Bilateral, wide-spread, mechanical pain sensitivity in children with frequent episodic tension-type headache suggesting impairment in central nociceptive processing

Cephalalgia ◽  
2010 ◽  
Vol 30 (9) ◽  
pp. 1049-1055 ◽  
Author(s):  
César Fernández-de-las-Peñas ◽  
Daniel M Fernández-Mayoralas ◽  
Ricardo Ortega-Santiago ◽  
Silvia Ambite-Quesada ◽  
Antonio Gil-Crujera ◽  
...  
Keyword(s):  
Tibialis Anterior ◽  
Trapezius Muscle ◽  
Tension Type Headache ◽  
Healthy Children ◽  
Wide Spread ◽  
Pressure Pain ◽  
Upper Trapezius ◽  
Pressure Pain Thresholds ◽  
Upper Trapezius Muscle ◽  
Type Headache

Introduction: The aim was to investigate bilateral, wide-spread pressure pain hyperalgesia in symptomatic (trigeminocervical) and non-symptomatic (pain-free distant) regions in children with frequent episodic tension-type headache (FETTH). Methods: Twenty-five children, 6 boys and 19 girls (mean age, 8.9 ± 1.8 years) with FETTH and 50 age- and sex-matched healthy children (12 boys, 38 girls; mean age: 8.8 ± 1.7 years) were recruited. Pressure pain thresholds (PPTs) were bilaterally assessed over temporalis muscle, upper trapezius muscle, second metacarpal and tibialis anterior muscles in a blinded design. Results: The results showed that PPT levels were significantly decreased bilaterally over the temporalis, upper trapezius and tibialis muscles, and the second metacarpal in children with FETTH as compared to controls (all sites, P < 0.001). No significant differences in the magnitude of PPT decrease between the upper trapezius muscle, second metacarpal and tibialis anterior muscles were found. PPT over both upper trapezius muscles were negatively correlated with the history and intensity of headache (rs = −0.415; P = 0.045). Conclusions: The findings revealed bilateral, wide-spread pressure pain hypersensitivity in children with FETTH suggesting that wide-spread central sensitisation is involved in children with this headache pain condition.

Generalized Neck-Shoulder Hyperalgesia in Chronic Tension-Type Headache and Unilateral Migraine Assessed by Pressure Pain Sensitivity Topographical Maps of the Trapezius Muscle

Cephalalgia ◽  
2009 ◽  
Vol 30 (1) ◽  
pp. 77-86 ◽  
Author(s):  
C Fernández-de-las-Peñas ◽  
P Madeleine ◽  
AB Caminero ◽  
ML Cuadrado ◽  
L Arendt-Nielsen ◽  
...  
Keyword(s):  
Pain Sensitivity ◽  
Trapezius Muscle ◽  
Tension Type Headache ◽  
Healthy Controls ◽  
Pressure Pain ◽  
Chronic Tension Type Headache ◽  
Pressure Pain Thresholds ◽  
Pressure Algometer ◽  
Type Headache ◽  
Topographical Maps

Spatial changes in pressure pain hypersensitivity are present throughout the cephalic region (temporalis muscle) in both chronic tension-type headache (CTTH) and unilateral migraine. The aim of this study was to assess pressure pain sensitivity topographical maps on the trapezius muscle in 20 patients with CTTH and 20 with unilateral migraine in comparison with 20 healthy controls in a blind design. For this purpose, a pressure algometer was used to assess pressure pain thresholds (PPT) over 11 points of the trapezius muscle: four points in the upper part of the muscle, two over the levator scapulae muscle, two in the middle part, and the remaining three points in the lower part of the muscle. Pressure pain sensitivity maps of both sides (dominant/non-dominant; symptomatic/non-symptomatic) were depicted for patients and controls. CTTH patients showed generalized lower PPT levels compared with both migraine patients ( P = 0.03) and controls ( P < 0.001). The migraine group had also lower PPT than healthy controls ( P < 0.001). The most sensitive location for the assessment of PPT was the neck portion of the upper trapezius muscle in both patient groups and healthy controls ( P < 0.001). PPT was negatively related to some clinical pain features in both CTTH and unilateral migraine patients (all P < 0.05). Side-to-side differences were found in strictly unilateral migraine, but not in those subjects with bilateral pain, i.e. CTTH. These data support the influence of muscle hyperalgesia in both CTTH and unilateral migraine patients and point towards a general pressure pain hyperalgesia of neck-shoulder muscles in headache patients, particularly in CTTH.

