Musculoskel Pain"},{"key":"e_1_2_6_14_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1468-2982.1992.00369.x"},{"key":"e_1_2_6_15_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0304-3959(96)03248-4"},{"key":"e_1_2_6_16_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0003-9993(97)90335-X"},{"key":"e_1_2_6_17_2","doi-asserted-by":"publisher","DOI":"10.1046\/j.1468-2982.1993.1304272.x"},{"key":"e_1_2_6_18_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0003-9993(97)90335-X"},{"key":"e_1_2_6_19_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0304-3959(99)00101-3"},{"key":"e_1_2_6_20_2","first-page":"1382","article-title":"Epidemiology of rheumatic disease in rural Thailand: A WHOILAR COPCORD study. Community Oriented Programme for the Control of the Rheumatic Disease","volume":"25","author":"Chaiamnuay P","year":"1998","journal-title":"J Rheumatol"},{"key":"e_1_2_6_21_2","first-page":"67","article-title":"The anatomical basis for cervicogenic headache","volume":"15","author":"Bogduk N","year":"1992","journal-title":"J Manipulative Physiol Ther"},{"key":"e_1_2_6_22_2","doi-asserted-by":"publisher","DOI":"10.1046\/j.1468-2982.2000.00070.x"},{"key":"e_1_2_6_23_2","doi-asserted-by":"publisher","DOI":"10.1046\/j.1468-2982.1994.1404273.x"}],"container-title":["Headache: The Journal of Head and Face Pain"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1111%2Fj.1526-4610.2006.00288.x","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/headachejournal.onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/j.1526-4610.2006.00288.x","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,2]],"date-time":"2025-11-02T12:24:46Z","timestamp":1762086286000},"score":1,"resource":{"primary":{"URL":"https:\/\/headachejournal.onlinelibrary.wiley.com\/doi\/10.1111\/j.1526-4610.2006.00288.x"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2006,1,26]]},"references-count":22,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2006,3]]}},"alternative-id":["10.1111\/j.1526-4610.2006.00288.x"],"URL":"https:\/\/doi.org\/10.1111\/j.1526-4610.2006.00288.x","archive":["Portico"],"relation":{},"ISSN":["0017-8748","1526-4610"],"issn-type":[{"value":"0017-8748","type":"print"},{"value":"1526-4610","type":"electronic"}],"subject":[],"published":{"date-parts":[[2006,1,26]]}}}