Sage Journals: Discover world-class research

Abstract

Objectives

To explore the validity of the roller pressure algometer as a new tool for evaluating dynamic pressure sensitivity by assessing its association with pain features and widespread pressure pain sensitivity in migraine women, and also to determine whether dynamic pressure algometry differentiates between episodic and chronic migraine.

Methods

One hundred and twenty women with migraine (42% chronic, 58% episodic) participated. Dynamic pressure sensitivity was assessed with a set of roller pressure algometers (Aalborg University, Denmark®) consisting of 11 rollers with fixed pressure levels from 500 to 5300 g. Each roller was moved at a speed of 0.5 cm/sec over a 60 mm horizontal line covering the temporalis muscle. The dynamic pain threshold (the pressure level of the first painful roller) and pain elicited during the pain threshold (roller evoked pain) were determined. Static pressure pain thresholds were assessed over the temporalis muscle, C5/C6 joint, second metacarpal, and tibialis anterior.

Results

Side-to-side consistency between dynamic pain threshold (r_s = 0.769, p < 0.001) and roller evoked pain (r_s = 0.597; p < 0.001) were found. Women with chronic migraine exhibited bilateral lower dynamic pain thresholds (p < 0.01), but similar widespread pressure pain thresholds (all, p > 0.284) than those with episodic migraine. Dynamic pain threshold was moderately positively associated with widespread pressure pain thresholds (0.358 > r_s > 0.700, all p < 0.001). This association was slightly stronger in chronic migraine. Pain during dynamic pain threshold was negatively associated with widespread pressure pain thresholds (−0.336 < r_s < −0.235, all p < 0.01).

Conclusions

Roller pressure algometry was valid for assessing dynamic pressure sensitivity in migraine in the trigeminal area and is consistent with widespread static pressure pain sensitivity. Roller, but not static, pressure algometry differentiated between episodic and chronic migraine. Assessing static and dynamic deep somatic tissue sensitivity may provide new opportunities for evaluating treatment outcomes.

Keywords

Migraine dynamic pressure pain pressure pain threshold assessment

Introduction

Migraine is a primary headache disorder with an important burden for society (1). The worldwide prevalence of migraine ranges from 5% to 12% (2). A recent meta-analysis including 302 studies (n = 6,216,995 participants) reported that the global prevalence of migraine was 11.6%, being 13.8% among females and 6.9% among males (3). In addition, the general costs in Europe were €13.8 billion for headaches, including migraine and tension-type headache (4).

It is well accepted that migraine is associated with abnormal neuronal excitability leading to cortical spreading depression and to central sensitization of the trigemino-vascular pain pathways (5). This sensitization of pain pathways may result in facilitation of nociceptive gain due to sensitization of the trigemino-cervical nucleus caudalis (6). One of the most common clinical manifestations of central sensitization is the presence of hyperalgesia and allodynia. The most common tool for assessing mechanical hyperalgesia is static pressure algometry using a hand-held pressure algometer. Previous studies investigating pressure pain hyperalgesia in migraine sufferers, using algometry, had reported conflicting results since some studies reported pressure pain hyperalgesia, that is, lower pressure pain thresholds, in patients with migraine (7 –9) whereas others did not (10,11). A recent review concluded that individuals with migraine consistently show pressure pain hyperalgesia within the trigeminal area (12). Further, recent data suggests that individuals with migraine also exhibit widespread pressure pain hyperalgesia as a clinical manifestation of generalized sensitization (13). However, pressure algometry is statically applied to a localised spot, representing a static outcome of nociception in a restricted focal point. In fact, it is currently known that pain sensitivity varies greatly in the same muscle, for example, the temporalis (14).

