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Bilateral Widespread Mechanical Pain Hypersensitivity as Sign of Central Sensitization in Patients With Cluster Headache

Authors

  • César Fernández-de-las-Peñas PT, PhD,

    1. 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).
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  • Ricardo Ortega-Santiago PT,

    1. 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).
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  • María L. Cuadrado MD, PhD,

    1. 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).
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  • Carlos López-de-Silanes MD,

    1. 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).
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  • Juan A. Pareja MD, PhD

    1. 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).
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  • Conflict of Interest: None.

C. Fernández de las Peñas, Facultad de Ciencias de la Salud, Universidad Rey Juan Carlos, Avenida de Atenas s/n, 28922 Alcorcón, Madrid, Spain.

Abstract

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.

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