Association between widespread pressure pain hypersensitivity, health history, and trigger points in subjects with neck pain

2017 ◽  
Vol 16 (1) ◽  
pp. 168-168
Author(s):  
Matteo Castaldo ◽  
Antonella Catena ◽  
César Fernández-de-las-Peñas ◽  
Lars Arendt-Nielsen
Keyword(s):  
Neck Pain ◽  
Tibialis Anterior ◽  
Trapezius Muscle ◽  
Trigger Points ◽  
Pressure Pain ◽  
Pain Hypersensitivity ◽  
Health History ◽  
Upper Trapezius ◽  
Upper Trapezius Muscle ◽  
Extensor Carpi Radialis

Abstract Aims Health history (medical conditions, comorbid musculoskeletal pain, surgical operation, long term intake of medications) may contribute to central sensitization. The duration and the number of the peripheral nociceptive input seem to play a crucial role in the development and maintenance of sensitization. No study has previously investigated these relationships. Our aim was to investigate the association between pressure pain thresholds (PPTs) and health history in patients with neck pain, and the role of active trigger points (TrPs) on PPTs. Methods Thirty-four subjects with mechanical neck pain and 34 with whiplash-associated neck pain participated. They underwent an assessment of PPTs over upper trapezius, extensor carpi radialis longus, and tibialis anterior muscles, and were screened for the presence of active TrPs in upper trapezius muscle. Further, patients fulfilled a questionnaire investigating health history outcomes number and duration. Results Significant negative correlations between all PPTs and the duration of health history outcomes were found in both groups (all, P < 0.02), with no correlations between PPTs and the number of health history outcomes (all, P > 0.15). Significant lower PPTs over upper trapezius, extensor carpi radialis longus, and tibialis anterior (all, P < 0.01) muscles were found in subjects with active TrPs as compared to those with latent TrPs. Conclusions Widespread pressure pain hypersensitivity was associated with the duration, but not the number, of health history outcomes suggesting that long-lasting health complains may act as triggering factor driving sensitization in individuals with neck pain regardless the origin of neck pain. Patients with active TrPs in the upper trapezius muscle showed higher widespread pressure sensitivity than those with latent TrPs. These data should be included in the assessment of neck pain subjects, as they may be useful for planning the management of their symptoms.

Trigger points are associated with widespread pressure pain sensitivity in people with tension-type headache

Cephalalgia ◽  
2016 ◽  
Vol 38 (2) ◽  
pp. 237-245 ◽  
Author(s):  
María Palacios-Ceña ◽  
Kelun Wang ◽  
Matteo Castaldo ◽  
Amparo Guillem-Mesado ◽  
Carlos Ordás-Bandera ◽  
...  
Keyword(s):  
Pain Sensitivity ◽  
Tibialis Anterior Muscle ◽  
Trigger Points ◽  
Cross Sectional Study ◽  
Tension Type Headache ◽  
Cross Sectional ◽  
Pressure Pain ◽  
Upper Trapezius ◽  
Pressure Pain Thresholds ◽  
Type Headache

Objective To investigate the association between trigger points (TrPs) and widespread pressure pain sensitivity in people with tension-type headache (TTH) and to determine if this association is different between frequent episodic (FETTH) or chronic (CTTH) headache. Design A cross-sectional study. Methods One hundred and fifty-seven individuals (29% male) with TTH participated. Clinical features of headache, i.e., intensity, duration, and frequency, were recorded in a headache diary. Active and latent TrPs were bilaterally explored in the temporalis, masseter, suboccipital, upper trapezius, sternocleidomastoid, and splenius capitis muscles. Pressure pain thresholds (PPT) were assessed over the trigeminal area (i.e., temporalis muscle), extra-trigeminal (i.e., C5/C6 zygapophyseal joint), and two distant pain-free points (i.e., second metacarpal and tibialis anterior muscle). Results Eighty (51%) patients were classified as FETTH, whereas 77 (49%) were classified as CTTH. No differences in the number of either active or latent TrPs (all p > 0.171) or widespread pressure pain sensitivity (all p > 0.351) were observed between FETTH and CTTH groups. The number of active and latent TrPs was significantly and negatively associated with PPTs: The higher the number of active or latent TrPs, the lower the widespread PPT, and the more generalized sensitization. This association was stronger within the FETTH group than the CTTH group. Conclusions This study found that the number of TrPs in head and neck/shoulder muscles was associated with widespread pressure hypersensitivity independently of the frequency of headache.

