Pressure pain thresholds over the cranio-cervical region in headache: a systematic review and meta-analysis

Castien, René; Wouden, Johannes C. van der; Hertogh, Willem De

doi:10.1186/s10194-018-0833-7

Cited by 75 publications

(79 citation statements)

References 36 publications

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“…Central sensitization is not new in primary headaches. Recent reviews have reported that PPTs are consistently lower in patients with migraine or tension‐type headache when compared with asymptomatic healthy subjects, with the trigemino‐cervical region being the most sensitive area . Our findings supporting the presence of widespread pain hyperalgesia and central sensitization in individuals with CH agree with those of Ladda et al, Fernández‐de‐las‐Peñas et al, and Gil‐Martínez et al However, these studies included small samples (ranging from 16 to 20) and did not control for the presence of depressive and anxiety levels, which could modify the excitability of central pain pathways .…”

Section: Discussionsupporting

confidence: 88%

Widespread Hypersensitivity to Pressure Pain in Men With Cluster Headache During Prolonged Remission Is Not Related to the Levels of Depression and Anxiety

et al. 2019

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Background Diminished pressure pain thresholds (PPTs) have been found in patients with cluster headache (CH), suggesting the presence of central sensitization. However, it is not known whether sensitization persists over time during the asymptomatic periods. Objective To investigate if men with episodic CH in a long‐lasting remission phase exhibit widespread pressure pain hypersensitivity. Methods Forty men with episodic CH and 40 matched controls were enrolled. PPTs were assessed bilaterally over 1 trigeminal (temporalis muscle) and 3 extra‐trigeminal points (C5/C6 zygapophyseal joint, second metacarpal, tibialis anterior muscle) by a blinded assessor. Patients were assessed in a prolonged remission phase, at least 6 months after their last CH attack and without taking any medication. Depression and anxiety levels were assessed with the Hospital Anxiety and Depression Scale (HADS). For each point, differences in PPTs were evaluated with a multivariate mixed‐model analysis of covariance test, with side and group as main factors and depression and anxiety levels as covariates. Results PPTs were significantly decreased bilaterally over the temporalis muscle (mean difference: 85 to 100 kPa), C5/C6 zygapophyseal joint (mean difference: 65 to 80 kPa), second metacarpal (mean difference: 65 to 90 kPa), and tibialis anterior muscle (mean difference: 135 to 155 kPa) in patients with CH when compared to headache‐free subjects (all, P < 0.001). No effect of anxiety or depression levels was found. Conclusions Patients with CH exhibited bilateral widespread hypersensitivity to pressure pain during long‐lasting remission periods, which was not associated with depression or anxiety. These results support the persistence of central sensitization in episodic CH, even in remote asymptomatic phases.

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Section: Discussionsupporting

confidence: 88%

Widespread Hypersensitivity to Pressure Pain in Men With Cluster Headache During Prolonged Remission Is Not Related to the Levels of Depression and Anxiety

et al. 2019

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“…Pain tolerance refers to the maximum duration of experiencing a painful stimulus, beyond which pain is no longer bearable [3]. Pressure pain threshold (PPT) reflects pain sensitivity and can be quantitatively measured using a mechanical or electronic pressure algometer [4], which has been reported to be a reliable, objective instrument [5,6]. Trigger points in the neck and shoulders are commonly used for measuring PPT, but PPT can also be measured in muscles without trigger points [7].…”

Section: Introductionmentioning

confidence: 99%

Pressure Pain Threshold in Depression: Is There a Difference between Unipolar and Bipolar Depressed Patients?

Kizilkurt¹,

Niflioglu²,

Domaç³

et al. 2019

Int J Brain Disord Treat

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Objective: A complex relationship exists between mood and pain, which is supported by different pain tolerance in clinically depressed patients compared to healthy people. In the present study we aimed to investigate pressure pain threshold (PPT) in unipolar and bipolar depressed patients and assess any differences between these two diagnoses. Method: This study included 40 patients diagnosed with unipolar depression and 89 patients diagnosed with bipolar depression according to DSM-IV criteria, also 40 healthy, age and gender-matched subjects without any known disease that could affect pain threshold were included in the study as a control group. PPT for mechanical pressure was examined by a handheld algometer at three body points. Student's t-test and analysis of variance was used to assess statistical differences between groups. The predictive level was investigated by univariate and multivariable linear regressions. Results: Depressed patients had significantly higher PPT than that in controls, and bipolar depressed patients had significantly higher PPT than that in unipolar depressed patients. PPT was also significantly associated with gender and use of anticonvulsant drugs. Conclusion: Bipolar patient group was observed to have higher pain thresholds than unipolar depression and control group in this study. Therefore, better understanding of the pain risk and burden of this group is an important step in improving the clinical outcomes of these patients.