It is important to note that quantitative sensory assessment in neuropathic pain conditions normally assesses both static hypersensitivity (e.g. a pinprick) and dynamic allodynia (e.g. brushing the skin). For instance, dynamic stroking over the skin, for example by a brush, is used to provoke dynamic cutaneous allodynia, which cannot be assessed by a static stimulus applied on a specific point (15,16). In fact, different studies, using structured questionnaires, reported that patients with migraine exhibit both dynamic and static cutaneous allodynia (17,18). Similarly, LoPinto et al. also observed the presence of dynamic and static cutaneous allodynia in migraine sufferers using a brush and von Frey monofilaments, respectively (19). However, there is no quantitative sensory testing used for assessing deep dynamic mechanical pain sensitivity. In fact, assessment of dynamic mechanical deep somatic sensitivity could give different information to static pressure algometry. A novel device, the roller pressure algometer, was recently developed to apply quantifiable dynamic pressure into a deep musculoskeletal structure (20). Finocchietti et al. demonstrated that roller pressure algometry was an easy-to-use and reliable tool for quantitative evaluation of spatial muscle pain hyperalgesia and may, as such, provide complementary information to static pressure algometry (20).

This new device can help with better understanding of nociceptive processing in primary headaches. Nevertheless, no study has previously evaluated roller pressure algometry in subjects with migraine. To explore the validity of the roller pressure algometer, the present study aimed to investigate its association with static pressure algometry and with migraine features in a sample of migraine women. Therefore, the objectives of our study were to investigate: a) the association between roller pressure algometry and the intensity, duration or frequency of migraine attack; b) the association between dynamic pressure sensitivity, as assessed with roller pressure algometry, and widespread pressure pain sensitivity, as assessed by static pressure algometry, in migraine sufferers; c) whether this association differs between women with episodic or chronic migraine; d) whether dynamic pressure algometry is able to differentiate between episodic and chronic migraine sufferers.

Methods

Participants

Consecutive women with migraine were recruited from a headache unit located in a tertiary university-based hospital between November 2014 and December 2016. Patients were diagnosed following the third edition of International Headache Society (ICHD-III) criteria down to third-digit level (code 1.1, 1.3) by an experienced neurologist (21). Migraine features including location, quality of pain, years with disease, the frequency (days/month), duration (hours/attack) and intensity of attacks, family history, and medication intake were standardized and collected in the clinical history.

Patients were excluded if they presented any of the following: a) another primary or secondary headache including medication overuse headache defined by the ICHD-III; b) previous cervical or head trauma (i.e. whiplash); c) a history of cervical herniated disk and/or cervical osteoarthritis on medical records; d) pregnancy; e) systemic medical disease, such as rheumatoid arthritis; f) comorbid diagnosis of fibromyalgia syndrome; or g) use of anesthetic block or botulinum toxin in the past six months. All subjects signed the informed consent form before their inclusion in the study. The local Ethics Committee of Hospital Clínico Universitario de Valladolid (PI 15/274) approved the study design.

The evaluations were conducted when all patients were headache-free, and when at least one week had elapsed since the last migraine attack to avoid migraine related allodynia in those with episodic migraine. In those patients with chronic migraine, evaluation was conducted at least three days after a migraine attack. Participants were asked to avoid any analgesic or muscle relaxant 24 hours prior to the examination. No change was made to their prophylactic treatment.

Deep dynamic pressure pain sensitivity

A roller pressure algometer was used as a new tool to evaluate dynamic pressure sensitivity (Aalborg University®, Denmark). The roller pressure algometer consisted of a wheel through which the assessor could apply 11 different rollers, each with a fixed load level of 500 g, 700 g, 850 g, 1350 g, 1550 g, 2200 g, 2500 g, 3100 g, 3500 g, 3850 g, and 5300 g, controlled by springs (Figure 1). The wheel, made of hard plastic, has a diameter of 35 mm and a width of 10 mm. The assessor maintained a constant pressure while the roller was moving at a speed of approximately 0.5 cm/sec. The track of the roller was around 60 mm, crossing over the temporalis muscle from anterior to posterior, with a total dynamically-stimulated area of 10 × 60 mm (Figure 2). The assessment was repeated two times on each side of the head. The second stimulation on the same side was applied when the pain provoked by the first stimulation disappeared.

Figure 1.

