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

Cephalalgia ◽  
2020 ◽  
pp. 033310242095838
Author(s):  
César Fernández-de-las-Peñas ◽  
Gustavo Plaza-Manzano ◽  
Marcos J Navarro-Santana ◽  
Jes Olesen ◽  
Rigmor H Jensen ◽  
...  
Keyword(s):  
Methodological Quality ◽  
Meta Analysis ◽  
Tension Type Headache ◽  
Pain Thresholds ◽  
Pressure Pain ◽  
Pain Hypersensitivity ◽  
Moderate Evidence ◽  
Pressure Pain Thresholds ◽  
Type Headache ◽  
Distant Pain

Objective This meta-analysis evaluates pressure pain sensitivity values in symptomatic and distant pain-free areas comparing individuals with tension-type headache to controls. Databases and data treatment Electronic databases were searched for cross-sectional or prospective case-control studies comparing pressure pain thresholds in patients with tension-type headache to headache-free controls. Data were extracted by three reviewers. The methodological quality was assessed by the Newcastle-Ottawa Quality Assessment Scale. Meta-analyses of trigeminal, extra-trigeminal (neck) and distant pain-free areas in tension-type headache were compared to headache-free controls. Frequency of tension-type headache and gender were taken into account. Results Twenty studies were included. Patients with tension-type headache exhibited lower pressure pain thresholds than headache-free controls: Trigeminal (MD −49.11 kPa, 95% CI −66.05 to −32.17), cervical spine (MD −88.17 kPa, 95% CI −108.43 to −67.92) and distant pain-free areas (MD −98.43 kPa, 95% CI −136.78 to −60.09). Differences were significant for chronic, episodic, and mixed episodic and chronic tension-type headache within the trigeminal and neck (symptomatic areas), but only significant for chronic tension-type headache (MD −102.86, 95% CI −139.47 to −66.25 kPa) for distant pain-free areas. In general, women had lower pressure pain thresholds than men. The methodological quality ranged from fair (45%) to good (40%). The results showed a high heterogeneity and publication bias. Conclusion This first meta-analysis addressing pressure pain thresholds differences in symptomatic and distant pain-free areas between patients with tension-type headache and controls found low to moderate evidence supporting the presence of pressure pain hypersensitivity in the trigeminal and neck areas in tension-type headache in comparison with headache-free controls. Sensitivity to pressure pain was widespread only in chronic, not episodic, tension-type headache (moderate evidence). Registration number: https://doi.org/10.17605/OSF.IO/R29HY

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.

Pressure pain thresholds and thermal nociceptive thresholds in chronic tension-type headache

Pain ◽  
1989 ◽  
Vol 38 (2) ◽  
pp. 203-210 ◽  
Author(s):  
Michael Langemark ◽  
Kai Jensen ◽  
Troels S. Jensen ◽  
Jes Olesen
Keyword(s):  
Tension Type Headache ◽  
Pain Thresholds ◽  
Pressure Pain ◽  
Chronic Tension Type Headache ◽  
Pressure Pain Thresholds ◽  
Type Headache

Altered pain processing and sensitisation is evident in adults with patellofemoral pain: a systematic review including meta-analysis and meta-regression

2019 ◽  
Vol 20 (1) ◽  
pp. 11-27 ◽  
Author(s):  
Clare Bartholomew ◽  
Simon Lack ◽  
Bradley Neal
Keyword(s):  
Systematic Review ◽  
Meta Analysis ◽  
Symptom Duration ◽  
Pain Processing ◽  
Detection Thresholds ◽  
Pain Thresholds ◽  
Pressure Pain ◽  
Moderate Evidence ◽  
Pressure Pain Thresholds ◽  
Meta Regression

AbstractBackground and aimsPrevious systematic reviews have reported manifestations of pain sensitisation as a feature of painful knee disorders, in particular osteoarthritis, with moderate evidence for pain sensitisation in patellofemoral pain (PFP). However, despite past studies recruiting female mostly adolescent PFP patients, it is unclear if sex or age plays a role. Investigation is required to determine if altered pain processing is a key feature of PFP and if a subgroup of patients is at an increased risk to help provide targeted management. The primary aim of this systematic review was to examine evidence investigating pain processing in PFP. Secondary aims were to evaluate the relationship between pain processing and (1) sex, (2) age and (3) symptom duration.MethodsThe protocol was prospectively registered with PROSPERO (CRD42019129851). PubMed, CINAHL, Web of Science and EMBASE were systematically searched from inception to April 2019 for studies investigating pain processing in PFP patients compared to controls using quantitative sensory testing. Each included paper was assessed for methodological quality using a modified version of Downs and Black. Means and standard deviations were extracted to calculate standardised mean differences (SMD) and 95% confidence intervals (95% CI). Where possible meta-analysis and meta-regression were performed using a random effects model.ResultsEleven studies were identified, two medium and nine high quality. Meta-analysis indicates moderate evidence for decreased pressure pain thresholds (SMD −0.68, 95% CI −0.93 to −0.43), increased tactile detection thresholds (SMD 1.35, 95% CI 0.49–2.22) and increased warmth detection thresholds (SMD 0.61, 95% CI 0.30–0.92) in PFP patients compared to controls. Secondary analysis indicates moderate evidence for decreased pressure pain thresholds in female compared to male patients (SMD −0.75, 95% CI −1.34 to −0.16). Meta-regression indicates a moderate correlation between decreasing local and distal pressure pain thresholds and decreasing patient age (local R2 = 0.556, p = 0.0211; distal R2 = 0.491, p = 0.0354) but no correlation with symptom duration (p > 0.05).ConclusionsEvidence from this systematic review with meta-analysis and meta-regression appears to suggest the presence of altered pain processing and sensitisation in patients with PFP with increased sensitivity indicated in female patients and younger patients.ImplicationsWith evidence of altered pain processing and sensitisation in PFP, it may be beneficial for clinicians to consider management approaches that aim specifically at adressing neuropathic pain, for example neuroscience education, to improve patients outcomes. With female patients and younger patients indicated as experiencing greater degree of sensitivity, this may be a good demographic to start screening for sensitisation, in order to better identify and treat those most affected.

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