Pericranial muscle tenderness and pressure-pain threshold in the temporal region during common migraine

Abstract

Twenty-six patients were examined during attacks of common migraine as well as during headache-free interval. Pericranial tenderness was scored blindly by a systematic manual palpation on both occasions by the same observer. Pressure-pain threshold (PPT) in a fixed location over the temporal muscle was determined by the use of a pressure algometer. A 28% increase in total tenderness score was observed during attacks (P less than 0.01). During unilateral attacks, tenderness scores were significantly higher on the ipsilateral side as compared to the contralateral (P less than 0.01). A positive correlation was observed between tenderness on the two sides (P less than 0.05) and the two occasions (P less than 0.01). PPT showed no changes during migraine attacks and there was no difference in PPT between the ipsilateral and contralateral side. A positive correlation was observed between PPT on the two sides and the two occasions (P less than 0.01). PPT was not correlated to the tenderness scores obtained by manual palpation. The absence of a decrease in PPT and the presence of several tender areas in multiple regions, particularly where pain was spontaneously reported to be located, suggest the presence of either a multi-focal peripheral pathological process or referred pain from other structures in the head and neck region.

Generalized Mechanical Pain Sensitivity Over Nerve Tissues in Patients With Strictly Unilateral Migraine

“…3,4 Central sensitization is usually apparent by increased tenderness to manual palpation and increased pressure pain sensitivity. Some studies have found increased pericranial tenderness in migraine patients during headache attacks, 5 and even in headache-free periods, 6 whereas others have not. 7 In contrast, an increased pressure pain sensitivity with lower pressure pain thresholds (PPTs) has been identified in tension-type headache, 8,9 but not in migraine.…”

Temporomandibular disorders and tension-type headache

“…It includes tooth clenching, bruxism, tongue thrust, nail or lip biting, sustained contraction of the craniofacial and cervical muscles, and so on. Muscle disorder may increase muscle tenderness at palpation and may be of importance in TTH [23][24][25][26][27][28], and, to some extent, in migraine [29][30][31]. Moreover, muscle disorder can lead to spontaneous myogenous pain in the craniofacial-cervical area [32,33].…”

Painful scalp arteries in migraine

“…Many studies have evaluated pressurepain threshold or tenderness or trigger points in pericranial muscles [1][2][3][4][5][6][7][8] and nerves [13]. Surprisingly, the most frequent ''trigger'' (not only ''tender'') points detected by Calandre et al [5] are located in the same areas (''anterior temporal'' in 42.6% and ''suboccipital'' in 33.4%) of the arteries we found to be most frequently painful.…”

“…Muscular or myofascial tender and trigger points, both pericranial and in the neck-shoulder region, have been extensively studied in migraine [1][2][3][4][5][6][7][8]. Although migraine is considered to be a neurovascular disorder, evaluation of pressure-painful scalp arteries has never been reported, probably due to the prevailing opinion that only intra-cranial neurovascular structures are involved in migraine.…”