Pressure in head pain
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Understanding Pressure in Head Pain: Insights from Recent Research
Pressure Pain Thresholds in Headache Disorders
Pressure Pain Thresholds in Migraine, Tension-Type Headache, and Cervicogenic Headache
Research has shown that patients with migraine, tension-type headache (TTH), and cervicogenic headache (CeH) exhibit lower pressure pain thresholds (PPT) in the cranio-cervical region compared to healthy controls. This suggests a heightened sensitivity in these areas, potentially reflecting sensitization of the trigemino-cervical nucleus caudalis. The trapezius muscle, particularly, has been identified as a common site of reduced PPT in individuals with migraine and chronic TTH.
Pressure Pain Sensitivity in Tension-Type Headache
Patients with TTH demonstrate lower PPTs not only in symptomatic areas such as the trigeminal and cervical spine regions but also in distant pain-free areas, indicating widespread pressure pain hypersensitivity. This hypersensitivity is more pronounced in chronic TTH compared to episodic TTH. Additionally, women with TTH tend to have lower PPTs than men, highlighting a potential gender difference in pain sensitivity.
Myofascial Trigger Points and Tension-Type Headache
Myofascial trigger points (MTrPs) in the cervical musculature are significant in the context of TTH. Massage therapy targeting these MTrPs has been shown to reduce headache frequency and improve pressure-pain thresholds, although the placebo effect also plays a role in perceived pain reduction. This underscores the importance of considering MTrPs in the treatment of TTH.
Localized Pressure Pain Sensitivity in Nummular Headache
Nummular headache (NH) is characterized by focal pain within a small, defined area of the head. Studies have found that pressure pain sensitivity is significantly lower in the symptomatic area compared to non-symptomatic areas, supporting the notion that NH is a localized disorder with a peripheral source of pain.
Head Pain Referral in Migraine and Tension-Type Headache
Sustained pressure applied to specific cervical segments can reproduce typical head pain in both migraine and TTH sufferers. This suggests that cervical structures may play a role in the pathogenesis of these headaches.
Pressure Pain Thresholds in Cluster Headache
Cluster headache (CH) patients exhibit lower PPTs in both the head and deltoid regions, with the lowest values observed in the temporal muscle on the symptomatic side. This pattern is more evident during a cluster period than in remission, indicating a central mechanism in CH pathogenesis.
Pressure Sensitivity in Healthy Individuals and Headache Patients
A systematic review has shown that PPT values are generally lower in patients with TTH and migraine compared to healthy individuals, particularly in the temporalis, masseter, and frontalis muscles. This sensitivity is more pronounced in females than males. These findings provide a reference for PPT values in craniofacial muscles, aiding in the diagnosis and study of headache disorders.
Conclusion
The research highlights the significance of pressure pain thresholds in understanding various headache disorders. Lower PPTs in specific head and neck regions are common in migraine, TTH, CeH, and CH, indicating heightened sensitivity and potential central mechanisms. Myofascial trigger points and gender differences also play crucial roles in headache pain perception. These insights can guide more effective diagnosis and treatment strategies for headache sufferers.
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