Abstract
BackgroundSensitivity of tissues can be measured by algometry. Decreased pressure pain thresholds over the cranio-cervical area are supposed to reflect signs of sensitization of the trigemino-cervical nucleus caudalis. A systematic review was conducted to assess the current scientific literature describing pressure pain threshold (PPT) values over the cranio-cervical region in patients with migraine, tension-type headache (TTH), and cervicogenic headache (CeH). A literature search was executed in three databases. The search strategy included the following keywords: migraine, TTH, CeH, PPT and algometry. A total of 624 papers was identified of which relevant papers were subsequently assessed for methodological quality. Twenty-two selected papers were assessed by two independent reviewers and the majority of studies scored low risk of bias on the selected items. Mean PPT values of several sites measured in the cranio-cervical region in patients with migraine, chronic TTH and CeH scored lower values compared to controls. The trapezius muscle (midpoint between vertebrae C7 and acromion) was the most frequently targeted site and showed significantly lower PPT values in adults with migraine (pooled standardized mean difference kPa: 1.26 [95%CI -1.71, −0.81]) and chronic TTH (pooled standardized mean difference kPa: -2.00 [95%CI -2.93, −1.08]). Most studies found no association between PPT values and headache characteristics such as frequency, duration or intensity. Further standardization of PPT measurement in the cranio-cervical region is recommended.
Highlights
Sensitivity of tissues can be measured by algometry
The following inclusion criteria were applied to decide if papers would be included for further evaluation: (a) headaches were classified as migraine, tension-type headache (TTH) or cervicogenic headache (CeH), (b) pain threshold measurements were applied in the cranio-cervical region, (c) scores on pressure pain threshold (PPT) were available, (d) research involved humans, (e) were case-control studies, and (f ) research was published after 2004
Found significant lower PPT values in participants with chronic TTH compared to controls with a pooled mean difference of -109.57 [95%CI -129.25, −89.88] (Table 4)
Summary
Sensitivity of tissues can be measured by algometry. Decreased pressure pain thresholds over the cranio-cervical area are supposed to reflect signs of sensitization of the trigemino-cervical nucleus caudalis. A systematic review was conducted to assess the current scientific literature describing pressure pain threshold (PPT) values over the cranio-cervical region in patients with migraine, tension-type headache (TTH), and cervicogenic headache (CeH). Mean PPT values of several sites measured in the cranio-cervical region in patients with migraine, chronic TTH and CeH scored lower values compared to controls. Pain perception studies in headache patients measuring muscle tenderness, including PPT, have clarified the pathophysiological mechanism in different types of headache. A narrative review reported on studies describing the correlation between PPT in the cervico-cephalic region and different types of headache in the period till 2010 [4]. The majority of studies included in that review showed several methodological shortcomings in not fulfilling the ICHD II criteria and standardization of PPT measurements.
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