Bilateral widespread mechanical pain hypersensitivity as sign of central sensitization in patients with cluster headache. 2011

César Fernández-de-Las-Peñas, and Ricardo Ortega-Santiago, and María L Cuadrado, and Carlos López-de-Silanes, and Juan A Pareja
From the Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain; Esthesiology Laboratory of Universidad Rey Juan Carlos, Alcorcón, Spain (C. Fernández-de-las-Peñas and R. Ortega-Santiago); Esthesiology Laboratory of Universidad Rey Juan Carlos, Alcorcón, Spain; Department of Neurology of Hospital Clínico San Carlos, Madrid, Spain; Universidad Complutense, Madrid, Spain (M.L. Cuadrado); Department of Neurology and Neurophysiology of Fundación Hospital, Alcorcón, Spain (C. López-de-Silanes); Esthesiology Laboratory of Universidad Rey Juan Carlos, Alcorcón, Spain; Department of Neurology and Neurophysiology of Fundación Hospital, Alcorcón, Spain (J.A. Pareja).

OBJECTIVE To investigate bilateral widespread pressure pain hyperalgesia in deep tissues over symptomatic (trigemino-cervical) and nonsymptomatic (distant pain-free) regions in patients with cluster headache (CH). BACKGROUND Central sensitization is claimed to play a relevant role in CH. No study has previously searched for widespread pressure hyperalgesia in deep tissues over both symptomatic (trigemino-cervical) and nonsymptomatic (distant pain-free) regions in patients with CH. METHODS Sixteen men (mean age: 43 ± 11 years) with CH in a remission phase and 16 matched controls were recruited. Pressure pain thresholds (PPTs) were bilaterally measured over the supra-orbital (V1), infra-orbital (V2), mental (V3), median (C5), radial (C6), and ulnar (C7) nerves, C5-C6 zygapophyseal joint, mastoid process, and tibialis anterior muscle by an assessor blinded to the subjects' condition. RESULTS The results showed that PPT levels were significantly decreased bilaterally in patients with CH as compared with healthy controls (all sites, P < .001). A greater degree of sensitization over the mastoid process (P < .001) and a lower degree of sensitization over the tibialis anterior muscle (P < .01) was found. CONCLUSIONS Our findings revealed bilateral widespread pressure pain hypersensitivity in patients with CH confirming the presence of central sensitization mechanisms in this headache condition.

UI MeSH Term Description Entries
D008297 Male Males
D008875 Middle Aged An adult aged 45 - 64 years. Middle Age
D010525 Peripheral Nerves The nerves outside of the brain and spinal cord, including the autonomic, cranial, and spinal nerves. Peripheral nerves contain non-neuronal cells and connective tissue as well as axons. The connective tissue layers include, from the outside to the inside, the epineurium, the perineurium, and the endoneurium. Endoneurium,Epineurium,Perineurium,Endoneuriums,Epineuriums,Nerve, Peripheral,Nerves, Peripheral,Perineuriums,Peripheral Nerve
D011312 Pressure A type of stress exerted uniformly in all directions. Its measure is the force exerted per unit area. (McGraw-Hill Dictionary of Scientific and Technical Terms, 6th ed) Pressures
D002490 Central Nervous System The main information-processing organs of the nervous system, consisting of the brain, spinal cord, and meninges. Cerebrospinal Axis,Axi, Cerebrospinal,Axis, Cerebrospinal,Central Nervous Systems,Cerebrospinal Axi,Nervous System, Central,Nervous Systems, Central,Systems, Central Nervous
D003027 Cluster Headache A primary headache disorder that is characterized by severe, strictly unilateral PAIN which is orbital, supraorbital, temporal or in any combination of these sites, lasting 15-180 min. occurring 1 to 8 times a day. The attacks are associated with one or more of the following, all of which are ipsilateral: conjunctival injection, lacrimation, nasal congestion, rhinorrhea, facial SWEATING, eyelid EDEMA, and miosis. (International Classification of Headache Disorders, 2nd ed. Cephalalgia 2004: suppl 1) Ciliary Neuralgia,Headache, Cluster,Histamine Cephalgia,Horton Syndrome,Neuralgic Migraine,Atypical Cluster Headache,Chronic Cluster Headache,Cluster Headache Syndrome,Episodic Cluster Headache,Horton's Syndrome,Atypical Cluster Headaches,Cephalgia, Histamine,Cephalgias, Histamine,Chronic Cluster Headaches,Ciliary Neuralgias,Cluster Headache Syndromes,Cluster Headache, Atypical,Cluster Headache, Chronic,Cluster Headache, Episodic,Cluster Headaches,Cluster Headaches, Atypical,Cluster Headaches, Chronic,Cluster Headaches, Episodic,Episodic Cluster Headaches,Headache Syndrome, Cluster,Headache Syndromes, Cluster,Headache, Atypical Cluster,Headache, Chronic Cluster,Headache, Episodic Cluster,Headaches, Atypical Cluster,Headaches, Chronic Cluster,Headaches, Cluster,Headaches, Episodic Cluster,Histamine Cephalgias,Hortons Syndrome,Migraine, Neuralgic,Migraines, Neuralgic,Neuralgia, Ciliary,Neuralgias, Ciliary,Neuralgic Migraines,Syndrome, Cluster Headache,Syndrome, Horton,Syndrome, Horton's,Syndromes, Cluster Headache
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D006930 Hyperalgesia An increased sensation of pain or discomfort produced by minimally noxious stimuli due to damage to soft tissue containing NOCICEPTORS or injury to a peripheral nerve. Hyperalgesia, Tactile,Hyperalgesia, Thermal,Hyperalgia,Hyperalgia, Mechanical,Hyperalgia, Primary,Hyperalgia, Secondary,Allodynia,Allodynia, Mechanical,Allodynia, Tactile,Allodynia, Thermal,Hyperalgesia, Mechanical,Hyperalgesia, Primary,Hyperalgesia, Secondary,Hyperalgesic Sensations,Mechanical Allodynia,Mechanical Hyperalgesia,Tactile Allodynia,Thermal Allodynia,Allodynias,Hyperalgesias,Hyperalgesias, Thermal,Hyperalgesic Sensation,Mechanical Hyperalgia,Mechanical Hyperalgias,Primary Hyperalgia,Primary Hyperalgias,Secondary Hyperalgia,Secondary Hyperalgias,Sensation, Hyperalgesic,Sensations, Hyperalgesic,Thermal Hyperalgesia
D000328 Adult A person having attained full growth or maturity. Adults are of 19 through 44 years of age. For a person between 19 and 24 years of age, YOUNG ADULT is available. Adults
D014276 Trigeminal Nerve The 5th and largest cranial nerve. The trigeminal nerve is a mixed motor and sensory nerve. The larger sensory part forms the ophthalmic, mandibular, and maxillary nerves which carry afferents sensitive to external or internal stimuli from the skin, muscles, and joints of the face and mouth and from the teeth. Most of these fibers originate from cells of the TRIGEMINAL GANGLION and project to the TRIGEMINAL NUCLEUS of the brain stem. The smaller motor part arises from the brain stem trigeminal motor nucleus and innervates the muscles of mastication. Cranial Nerve V,Fifth Cranial Nerve,Nerve V,Nervus Trigeminus,Cranial Nerve, Fifth,Fifth Cranial Nerves,Nerve V, Cranial,Nerve Vs,Nerve, Fifth Cranial,Nerve, Trigeminal,Trigeminal Nerves,Trigeminus, Nervus

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