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Pain sensitivity and pericranial tenderness in children with tension-type headache: a controlled study
Ann-Britt L Soee1, Liselotte Skov, Svend Kreiner
1Department of Paediatrics, Children's Headache Clinic, Copenhagen University Hospital Herlev, Copenhagen, Denmark.
Insights
Children with tension-type headache (TTH) show increased tenderness but not altered pain sensitivity compared to healthy peers. This suggests TTH involves heightened tenderness, potentially reflecting central pain processing differences.
Area of Science:
- Pediatric Neurology
- Pain Medicine
- Clinical Psychology
Background:
- Tension-type headache (TTH) is common in children.
- Understanding pain mechanisms in pediatric TTH is crucial for effective treatment.
- Previous studies suggest altered pain sensitivity in adults with TTH.
Purpose of the Study:
- To compare tenderness and pain sensitivity in children with TTH and healthy controls.
- To utilize total tenderness score (TTS), pressure pain threshold (PPT), and suprapressure pain threshold (supraPPT) for assessment.
Main Methods:
- Included 23 children with frequent episodic TTH, 36 with chronic TTH, and 57 healthy controls.
- Measured TTS at seven pericranial myofascial structures.
- Assessed PPT and supraPPT in the finger, m. temporalis, and m. trapezius using a Somedic® algometer.
Main Results:
- Children with frequent episodic TTH and chronic TTH exhibited significantly higher tenderness scores compared to controls.
- No significant differences in PPT or supraPPT were found between TTH groups and controls.
- Factor analysis indicated that PPT and supraPPT measurements reflect central pain processing.
Conclusions:
- Increased pericranial tenderness is a characteristic feature of TTH in children.
- Pain sensitivity, as measured by PPT and supraPPT, does not appear to be altered in pediatric TTH.
- Findings suggest that central pain processing mechanisms may be involved in pediatric TTH.
Purpose:
To compare tenderness and pain sensitivity in children (aged 7-17 years) with tension-type headache (TTH) and healthy controls using total tenderness score (TTS), pressure pain threshold (PPT), and pain perceived at suprapressure pain threshold (supraPPT).
Patients And Methods:
Twenty-three children with frequent episodic TTH, 36 with chronic TTH, and 57 healthy controls were included. TTS was measured bilaterally at seven pericranial myofascial structures. PPT and supraPPT were assessed in the finger, m. temporalis, and m. trapezius by a Somedic® algometer. SupraPPT was defined as the pain perceived at a stimulus calculated as the individual site-specific PPT + 50%.
Statistics:
The effect of group, sex, age, headache frequency, intensity, and years on TTS, PPT, and supraPPT was analyzed by general linear models. Confirmatory factor analysis was analyzed for mutual relations between measurements.
Results And Conclusion:
Tenderness increased uniformly in both frequent episodic TTH (median 14; interquartile range [IQR] 10-18; P < 0.001) and chronic TTH (median 13; IQR 9-20; P < 0.001) compared to controls (median 5, IQR 3-11). However, the children with frequent episodic TTH and chronic TTH did not show significantly increased sensitivity when measured by PPT or supraPPT. Factor analysis confirmed that the site-specific measurements depended on general latent variables. Consequently, the PPT and supraPPT tests can be assumed to measure central pain-processing levels.
