title: Differences in Topographical Pressure Pain Sensitivity Maps of the Scalp Between Patients With Migraine and Healthy Controls.
abstract: OBJECTIVE
  To investigate differences in topographical pressure pain sensitivity maps of the scalp between patients with migraine and healthy controls considering the chronicity (episodic/chronic) and side (strictly unilateral/bilateral) of the symptoms.
  
  
  BACKGROUND
  It seems that the trigeminal area is sensitized in migraine. No study has investigated topographical pressure sensitivity maps of the scalp in patients with migraine.
  
  
  METHODS
  Pressure pain thresholds (PPTs) were assessed from 21 points distributed over the scalp in 86 patients with episodic migraine, 76 with chronic migraine, and 42 healthy age and matched healthy controls in a blinded design. Topographical pressure pain sensitivity maps based on interpolation of the PPTs were constructed. Clinical features of migraine, anxiety, and depression (Hospital Anxiety and Depression Scale, HADS) were collected.
  
  
  RESULTS
  The multivariate ANCOVA revealed significant differences in PPT between points (F = 55.674; P < .001) and groups (F = 5.316; P = .006), but not sides (F = 0.880; P = .417). No significant effect of gender (F = 0.897; P = .656), depression (F = 1.109; P = .220), or anxiety (F = 0.981; F = 0.569) was found. Post hoc comparisons revealed: (1) lower PPTs in both migraine groups than in healthy controls in all points (P < .001); (2) no significant differences between chronic or episodic migraine (P > .335) except for Fp1 (P = .045) and Fp2 (P = .017) points where subjects with chronic migraine had lower PPTs than those with episodic migraine; (3) no differences between bilateral/unilateral migraine (P > .417). An anterior to posterior gradient was found, with the lowest PPTs located in frontal regions and the highest PPTs in occipital areas (all groups, P < .001).
  
  
  CONCLUSIONS
  We found that patients with migraine exhibited generalized pressure pain hypersensitivity in the head as compared to healthy controls and that hypersensitivity was similar between episodic/chronic and unilateral/bilateral migraine. Topographical pressure pain sensitivity maps revealed an anterior to posterior gradient of pressure pain sensitivity in both migraine and control groups.
authors.affiliation: Headache Unit, Hospital Clínico Universitario de Valladolid, Valladolid, Spain.
authors.forename: Johanna
authors.initials: J
authors.lastname: Barón
authors.affiliation: Headache Unit, Hospital Clínico Universitario de Valladolid, Valladolid, Spain.
authors.forename: Marina
authors.initials: M
authors.lastname: Ruiz
authors.affiliation: Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos, Alcorcón, Spain.
authors.forename: María
authors.initials: M
authors.lastname: Palacios-Ceña
authors.affiliation: Physical Activity and Human Performance group, SMI, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark.
authors.forename: Pascal
authors.initials: P
authors.lastname: Madeleine
authors.affiliation: Headache Unit, Hospital Clínico Universitario de Valladolid, Valladolid, Spain.
authors.forename: Ángel L
authors.initials: ÁL
authors.lastname: Guerrero
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
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
mesh_terms: D000328:Adult; D001007:Anxiety / Q000503:physiopathology; D003863:Depression / Q000503:physiopathology; D005260:Female; D007839:Functional Laterality; D006801:Humans; D006930:Hyperalgesia / Q000503:physiopathology* / Q000523:psychology; D008297:Male; D008881:Migraine Disorders / Q000145:classification / Q000503:physiopathology* / Q000523:psychology; D015999:Multivariate Analysis; D010147:Pain Measurement; D017288:Pain Threshold; D011312:Pressure; D011569:Psychiatric Status Rating Scales; D012535:Scalp / Q000503:physiopathology*; D011795:Surveys and Questionnaires
keywords: head; migraine; pressure pain