Algometer Assessment of Pressure Pain Threshold After Onabotulinumtoxin-A and Physical Therapy Treatments in Patients With Chronic Migraine: An Observational Study

Abstract

The purpose of this study was to evaluate pain hypersensitivity in chronic migraine patients 3 months after undergoing onabotulinumtoxin-A therapy, physical therapy (PT), or the combination of the two. Pressure pain threshold (PPT) was assessed in accordance with Andersen's guidelines, focusing on five muscles in the trigeminocervical area (namely, trapezius, levator scapulae, temporalis, sub-occipitalis, and scalenus medius) and one muscle outside of the area, (i.e., tensor fasciae latae). Moreover, three headache parameters, namely, attack frequency, duration, and pain intensity, were recorded in an ad hoc diary kept by the patients. A total of 30 patients were included in three treatment groups: 1. onabotulinumtoxin-A therapy, 2. PT, and 3. a combination of onabotulinumtoxin-A and PT. The results show that, at the final assessment, the PPT was significantly reduced in the combined treatment group compared to the two single-therapy groups. As regards headache parameters, frequency and duration of the attacks were decreased significantly in all three treatment groups, whereas in pain intensity, the reduction was statistically significant in the combined treatment group and the onabotulinumtoxin-A therapy. Results suggest that a better pain modulation in patients with chronic migraine can be achieved with a combined treatment of onabotulinumtoxin-A and physical therapy. Indeed, the combination of both pharmacological and non-pharmacological treatments results in the reduction of both headache-related parameters and widespread pressure hyperalgesia.

Predictors of acute postoperative pain in patients with breast cancer

“…although the medical literature investigating pain threshold is scarce, algometry is a useful tool in assessing pain sensitivity (2). assessment of sensitivity to pain is particularly important for the identification of patients who are very sensitive to pain, as we have shown in our research (3).…”

“…For the attitudes of pain and pain coping mechanisms we applied questionnaires: pain sensitivity Questionnaire (psQ) and Coping strategies Questionnaire (CSQ) (2,3). PSQ offers a variety of everyday situations for which respondents have to estimate how painful that situation would 17.…”

Skin wetness sensitivity across body sites commonly affected by pain in people with migraine

“…13 As an example, people with migraine have been shown to have cutaneous allodynia and hypersensitivity in response to noxious and non-noxious mechanical and thermal stimuli when compared with healthy controls. [14][15][16][17] These findings could provide evidence on the potential mechanisms underlying the impact of changes in ambient temperature in triggering migraine. Specifically, it would be reasonable to hypothesize that a migraine-induced sensitization of nociceptive pathways and related decrease in thermal thresholds for discomfort and pain may result in a non-noxious change in skin temperature to be perceived as painful, 18 similar to what has been hypothesized for the hypersensitivity to light.…”

“…The pathophysiology of migraine has been linked to altered sensory processing 13 . As an example, people with migraine have been shown to have cutaneous allodynia and hypersensitivity in response to noxious and non‐noxious mechanical and thermal stimuli when compared with healthy controls 14–17 . These findings could provide evidence on the potential mechanisms underlying the impact of changes in ambient temperature in triggering migraine.…”

Neurophysiological and Clinical Outcomes in Episodic Migraine Without Aura: A Cross-Sectional Study

“…Reduced pressure pain threshold and increased muscle activity have been described in migraine because of peripheral and central sensitization over the trigeminal and extratrigeminal areas. 13,[15][16][17][18] Centrally, transcranial magnetic stimulation (TMS) is a well-validated and safe neurophysiological technique used to study the function of the cerebral cortex and, in particular, its excitability. 9,[19][20][21] Altered visual 22 and motor cortex 23 excitability have been described in migraine.…”