Evidence of localized and widespread pressure pain hypersensitivity in           patients with tension-type headache: A systematic review and meta-analysis

Martín-Guerrero

et al. 2020

Applied Sciences

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Profiling groups of patients in clusters can provide meaningful insights into the features of the population, thus helping to identify people at risk of chronification and the development of specific therapeutic strategies. Our aim was to determine if spectral clustering is able to distinguish subgroups (clusters) of tension-type headache (TTH) patients, identify the profile of each group, and argue about potential different therapeutic interventions. A total of 208 patients (n = 208) with TTH participated. Headache intensity, frequency, and duration were collected with a 4-week diary. Anxiety and depressive levels, headache-related burden, sleep quality, health-related quality of life, pressure pain thresholds (PPTs), dynamic pressure thresholds (DPT) and evoked-pain, and the number of trigger points (TrPs) were evaluated. Spectral clustering was used to identify clusters of patients without any previous assumption. A total of three clusters of patients based on a main difference on headache frequency were identified: one cluster including patients with chronic TTH (cluster 2) and two clusters including patients with episodic TTH (clusters 0–1). Patients in cluster 2 showed worse scores in all outcomes than those in clusters 0–1. A subgroup of patients with episodic TTH exhibited pressure pain hypersensitivity (cluster 0) similarly to those with chronic TTH (cluster 2). Spectral clustering was able to confirm subgrouping of patients with TTH by headache frequency and to identify a group of patients with episodic TTH with higher sensitization, which may need particular attention and specific therapeutic programs for avoiding potential chronification.

Section: Discussionsupporting

confidence: 87%

Patient Profiling Based on Spectral Clustering for an Enhanced Classification of Patients with Tension-Type Headache

Pellicer-Valero

Martín-Guerrero

et al. 2020

Applied Sciences

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“…There is evidence supporting the presence of an altered nociceptive processing in patients with TMDs expressed by widespread lower pain thresholds to mechanical but not thermal stimuli [ 12 ]. In fact, widespread pressure hypersensitivity seems to be a common feature of musculoskeletal pain conditions of the head-neck region, such as TMD [ 12 ], or tension-type headaches [ 13 ].…”

Section: Clinical Examination Temporomandibular Pain Disordersmentioning

confidence: 99%

Clinical Reasoning for the Examination and Physical Therapy Treatment of Temporomandibular Disorders (TMD): A Narrative Literature Review

Piekartz²

2020

JCM

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The current narrative literature review aims to discuss clinical reasoning based on nociceptive pain mechanisms for determining the most appropriate assessment and therapeutic strategy and to identify/map the most updated scientific evidence in relation to physical therapy interventions for patients with temporomandibular disorders (TMDs). We will also propose an algorithm for clinical examination and treatment decisions and a pain model integrating current knowledge of pain neuroscience. The clinical examination of patients with TMDs should be based on nociceptive mechanisms and include the potential identification of the dominant, central, or peripheral sensitization driver. Additionally, the musculoskeletal drivers of these sensitization processes should be assessed with the aim of reproducing symptoms. Therapeutic strategies applied for managing TMDs can be grouped into tissue-based impairment treatments (bottom-up interventions) and strategies targeting the central nervous system (top-down interventions). Bottom-up strategies include joint-, soft tissue-, and nerve-targeting interventions, as well as needling therapies, whereas top-down strategies include exercises, grade motor imagery, and also pain neuroscience education. Evidence shows that the effectiveness of these interventions depends on the clinical reasoning applied, since not all strategies are equally effective for the different TMD subgroups. In fact, the presence or absence of a central sensitization driver could lead to different treatment outcomes. It seems that multimodal approaches are more effective and should be applied in patients with TMDs. The current paper also proposes a clinical decision algorithm integrating clinical diagnosis with nociceptive mechanisms for the application of the most appropriate treatment approach.

“…Pressure pain threshold (PPT) is a static measure of pain reflecting the basal state of pain perception in relation to the pressure experienced a patient [ 85 ]. In fact, PPT is one of the quantitative sensory tests most commonly used for characterization of TTH [ 5 ] and migraine [ 4 ]. Nevertheless, its reliability and validity are controversial.…”

Section: Discussionmentioning

confidence: 99%

“…Similarly, migraine has been ranked the third-highest cause of disability worldwide in both genders under the age of 50 years [ 3 ]. Both headaches feature the presence of pressure pain hyperalgesia [ 4 , 5 ]. This assumption is based on the results from several studies investigating sensitivity to pressure pain in both TTH [ 5 , 6 , 7 , 8 , 9 , 10 , 11 ] and migraine [ 12 , 13 , 14 , 15 ].…”

Section: Introductionmentioning

confidence: 99%

“…Both headaches feature the presence of pressure pain hyperalgesia [ 4 , 5 ]. This assumption is based on the results from several studies investigating sensitivity to pressure pain in both TTH [ 5 , 6 , 7 , 8 , 9 , 10 , 11 ] and migraine [ 12 , 13 , 14 , 15 ]. Additionally, migraine is also characterized by an increased sensitivity to visual or auditory stimulus during but also outside of the headache attack [ 4 , 16 ].…”

Section: Introductionmentioning

confidence: 99%

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Has the Phase of the Menstrual Cycle Been Considered in Studies Investigating Pressure Pain Sensitivity in Migraine and Tension-Type Headache: A Scoping Review

Curiel-Montero

Alburquerque‐Sendín

et al. 2021

Brain Sciences

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Objective: The aim of this scoping review was to identify if the phase of the menstrual cycle was considered in observational studies comparing pressure pain sensitivity between women with migraine or tension-type headache (TTH) and headache-free women. Methods: A systematic electronic literature search in PubMed, Medline, Web of Science, Scopus, and CINAHL databases was conducted. Observational studies including one or more groups with TTH and/or migraine comparing pressure pain thresholds (PPTs) were included. The methodological quality (risk of bias) was assessed with the Newcastle-Ottawa Scale. Authors, objectives, inclusion/exclusion criteria, size sample, female sample, tool to assess PPTs, mean age, and the use of any medication were extracted and analyzed independently by two authors. Results: From a total of 1404 and 1832 identified articles for TTH and migraine, 30 and 18 studies satisfied the criteria and were included. Nineteen (63.4%) studies assessing TTH patients and eleven (61.1%) assessing migraine patients showed a high risk of bias. The most common flaws were attributed to improper selection of control and control over other additional factors. Based on the systematic review, just one study including TTH and one including migraine patients considered the menstrual cycle. Conclusion: The results of this scoping review identified that the phase of the menstrual cycle has been rarely considered in studies investigating sensitivity to pressure pain in primary headaches, such as TTH or migraine, although there is evidence showing the relevance of the phase of the menstrual cycle in pain perception.