Cephalic and extracephalic pressure pain thresholds in chronic tension-type headache

Schoenen, Jean; Bottin, D.; Hardy, F.; Gérard, Pascale

doi:10.1016/0304-3959(91)90198-7

Cited by 190 publications

(164 citation statements)

References 20 publications

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“…Furthermore, a strong positive correlation between tenderness, evaluated by manual palpation, and frequency of TTH was found, while no relation between tenderness and migraine frequency was seen [26]. Further studies carried out in patients with CTTH reported PPT values in the temporal region not dissimilar from those detected in patients with ETTH or in healthy controls [27].…”

Section: Pain Pressure Thresholdmentioning

confidence: 85%

Clinical neurophysiology of chronic daily headache

Tommaso¹,

Sciruicchio²,

Puca³

2000

J Headache Pain

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IntroductionChronic daily headache (CDH) occurs in almost 2% of general population. Although CDH is the most frequent headache disorder observed in headache centers [1], it is not clearly classified by International Headache Society (IHS) diagnostic criteria [2]. The clinical variability characterizing CDH suggests that the underlying causes are heterogeneous.The pathophysiology of chronic daily headache is still unclear. Clinical research of basic mechanisms is often inconclusive for the variability of the involved factors. Furthermore, there is a recent trend to use neurophysiological tests in the investigation of functional disorders in brain structures. These techniques permit the selective investigation of well-known circuits in the peripheral nervous system, spinal cord and brainstem, although other than expected neurophysiological responses may occur as a consequence of modulation in the complex investigated pathways. In order to evaluate the pathophysiology of chronic daily headache, several methodologies have been employed. ReflexologyNociceptive flexion reflex An objective method for measuring pain in humans is represented by the nociceptive flexion reflex (NFR). NFR has two successive components (RII and RIII). The RIII response is associated with pain sensation localized to the stimulation site. Nociceptive flexion reflexes are related to A-delta fiber activation. In normal subjects the value of the reflex threshold is strictly related to that of subjective pain perception.Sandrini and co-workers [3] observed a reduction of RIII reflex threshold, strictly related to the severity of the Abstract The pathophysiology of chronic daily headache is unclear. Clinical research aiming to elucidate causative mechanisms is often confounded by the variability of factors involved. Furthermore, there is a recent trend to use neurophysiological tests in the investigation of functional disorders in brain structures. In order to evaluate the pathophysiology of chronic daily headache, several methodologies have been employed. The aim of the present review is to relate the obtained results in the most frequently used neurophysiological tests to possible pathophysiological mechanisms of chronic daily headache. The neurophysiological findings suggest that a common neuronal dysfunction predisposes to primary headaches subtypes, whose chronicization may depend upon many factors, such as the influence of peripheral muscular factors and the dysfunction in central nociceptive modulation. These factors may explain the large variability observed in clinical features.

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Section: Pain Pressure Thresholdmentioning

confidence: 85%

Clinical neurophysiology of chronic daily headache

Tommaso¹,

Sciruicchio²,

Puca³

2000

J Headache Pain

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“…the lowest pressure stimulus that is perceived as painful, is normal in patients with episodic tension-type headache [57] and in groups of mixed episodic and chronic tension-type headache patients [58,59]. In contrast, pressure pain detection thresholds were decreased in patients with chronic tension-type headache in two studies [18,20].…”

Section: Neurophysiological Evidencementioning

confidence: 96%

“…increased excitability of neurons in the central nervous system generated by prolonged nociceptive input from the pericranial myofascial tissues, plays an important role in the pathophysiology of tension-type headache [16]. Sensitivity to the various stimulus modalities (pressure, thermal and electrical) is increased at both cephalic and extracephalic locations [4,[17][18][19][20]. This indicates that pain sensitivity in the central nervous system is increased in patients with chronic tension-type headache.…”

Section: Pathophysiological Hypothesesmentioning

confidence: 99%

“…Central mechanisms have only been sparsely investigated in tension-type headache, although it is increasingly evident that central factors are involved in the pathophysiology of this disorder [1,4,17,18]. Probably, the central mechanisms are more important for the pathophysiology of tension-type headache than previously anticipated [4].…”

Section: Pathophysiological Hypothesesmentioning

confidence: 99%

“…The decreased pain, thermal and electrical thresholds that have been reported in chronic tension-type headache patients [17,18] probably represent a central misinterpretation of the incoming signals. A study of the stimulus-response function to mechanical pressure [27] demonstrated for the first time that chronic tension-type headache has a physiological basis and is caused at least partly by qualitative changes in the central processing of sensory information, i.e.…”

Section: Neurophysiological Evidencementioning

confidence: 99%

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Pain and tension-type headache: a review of the possible pathophysiological mechanisms

Milanov

Богданова

2004

J Headache Pain

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Tension-type headache represents a considerable health problem and is one of the most costly diseases in the modern society. However, the knowledge about the pathophysiological mechanisms leading to this disorder is limited. The review presents a summary of available research and experimental data on the pathophysiological mechanisms and the recent pathophysiological models. Although the pain in tension-type headache clinically resembles pain from myofascial tissues, both peripheral and central mechanisms are believed to be involved. It is likely that myofascial nociception is important in episodic tension-type headache and that central mechanisms are involved in the pathophysiology of the chronic form. Neurophysiological investigations are introduced to be the most suitable to confirm an involvement of trigeminal pathways, to substantiate recent theories on sensitization phenomena, and to disclose the exact pain-control mechanisms. More studies are needed to elucidate the mechanisms leading to central sensitization and to develop new therapeutic strategies.

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