Objective

This meta-analysis evaluates pressure pain sensitivity values in symptomatic and distant pain-free areas comparing individuals with tension-type headache to controls.

Databases and data treatment

Electronic databases were searched for cross-sectional or prospective case-control studies comparing pressure pain thresholds in patients with tension-type headache to headache-free controls. Data were extracted by three reviewers. The methodological quality was assessed by the Newcastle-Ottawa Quality Assessment Scale. Meta-analyses of trigeminal, extra-trigeminal (neck) and distant pain-free areas in tension-type headache were compared to headache-free controls. Frequency of tension-type headache and gender were taken into account.

Results

Twenty studies were included. Patients with tension-type headache exhibited lower pressure pain thresholds than headache-free controls: Trigeminal (MD −49.11 kPa, 95% CI −66.05 to −32.17), cervical spine (MD −88.17 kPa, 95% CI −108.43 to −67.92) and distant pain-free areas (MD −98.43 kPa, 95% CI −136.78 to −60.09). Differences were significant for chronic, episodic, and mixed episodic and chronic tension-type headache within the trigeminal and neck (symptomatic areas), but only significant for chronic tension-type headache (MD −102.86, 95% CI −139.47 to −66.25 kPa) for distant pain-free areas. In general, women had lower pressure pain thresholds than men. The methodological quality ranged from fair (45%) to good (40%). The results showed a high heterogeneity and publication bias.

Conclusion

This first meta-analysis addressing pressure pain thresholds differences in symptomatic and distant pain-free areas between patients with tension-type headache and controls found low to moderate evidence supporting the presence of pressure pain hypersensitivity in the trigeminal and neck areas in tension-type headache in comparison with headache-free controls. Sensitivity to pressure pain was widespread only in chronic, not episodic, tension-type headache (moderate evidence).

Registration number: https://doi.org/10.17605/OSF.IO/R29HY

中文翻译：

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紧张型头痛患者局部和广泛的压痛超敏反应的证据：系统评价和荟萃分析。

客观的

这项荟萃分析评估了有症状和远处无痛区域的压痛敏感性值，将患有紧张型头痛的个体与对照组进行了比较。

数据库和数据处理

在电子数据库中搜索横断面或前瞻性病例对照研究，比较紧张型头痛患者与无头痛对照患者的压力痛阈值。数据由三位评审员提取。方法学质量由纽卡斯尔-渥太华质量评估量表评估。将紧张型头痛中三叉神经、三叉外（颈部）和远处无痛区域的荟萃分析与无头痛对照进行比较。考虑了紧张型头痛的频率和性别。

结果

纳入了 20 项研究。紧张型头痛患者的压痛阈值低于无头痛对照组：三叉神经（MD -49.11 kPa，95% CI -66.05 至 -32.17），颈椎（MD -88.17 kPa，95% CI -108.43 至 -67.92 ）和远处的无痛区域（MD -98.43 kPa，95% CI -136.78 至 -60.09）。三叉神经和颈部（症状区域）内的慢性、发作性和混合发作性和慢性紧张型头痛的差异显着，但仅对慢性紧张型头痛显着（MD -102.86，95% CI -139.47 至 -66.25 kPa ) 用于远处的无痛区域。一般来说，女性的压痛阈值低于男性。方法学质量从一般 (45%) 到良好 (40%) 不等。结果表明存在高异质性和发表偏倚。

结论

第一项荟萃分析解决了紧张型头痛患者和对照组之间有症状和远处无痛区域的压力痛阈值差异，发现低至中等证据支持紧张型头痛患者的三叉神经和颈部区域存在压力痛超敏反应与无头痛对照相比。对压痛的敏感性仅在慢性而非偶发性紧张型头痛中普遍存在（中等证据）。

注册号： https : //doi.org/10.17605/OSF.IO/R29HY