Women with frequent episodic tension-type headache (FETTH) may have widespread pressure pain hypersensitivity in musculoskeletal structures and over nerve trunks, suggesting that altered central nociceptive processing does not only affect musculoskeletal areas, according to study results published in Pain Medicine.

The goal of the current study was to assess pressure sensitivity over nerve trunk areas in women with tension-type headache compared with healthy controls, taking the effects of anxiety and depression into consideration.

Pressure pain threshold (PPT) was assessed over several nerve trunk (greater occipital, median, radial, ulnar, common peroneal, tibialis posterior) and musculoskeletal (temporalis muscle, C5/C6 joint, tibialis anterior) structures with an electronic algometer. Participants were asked to keep a headache diary for 4 weeks in which they reported the number of headache days per week and the mean intensity and duration of each headache attack (hours per day). Hospital Anxiety and Depression Scale was used to assess levels of anxiety and depression.

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The study cohort included 32 women with FETTH (aged 18-25 years), and 32 matched healthy controls without a history of headache (aged 18-21 years). 

Women with FETTH were found to have widespread pressure pain hyperalgesia over musculoskeletal structures compared with healthy controls, as indicated by a bilateral reduction of PPTs over local (trigeminal), related segment (cervical spine), and distant pain-free (tibialis anterior) points. The between-groups PPT differences ranged from 30 kPa (C5/C6 joint) to 115 kPa (tibialis anterior). Women with FETTH also exhibited widespread pressure pain hyperalgesia over nerve trunks, with between-group differences in PPTs in these areas ranging from 40 kPa (median nerve) to 70 kPa (common peroneal nerve).

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There was a negative association between headache frequency and PPTs over the temporalis muscle (P =.013). PPTs were not found to have an effect on anxiety and depressive levels.

Study limitations include its cross-sectional design, the sole inclusion of women, low levels of anxiety and depression in the cohort, and the lack of assessment of kinesiophobia, which is associated with cutaneous allodynia and central sensitization.

“Women with FETTH exhibited widespread hyperalgesia to pressure pain over nerve trunks and likewise over musculoskeletal structures, suggesting that the presence of altered central nociceptive processing is not just restricted to musculoskeletal structures. These findings also suggest the presence of nerve tissue sensitization, which may further drive the process of central sensitization, leading to the symptoms often found in people with FETTH,” concluded the researchers.

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Caamaño-Barrios LH, Galán-Del-Río F, Fernández-de-Las-Peñas C, Plaza-Manzano G, Arendt-Nielsen L, Ortega-Santiago R. Widespread pressure pain sensitivity over nerve trunk areas in women with frequent episodic tension-type headache as a sign of central sensitization (published online July 22, 2019). Pain Med. doi:10.1093/pm/pnz146