{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,16]],"date-time":"2026-01-16T08:43:14Z","timestamp":1768552994356,"version":"3.49.0"},"reference-count":53,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2019,3,12]],"date-time":"2019-03-12T00:00:00Z","timestamp":1552348800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pain Practice"],"published-print":{"date-parts":[[2019,6]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>A better understanding of gender differences can assist clinicians in further developing therapeutic programs in tension type headache (<jats:styled-content style=\"fixed-case\">TTH<\/jats:styled-content>).<\/jats:p><\/jats:sec><jats:sec><jats:title>Objective<\/jats:title><jats:p>To evaluate gender differences in the presence of trigger points (TrPs) in the head, neck, and shoulder muscles and their relationship with headache features, pressure pain sensitivity, and anxiety in people with <jats:styled-content style=\"fixed-case\">TTH<\/jats:styled-content>.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Two hundred and ten (59 men, 151 women) patients with <jats:styled-content style=\"fixed-case\">TTH<\/jats:styled-content> participated. TrPs were bilaterally explored in the temporalis, masseter, suboccipital, upper trapezius, splenius capitis, and sternocleidomastoid muscles. Headache features were collected using a 4\u2010week headache diary. Trait and state anxiety levels were assessed using the State\u2010Trait Anxiety Inventory. Pressure pain thresholds (<jats:styled-content style=\"fixed-case\">PPTs<\/jats:styled-content>) over the temporalis, C5\/C6 joint, second metacarpal, and tibialis anterior were assessed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Women with <jats:styled-content style=\"fixed-case\">TTH<\/jats:styled-content> exhibited a significantly higher number of total (<jats:italic>P<\/jats:italic> = 0.027) and active (<jats:italic>P<\/jats:italic> = 0.030), but similar number of latent (<jats:italic>P<\/jats:italic> = 0.461), TrPs than men with <jats:styled-content style=\"fixed-case\">TTH<\/jats:styled-content>. Active TrPs in the temporalis, suboccipital, and splenius capitis muscles were the most prevalent in both men and women with <jats:styled-content style=\"fixed-case\">TTH<\/jats:styled-content>. The number of active TrPs was associated with anxiety levels (<jats:italic>r<\/jats:italic> = 0.217; <jats:italic>P<\/jats:italic> = 0.045) in women, but not in men (<jats:italic>P<\/jats:italic> = 0.453): the higher the number of active TrPs, the more the trait levels of anxiety. Women exhibited lower <jats:styled-content style=\"fixed-case\">PPT<\/jats:styled-content>s than men (all, <jats:italic>P<\/jats:italic> &lt; 0.001). In men, the number of active, but not latent, TrPs was negatively associated with localized <jats:styled-content style=\"fixed-case\">PPT<\/jats:styled-content>s (all, <jats:italic>P<\/jats:italic> &lt; 0.05), whereas in women, the number of active and latent TrPs was negatively associated with <jats:styled-content style=\"fixed-case\">PPT<\/jats:styled-content>s in all points (all, <jats:italic>P<\/jats:italic> &lt; 0.01): the higher the number of TrPs, the lower the widespread <jats:styled-content style=\"fixed-case\">PPT<\/jats:styled-content>s.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>This study described gender differences in the presence of TrPs in <jats:styled-content style=\"fixed-case\">TTH<\/jats:styled-content>. Women with <jats:styled-content style=\"fixed-case\">TTH<\/jats:styled-content> showed lower <jats:styled-content style=\"fixed-case\">PPTs<\/jats:styled-content> than men. The association between TrPs, anxiety levels, and pressure pain hyperalgesia seems to be more pronounced in women than in men with <jats:styled-content style=\"fixed-case\">TTH<\/jats:styled-content>.<\/jats:p><\/jats:sec>","DOI":"10.1111\/papr.12775","type":"journal-article","created":{"date-parts":[[2019,2,13]],"date-time":"2019-02-13T11:10:55Z","timestamp":1550056255000},"page":"522-529","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":20,"title":["Active Trigger Points Are Associated With Anxiety and Widespread Pressure Pain Sensitivity in Women, but not Men, With Tension Type Headache"],"prefix":"10.1111","volume":"19","author":[{"given":"Margarita","family":"Cigar\u00e1n\u2010M\u00e9ndez","sequence":"first","affiliation":[{"name":"Department of Psychology Universidad Rey Juan Carlos Alcorc\u00f3n Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carmen","family":"Jim\u00e9nez\u2010Antona","sequence":"additional","affiliation":[{"name":"Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine Universidad Rey Juan Carlos Alcorc\u00f3n Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paula","family":"Par\u00e1s\u2010Bravo","sequence":"additional","affiliation":[{"name":"Department of Nursing Universidad de Cantabria Cantabria Spain"},{"name":"Nursing Group IDIVAL Santander Cantabria Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stella","family":"Fuensalida\u2010Novo","sequence":"additional","affiliation":[{"name":"Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine Universidad Rey Juan Carlos Alcorc\u00f3n Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jorge","family":"Rodr\u00edguez\u2010Jim\u00e9nez","sequence":"additional","affiliation":[{"name":"Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine Universidad Rey Juan Carlos Alcorc\u00f3n Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"C\u00e9sar","family":"Fern\u00e1ndez\u2010de\u2010las\u2010Pe\u00f1as","sequence":"additional","affiliation":[{"name":"Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine Universidad Rey Juan Carlos Alcorc\u00f3n Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2019,3,12]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10072-013-1370-4"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(16)31678-6"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/ijcp.12650"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1111\/ane.12339"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.2174\/1573397112666151231113625"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1097\/AJP.0000000000000318"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11916-011-0216-0"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1097\/j.pain.0000000000000219"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1186\/s10194-018-0833-7"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1111\/head.12982"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11916-015-0503-2"},{"key":"e_1_2_7_13_1","volume-title":"Myofascial Pain and Dysfunction. 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