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“…5 Concerning the pathophysiologic process, more evidence for central sensitization (CS) in CTTH highlights the role of pain sensitivity in myofascial pericranial tissues. [6][7][8] Chronic tension-type headache is characterized by CS triggered by nociceptive peripheral inputs, ie, the release of allogenic substances by pericranial tissues. One study found that in patients with CTTH, the pressure pain thresholds were decreased in muscle and skin of the cephalic region more than in healthy controls.…”

mentioning

confidence: 99%

“…One study found that in patients with CTTH, the pressure pain thresholds were decreased in muscle and skin of the cephalic region more than in healthy controls. 8 Nociceptive inputs from the peripheral structures may activate painful afferents that produce an increase in peripheral sensitization. Peripheral sensitization is responsible for the plastic changes into the dorsal horn of the trigeminal nerve nucleus caudalis.…”

mentioning

confidence: 99%

Osteopathic Manipulative Therapy in Patients With Chronic Tension-Type Headache: A Pilot Study

Deodato¹,

Guolo²,

Monticco³

et al. 2019

Journal of Osteopathic Medicine

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Context: Nonpharmacologic treatment, such as osteopathic manipulative therapy (OMTh; manipulative care provided by foreign-trained osteopaths) may be a beneficial complementary treatment for tension-type headache. However, to the authors' knowledge, the benefit of OMTh in the management of tension-type headache has not been explored, especially chronic tension-type headache (CTTH). Objective: To investigate the effectiveness of OMTh compared with traditional treatment in reducing pain intensity, frequency, and duration of CTTH, and to evaluate the objective postural measurement of the forward head posture (FHP) as an integral parameter in the assessment of the effects of OMTh and traditional management of CTTH. Methods: Patients with CTTH were registered at the Headache Centre of Trieste in Italy. At the time of the study, none of the patients had been taking any headache prophylaxis in the past 3 months. A 3-month baseline period was recorded by all patients with an ad hoc diary. Patients were randomly placed in the test or control group using a simple randomization program in Excel (Microsoft). Patients in the OMTh group underwent a 3-month period of OMTh, and patients in the control group were treated with amitriptyline. Pain intensity, frequency, and duration of headaches, as well as FHP were analyzed. Results: The study enrolled 10 patients (mean [SD] age, 42.6 [15.2] years) in the OMTh group and 10 patients (51.4 [17.3] years) in the control group. The final assessment of OMTh patients showed statistically significant changes in all headache parameters: pain intensity decreased from a mean (SD) score of 4.9 (1.4) to 3.1 (1.1) (P=.002); frequency decreased from 19.8 (6) to 8.3 (6.2) days per month (P=.002); and the duration of headaches decreased from 10 (4.2) to 6 (3) hours (P=.01). Significant improvement of all parameters was found in the control group as well: pain intensity decreased from a mean (SD) score of 5.9 (0.7) to 4.2 (1.75) (P=.03); frequency decreased from 23.4 (7.2) to 7.4 (8.7) days per month (P=.003); and duration decreased from 7.8 (2.9) to 3.6 (2.1) hours (P=.002). Forward head posture significantly improved in OMTh patients (P=.003). Conclusions: Our data suggested that OMTh may be an effective treatment to improve headaches in patients with CTTH. Our results also suggest that OMTh may reduce FHP.

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Pressure pain thresholds over the cranio-cervical region in headache: a systematic review and meta-analysis

Cited by 75 publications

References 36 publications

Widespread Hypersensitivity to Pressure Pain in Men With Cluster Headache During Prolonged Remission Is Not Related to the Levels of Depression and Anxiety

Widespread Hypersensitivity to Pressure Pain in Men With Cluster Headache During Prolonged Remission Is Not Related to the Levels of Depression and Anxiety

Pressure Pain Threshold in Depression: Is There a Difference between Unipolar and Bipolar Depressed Patients?

Osteopathic Manipulative Therapy in Patients With Chronic Tension-Type Headache: A Pilot Study

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