Widespread Hypersensitivity to Pressure Pain in Men With Cluster Headache During Prolonged Remission Is Not Related to the Levels of Depression and Anxiety.

Abstract

Diminished pressure pain thresholds (PPTs) have been found in patients with cluster headache (CH), suggesting the presence of central sensitization. However, it is not known whether sensitization persists over time during the asymptomatic periods. To investigate if men with episodic CH in a long-lasting remission phase exhibit widespread pressure pain hypersensitivity. Forty men with episodic CH and 40 matched controls were enrolled. PPTs were assessed bilaterally over 1 trigeminal (temporalis muscle) and 3 extra-trigeminal points (C5/C6 zygapophyseal joint, second metacarpal, tibialis anterior muscle) by a blinded assessor. Patients were assessed in a prolonged remission phase, at least 6months after their last CH attack and without taking any medication. Depression and anxiety levels were assessed with the Hospital Anxiety and Depression Scale (HADS). For each point, differences in PPTs were evaluated with a multivariate mixed-model analysis of covariance test, with side and group as main factors and depression and anxiety levels as covariates. PPTs were significantly decreased bilaterally over the temporalis muscle (mean difference: 85 to 100kPa), C5/C6 zygapophyseal joint (mean difference: 65 to 80kPa), second metacarpal (mean difference: 65 to 90kPa), and tibialis anterior muscle (mean difference: 135 to 155kPa) in patients with CH when compared to headache-free subjects (all, P<0.001). No effect of anxiety or depression levels was found. Patients with CH exhibited bilateral widespread hypersensitivity to pressure pain during long-lasting remission periods, which was not associated with depression or anxiety. These results support the persistence of central sensitization in episodic CH, even in remote asymptomatic phases.