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

2020 ◽  
Vol 10 (24) ◽  
pp. 9109
Author(s):  
Oscar J. Pellicer-Valero ◽  
César Fernández-de-las-Peñas ◽  
José D. Martín-Guerrero ◽  
Esperanza Navarro-Pardo ◽  
Margarita I. Cigarán-Méndez ◽  
...  
Keyword(s):  
Spectral Clustering ◽  
Dynamic Pressure ◽  
Trigger Points ◽  
Tension Type Headache ◽  
Therapeutic Interventions ◽  
Headache Frequency ◽  
Pressure Pain ◽  
Pressure Pain Thresholds ◽  
Type Headache ◽  
Cluster 2

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.

scholarly journals Association between Physiological and Subjective Aspects of Pain and Disability in Post-Stroke Patients with Shoulder Pain: A Cross-Sectional Study

2019 ◽  
Vol 8 (8) ◽  
pp. 1093 ◽  
Author(s):  
Martín-Martín ◽  
Membrilla-Mesa ◽  
Lozano-Lozano ◽  
Galiano-Castillo ◽  
Fernández-Lao ◽  
...  
Keyword(s):  
Shoulder Pain ◽  
Tibialis Anterior ◽  
Pain Perception ◽  
Stroke Patients ◽  
Pressure Pain ◽  
Negatively Associated ◽  
Post Stroke ◽  
Upper Trapezius ◽  
Pain Disability ◽  
Pressure Pain Thresholds

Background: Patients often experience pain as a result of a stroke. However, the mechanism of this pain remains uncertain. Our aim was to investigate the relationship between pressure pain thresholds (PPTs) and disability pain in patients with hemiplegic shoulder pain (HSP). Methods: Twenty-six post-stroke patients (age 53.35 ± 13.09 years) and healthy controls (54.35 ± 12.37 years) participated. We investigated spontaneous shoulder pain, disability pain perception through the shoulder pain and disability index (SPADI), and the PPTs over joint C5–C6, upper trapezius, deltoid, epicondyle, second metacarpal, and tibialis anterior, bilaterally. Results: The analysis of variance (ANOVA) showed significant differences in pain between groups (p < 0.001) and differences in the SPADI (p < 0.001) between groups but not between sides for PPTs over deltoid (group: p = 0.007; side: p = 0.750), epicondyle (group: p = 0.001; side: p = 0.848), and tibialis anterior (group: p < 0.001; side: p = 0.932). Pain in the affected arm was negatively associated with PPTs over the affected epicondyle (p = 0.003) and affected tibialis anterior (p = 0.009). Pain (SPADI) appeared negatively correlated with PPTs over the affected epicondyle (p = 0.047), and disability (SPADI) was negatively associated with PPTs over the affected tibialis anterior (p = 0.041). Conclusions: Post-stroke patients showed a relationship between widespread pressure pain hypersensitivity with lower PPT levels and pain disability perception, suggesting a central sensitization mediated by bilateral and symmetric pain patterns.

Influence of scapular position on the pressure pain threshold of the upper trapezius muscle region

2008 ◽  
Vol 12 (2) ◽  
pp. 226-232 ◽  
Author(s):  
Daniel Camara Azevedo ◽  
Tatiana Lima Pires ◽  
Fernanda Souza Andrade ◽  
Mary Kate McDonnell
Keyword(s):  
Pain Threshold ◽  
Pressure Pain Threshold ◽  
Trapezius Muscle ◽  
Pressure Pain ◽  
Upper Trapezius ◽  
Muscle Region ◽  
Upper Trapezius Muscle

Stretch Reflex and Pressure Pain Thresholds in Chronic Tension-Type Headache Patients and Healthy Controls

Cephalalgia ◽  
2009 ◽  
Vol 29 (5) ◽  
pp. 556-565 ◽  
Author(s):  
A Peddireddy ◽  
K Wang ◽  
P Svensson ◽  
L Arendt-Nielsen
Keyword(s):  
Stretch Reflex ◽  
Tension Type Headache ◽  
Healthy Controls ◽  
Pain Thresholds ◽  
Pressure Pain ◽  
Chronic Tension Type Headache ◽  
Control Subjects ◽  
Pressure Pain Thresholds ◽  
Type Headache ◽  
Masseter Muscles

To compare the jaw-stretch reflex and pressure pain thresholds (PPT) in chronic tension-type headache (CTTH) patients and healthy controls, 30 patients (15 male and 15 female) and 30 age- and sex-matched healthy subjects were investigated. Stretch reflexes were recorded in the temporalis and masseter muscles and PPT was determined in the anterior temporalis, splenius capitis and masseter muscles. The results showed that the amplitude of the stretch reflex in CTTH patients was higher compared with control subjects ( P < 0.045), and higher in women compared with men in the right and left anterior temporalis muscles ( P < 0.009). There were no differences in the PPT value between CTTH and control subjects ( P > 0.509), whereas women showed significantly lower PPT measurements ( P < 0.046). The results demonstrated a facilitation of the stretch reflex pathways in CTTH patients that is unrelated to measures of pericranial sensitivity.

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