The Journal of Headache and Pain

Official Journal of the "European Headache Federation" and of "Lifting The Burden - The Global Campaign against Headache"

The Journal of Headache and Pain Cover Image

Volume 15 Supplement 1

Abstracts from the 4th European Headache and Migraine Trust International Congress: EHMTIC 2014

Open Access

EHMTI-0163. Reduced neck and shoulder strength in patients with tension-type headache. A case control study

  • BK Madsen1,
  • K Søgaard2,
  • LL Andersen3,
  • JH Skotte3 and
  • RH Jensen1
The Journal of Headache and Pain201415(Suppl 1):C40

Published: 18 September 2014


Flexor MuscleMaximal Voluntary Isometric ContractionHeadache FrequencyShoulder AbductionPeripheral Muscle


Tension-type headache (TTH) is associated with increased muscle tenderness, with an increasing headache frequency and intensity. The potential role of the peripheral muscles in TTH is unclear, and it is unknown if tenderness is related to strength.


To compare muscle strength in neck and shoulder in TTH patients and healthy controls, by examining the Maximal Voluntary Isometric Contraction (MVC) during shoulder abduction, neck flexion and extension as well as the extension-flexion strength ratio of the neck.


60 TTH patients and, 30 sex and aged matched healthy controls were included. Inclusion criteria for patients TTH ≥8 days per month. The MVC in neck extensor and flexor muscles were tested with the subject seated upright. MVC in shoulder abduction was tested with the subject lying supine. The MVC tests were performed using a computerized dynamometer.


Compared to controls TTH patients had a significantly weaker neck extension (21.49±10.31Nm) vs. (17.07±9.16 Nm) (p= 0.02) resulting in a significantly lower Extension/Flexion moment ratio (p=0.03). TTH-patients also showed a tendency to significantly lower shoulder abduction strength (44.3±19.3 Nm) vs. (38.7, ±15.9 Nm.) (p = 0.05).


The reduced neck Extension/Flexion ratio due to decreased strength of the neck extensors and the borderline lower shoulder abduction strength, suggests an unbalanced muscle activity in TTH patients.

No conflict of interest.

Authors’ Affiliations

Neurology, Danish Headache Center, Glostrup, Denmark
Physical Activity and Health in Work Life, Institute of Sports Science and Clinical Biomechanics University of Southern Denmark, Odense, Denmark
NRCWE, National Research Centre for the Working Environment, Copenhagen, Denmark


© Madsen et al; licensee Springer. 2014

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


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