Sensory Thresholds and Peripheral Nerve Responses in Chronic Tension-Type Headache and Neuropsychological Correlation

Abstract

Chronic tension-type headache (CTTH) is a common disease with no fully defined pathophysiological processes. We designed a study to value electrophysiological responses in these patients and their correlation with possible psychopathological manifestations in order to deepen understanding of central and peripheral mechanisms of CTTH. In 40 patients with CTTH and 40 healthy controls, we used electrical stimulation to determine sensory threshold (SPT) and pain perception threshold (PPT) and the characteristics of the electrophysiological sensory nerve action potential (SNAP): initial sensory response (ISR) and supramaximal response (SMR). We then calculated the intensity differences between thresholds (IDT), namely SPT-PPT, ISR-SMR and SMR-PPT, and correlated these IDTs with psychological characteristics: trait and state anxiety, depression, and emotional regulation. The SPT, together with the ISR and SMR thresholds, were higher (p < 0.01) in CTTH patients. The SMR-PPT IDT was smaller and correlated with significantly higher indicators of depression, state and trait anxiety, and poorer cognitive reappraisal. CTTH patients have less capacity to recognize non-nociceptive sensory stimuli, greater tendency toward pain facilitation, and a poor central pain control requiring higher stimulation intensity thresholds to reach the start and the peak amplitude of the SNAP. This is consistent with relative hypoexcitability of the Aβ nerve fibers in distant regions from the site of pain, and therefore, it could be considered a generalized dysfunction with a focal expression. Pain facilitation is directly associated with psychological comorbidity.

A Systematic Review on Effectiveness of Rajyoga Meditation on Chronic Tension Type Headache

“…Adverse effect was not reported in both the studies. [20] . It is observed that CTTH patients have significantly higher level of anxiety and depression compare to normal person [21] .…”

Effects of Dry Needling on Active Myofascial Trigger Points and Pain Intensity in Tension-Type Headache: A Randomized Controlled Study

“…This model established that the pain modulation process was deregulated by the sensitization of supraspinal structures and a decrease in the antinociceptive activity. These processes are combined by the effect of peripheral sensitization due to the excessive excitation of myelinated (Aδ) fibers and unmyelinated (C) afferents from peripheral nociceptors of the myofascial tissue [8]. A recent manuscript studying the trapezius muscle, as one of the muscles most frequently associated with myofascial pain in the neck and head region, and the cutaneous branches of spinal nerves that traverse it, established an interesting link between the entrapment neuropathy of the cutaneous branches of the dorsal rami of the spinal nerve traveling through the muscle and its fasciae and the myofascial pain evoked by the muscle [9].…”

“…TTH patients respond more intensely to painful stimuli, and also become more sensitive to a wider range of stimuli, resulting in hypersensitivity [8]. Recent studies have correlated this peripheral sensitization with the presence of myofascial trigger points (MTrPs), which are hypersensitive nodules with a local and referred pain pattern.…”

The Effect of State and Trait Anxiety on Pain-Pressure Threshold

“…Anxiety has been shown as a possible in uencer of pain-pressure thresholds, but its in uence is unclear. [9][10][11] Furthermore, Anxiety can be subdivided into two different constructs: state anxiety and trait anxiety.…”