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Pressure Pain Thresholds Across Nerve-Related and Muscular Sites in Frequent Episodic Tension-Type Headache: An
Rocío Carballo-Ponce1, Leandro H Caamaño-Barrios2, Alberto Nava-Varas1
1Escuela Internacional de Doctorado, Universidad Rey Juan Carlos, 28922 Alcorcón, Spain.
Journal of Clinical Medicine
|August 13, 2026
Summary
Pressure pain thresholds (PPTs) were lower in women with frequent episodic tension-type headache (TTH) compared to controls. Only the right greater occipital nerve showed significant differences after adjustments, indicating potential diagnostic value but with limitations.
Area of Science:
- Neuroscience
- Pain Research
- Diagnostic Accuracy Studies
Background:
- Pressure pain thresholds (PPTs) are key for assessing hyperalgesia in tension-type headache (TTH).
- Research on PPTs has primarily focused on muscular and segmental sites, neglecting peripheral nerve measurements.
- The diagnostic performance of PPTs over peripheral nerves in TTH remains under-explored.
Purpose of the Study:
- To compare PPTs at nerve and muscular sites between women with frequent episodic TTH and headache-free controls.
- To explore the discriminative performance of PPTs at various anatomical sites using ROC analysis.
- To derive exploratory, sample-specific cut-off values for PPT measurements.
Main Methods:
- A cross-sectional, case-control study involving 31 women with frequent episodic TTH and 32 controls.
- PPTs were measured over peripheral nerves (e.g., greater occipital, median, ulnar) and muscles (e.g., temporalis).
- ROC analyses were conducted to assess discrimination and determine exploratory cut-offs.
Main Results:
- Women with TTH exhibited lower PPTs across all measured locations compared to controls.
- After adjusting for age and applying Holm correction, only the right greater occipital nerve remained statistically significant (p=0.043).
- The right greater occipital nerve showed the highest AUC (0.706) and high specificity (0.969) at its exploratory cut-off, but low sensitivity (0.419).
Conclusions:
- Women with frequent episodic TTH generally have lower PPTs, but significant differences between groups were only found at the right greater occipital nerve.
- While the right greater occipital nerve demonstrated promising specificity, its low sensitivity and imprecise positive likelihood ratio limit its clinical utility for differential diagnosis.
- Findings highlight the need for further research into peripheral nerve PPTs for TTH diagnosis, acknowledging the exploratory nature and limitations of this study.
