Characterization of migraineurs presenting interictal widespread pressure hyperalgesia identified using a tender point count: a cross-sectional study

Abstract

BackgroundMigraineurs exhibit pain hypersensitivity throughout the body during and between migraine headaches. Migraine is classified as a central sensitivity syndrome, typified by fibromyalgia showing widespread pressure hyperalgesia determined by a tender point. This study was performed to examine whether: 1) there is a subgroup of episodic migraineurs with widespread pressure hyperalgesia during and between attacks; 2) if such a subgroup exists, what is the prevalence and what is the difference between groups with interictal widespread hyperalgesia and acute allodynia regarding the demographic and clinical characteristics of migraine.MethodsThis was a cross-sectional study. A total of 176 consecutive episodic migraineurs and 132 age- and sex-matched controls were recruited. The presence of widespread pressure hyperalgesia was investigated using manual tender point survey. To classify a subject’s response as widespread pressure hyperalgesia, the cutoff value for responders was defined as the positive tender point count below which 95% of controls responded.ResultsBased on the number of positive tender points in controls, the cutoff value of tender point count for pressure hyperalgesia responders was 7. Of the 176 subjects, interictal widespread pressure hyperalgesia and acute allodynia were observed in 74 (42%) and 115 (65.3%) patients, respectively. Univariate analysis indicated that risk factors associated with interictal widespread pressure hyperalgesia were female gender, younger age at migraine onset, higher frequency of migraine attacks, severe headache impact, cutaneous allodynia and depression. Multivariate logistic regression analysis confirmed that independent risk factors associated with interictal widespread pressure hyperalgesia were female gender, higher frequency of migraine attack and younger age at onset.ConclusionInterictal widespread pressure hyperalgesia was common (42%) in the episodic migraineurs and was associated with younger age at onset, female gender, and higher frequency of headache, but not duration of migraine illness. Presence of interictal widespread pressure hyperalgesia is assumed to be an indicator of genetic susceptibility to migraine attacks. We expect that a tender point count, as an alternative to quantitative sensory testing, will become useful as a diagnostic indicator of interictal hyperalgesia in migraineurs to predict susceptibility to migraine attacks and to permit tailored treatment.Electronic supplementary materialThe online version of this article (10.1186/s10194-017-0824-0) contains supplementary material, which is available to authorized users.

Circadian rhythms of migraine attacks in episodic and chronic patients: a cross sectional study in a headache center population

“…The results are substantially negative in this sense, as frequency of migraine was similar among the different onset time groups, as well as pericranial tenderness and allodynia. As regard to allodynia, the most of migraine patients were classified as allodynic, according to previous studies of our group [ 14 , 15 ], and other researchers [ 27 – 29 ]. The distribution of allodynic and not allodynic patients was similar among the different circadian categories, so allodynia did not emerge as a peculiar characteristic of a specific circadian profile.…”

Cephalic cutaneous allodynia in children and adolescents with migraine of short duration: A retrospective cohort study

“…Researchers hypothesize that repeated or prolonged noxious stimulation may lead to sensitization and, consequently, a lower threshold for pain that can manifest clinically as allodynia. Given clinical findings over the last two decades in adults that allodynia is more frequently associated with chronic than episodic migraine and with longer duration of disease (9), it has been suggested that repeated migraine attacks may increase the severity of the disease concomitant with an increase in the risk of allodynia (1).…”

“…Cutaneous allodynia is defined as pain provoked by stimulation of the skin that would ordinarily not produce pain (1). It is considered a clinical expression of central nervous system sensitization in migraine.…”

Phenotypic features of central sensitization

“…arbormedicalinnovations.com/) (Harte et al, 2013(Harte et al, , 2016Henry et al, 2014;Schrepf et al, 2015;Wasserman et al, 2015)-an automated QST platform. In patients presenting with a localized pain complaint, increased pain sensitivity at remote or unaffected body areas is strongly suggestive of central pain mechanisms and is a common feature of the COPCs (Berkley, Cason, Jacobs, Bradshaw, & Wood, 2001;Chaves et al, 2016;Janig, 2015;Jayaram et al, 2015;McAllister, McGinty, Resuehr, & Berkley, 2009;Scheich et al, 2017;Toriyama, Horiuchi, & Hongo, 2017).…”