Generalized Mechanical Nerve Pain Hypersensitivity in Children With Episodic Tension-type Headache

PEDIATRICS Vol. 126 No. 1 July 2010, pp. e187-e194 (doi:10.1542/peds.2010-0012)
Daniel M. Fernández-Mayoralas, MD, PhDa,b, César Fernández-de-las-Peñas, PT, PhDc,d,e, Ricardo Ortega-Santiago, PTc,d, Silvia Ambite-Quesada, PT, MScf, Rodrigo Jiménez-García, MD, PhDg, Alberto Fernández-Jaén, MDa,b
a Department of Neuropediatry, Hospital Quirón de Madrid, Madrid, Spain;
b Department of Neuropediatry, Centro "CADE," Madrid, Spain;
c Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine,
d Esthesiology Laboratory,
f Department of Anatomy, and
g Preventive Medicine and Public Health Teaching and Research Unit, Department of Health Sciences, Universidad Rey Juan Carlos, Alcorcón, Spain; and
e Centre for Sensory-Motor Interaction, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark

OBJECTIVES The objective of this study was to analyze the presence of generalized pressure pain hypersensitivity over nerve tissues in trigeminal and nontrigeminal regions in children with frequent episodic tension-type headache (FETTH).

METHODS Thirty children, 7 boys and 23 girls (mean age: 8.8 ± 1.7 years) with FETTH and 50 age- and gender-matched healthy children (14 boys, 36 girls; mean age: 8.5 ± 2.1 years; P = .743) were recruited. Pressure pain thresholds (PPTs) were bilaterally assessed over supra-orbital (V1), infra-orbital (V2), mental (V3), median (C5), radial (C6), and ulnar (C7) nerves by an assessor who was blinded to the patient's condition.

RESULTS The analysis of variance showed that PPT levels were significantly bilaterally decreased over both trigeminal (supra-orbital, infra-orbital, and mental) and nontrigeminal (median, ulnar, and radial) nerves in children with FETTH as compared with control subjects (all sites, P < .001). There was a greater magnitude of PPT decrease within trigeminal nerves as compared with nontrigeminal nerves (P < .03). PPTs over infra-orbital (rs = –0.4, P < .05) and radial (rs = –0.5, P < .01) nerves were negatively correlated with the duration of headache attacks (P < .05).

CONCLUSIONS Our study revealed bilateral and generalized pressure hypersensitivity over both trigeminal and nontrigeminal nerves in children with FETTH. Diffuse hypersensitivity of peripheral nerves evidences the presence of hyperexcitability of the central nervous system in children with FETTH.

Abbreviations: PPT = pressure pain threshold • CNS = central nervous system • FETTH = frequent episodic tension-type headache • NPRS = numerical pain rate scale • BDI-II = Beck Depression Inventory, Second Edition • TTS = Total Tenderness Score • CI = confidence interval • ANOVA = analysis of variance

Accepted Mar 24, 2010.