title: Widespread Pressure Pain Hypersensitivity Is Similar in Women With Frequent Episodic and Chronic Tension-Type Headache: A Blinded Case-Control Study.
abstract: OBJECTIVE
  To investigate differences in widespread pressure pain hyperalgesia in the trigemino-cervical and extra-trigeminal (distant pain-free) regions in women with frequent episodic (FETTH) and chronic (CTTH) tension-type headache.
  
  
  BACKGROUND
  It seems that people with tension-type headache exhibit central sensitization. No study has investigated differences between FETTH and CTTH in terms of widespread pressure pain hypersensitivity.
  
  
  METHODS
  Forty-three women with FETTH, 42 with CTTH, and 45 women without headache diagnosis were recruited. Pressure pain thresholds (PPTs) were bilaterally assessed over trigeminal area (ie, temporalis muscle), extra-trigeminal (ie, C5/C6 zygapophyseal joint), and two distant points (ie, second metacarpal and tibialis anterior muscle) by a blinded assessor. Clinical features of the headache were collected with a 4-week headache diary. Anxiety and depression were assessed using the Hospital Anxiety and Depression Scale (HADS).
  
  
  RESULTS
  The ANCOVA revealed that PPTs were significantly decreased bilaterally over trigeminal (mean differences ranging from 97.5 to 101.5 kPa), extra-trigeminal (from 94.3 to 114.5 kPa), and distant points (from 99.4 to 208.6 kPa) in both FETTH and CTTH groups compared with controls (all, P < .001). No differences between FETTH and CTTH were observed (all points, P > .217). Anxiety (all, P > .803) or depression (P > .206) did not influence pressure pain hyperalgesia. No associations between widespread pressure hypersensitivity and headache features were observed (all, P > .110).
  
  
  CONCLUSIONS
  Current results suggest the presence of similar local and widespread pressure hyperalgesia, not associated with anxiety or depression, in women with FETTH and CTTH supporting that localized and central manifestations are involved in both the episodic and chronic forms of tension-type headache.
authors.affiliation: Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos, Alcorcón, Spain.|Center for Sensory-Motor Interaction (SMI), Department of Health Science and Technology, School of Medicine, Aalborg University, Aalborg, Denmark.
authors.forename: María
authors.initials: M
authors.lastname: Palacios Ceña
authors.affiliation: Center for Sensory-Motor Interaction (SMI), Department of Health Science and Technology, School of Medicine, Aalborg University, Aalborg, Denmark.|Master in Sport Physiotherapy, University of Siena, Italy.|Poliambulatorio Fisiocenter, Collecchio (Parma), Italy.
authors.forename: Matteo
authors.initials: M
authors.lastname: Castaldo
authors.affiliation: Center for Sensory-Motor Interaction (SMI), Department of Health Science and Technology, School of Medicine, Aalborg University, Aalborg, Denmark.
authors.lastname: Kelun Wang
authors.affiliation: Department of Experimental Clinical Medicine, Headache Center, University of Parma, Italy.
authors.forename: Paola
authors.initials: P
authors.lastname: Torelli
authors.affiliation: Rehabilitative Sciences Occupational Unit - Policlinico S. Orsola-Malpighi, Department of Biomedical and Neurological Sciences, University of Bologna, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Pillastrini
authors.affiliation: Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos, Alcorcón, Spain.|Center for Sensory-Motor Interaction (SMI), Department of Health Science and Technology, School of Medicine, Aalborg University, Aalborg, Denmark.
authors.forename: César
authors.initials: C
authors.lastname: Fernández-de-Las-Peñas
authors.affiliation: Center for Sensory-Motor Interaction (SMI), Department of Health Science and Technology, School of Medicine, Aalborg University, Aalborg, Denmark.
authors.forename: Lars
authors.initials: L
authors.lastname: Arendt-Nielsen
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D001007:Anxiety; D016022:Case-Control Studies; D003863:Depression; D005260:Female; D005385:Fingers / Q000503:physiopathology; D006801:Humans; D006930:Hyperalgesia / Q000503:physiopathology* / Q000523:psychology; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000503:physiopathology; D017288:Pain Threshold; D011312:Pressure; D011569:Psychiatric Status Rating Scales; D016037:Single-Blind Method; D018781:Tension-Type Headache / Q000503:physiopathology* / Q000523:psychology; D012668:Trigeminal Ganglion / Q000503:physiopathology; D021801:Zygapophyseal Joint
keywords: pressure pain thresholds; sensitization; tension-type headache