The dynamic pressure algometry set (Aalborg University, Denmark®). Each device consists of a wheel that applies a specific force through a spring connected to the handle while the experimenter moves it along the desired muscle.

Figure 2.

Assessment of dynamic mechanical sensitivity over the temporalis muscle.

The load level of the roller where the dynamic pressure was first perceived as painful was defined as the dynamic pressure threshold (DPT). Additionally, subjects were asked to rate the pain intensity perceived at the DPT level (roller-evoked pain) while the roller was moving over the temporalis muscle on a 10-point numerical pain rate scale (NPRS, 0: no pain, 10: maximum pain). The roller pressure algometer showed good reliability in both DPT and pain ratings with interclass correlation coefficients ranging from 0.75 to 0.88 (21).

Static pressure pain sensitivity

Static pressure pain thresholds (PPTs), that is, the pressure where a sensation of static pressure changes to pain, were bilaterally assessed with a handheld electronic pressure algometer (Somedic AB®, Farsta), over the temporalis muscle (trigeminal point), the C5/C6 zygapophyseal joint (extra-trigeminal point), and the second metacarpal and tibialis anterior muscle (distant pain-free points), by an assessor blinded to the migraine subtype. Participants were instructed to press the algometer’s stop button as soon as the pressure resulted in the first sensation of pain. Pressure was approximately increased at a rate of 30 kPa/s. The order of assessment was randomized between participants. Subjects practiced first on the wrist extensors of the right forearm for familiarization with the procedure. The mean of three trials on each point, with a 30 second resting period to avoid temporal summation of pain (22), was calculated and used for the analyses. The reliability of pressure algometry has previously been found to be high (23,24).

Sample size calculation

The sample size was calculated using Ene 3.0® software (Autonomic University of Barcelona, Spain) and was based on detecting significant moderate-large correlations (r = 0.7) between DPT and PPTs with an alpha level (α) of 0.05, and a desired power (β) of 90%. This generated a sample size of at least 42 subjects in each headache subtype (chronic or episodic migraine).

Statistical analysis

Data were analyzed with the SPSS statistical package (version 22.0). Descriptive data was collected on all patients. The Kolmogorov-Smirnov test revealed that quantitative data exhibited a normal distribution (p > 0.05). Since no side-to-side differences in PPTs were found, the mean of both sides on each point was used in the analysis. Dynamic pressure pain sensitivity was analyzed unilaterally to determine side-to-side consistency in the assessment. Differences in migraine pain features (i.e. frequency, intensity, duration), DPT, pain intensity during DPT, and PPTs between patients with chronic or episodic migraine were assessed with the unpaired Student’s t-test. Several Pearson correlation tests (r_s) were used to determine the potential associations between clinical variables relating to migraine; DPT, pain intensity during DPT, and widespread PPTs. Correlations were first calculated for the total sample and for chronic or episodic migraine groups. Correlations were considered weak when r < 0.3; moderate 0.3 < r < 0.7, and strong when r > 0.7 (25). The statistical analysis was conducted at a 95% confidence level. In general, a p-value < 0.05 was considered significant, but for multiple comparisons a Bonferroni adjustment of 0.017 (three comparisons) was applied.

Results

Clinical data of the sample

A total of 150 subjects with headache were screened for possible eligibility criteria. Finally, 120 women (mean age: 40 ± 12 years old) satisfied all eligibility criteria, agreed to participate, and signed the informed consent. The remaining 30 were excluded for the following reasons: co-morbid headaches (n = 18); previous head or neck trauma (n = 6), or pregnancy (n = 2), fibromyalgia (n = 2) or medication overuse headache (n = 2). Seventy (n = 70, 58%) were classified as having episodic migraine, whereas the remaining 50 (42%) were classified as having chronic migraine accordingly to the ICHD-III beta 2013. All patients were taking prophylactic drugs on a regular basis.

Differences between episodic and chronic migraine

Demographic data and outcome measures are listed in Table 1. Subjects with chronic migraine exhibited significantly higher frequency, but similar duration and intensity, of migraine attacks than those with episodic migraine (p < 0.001). No significant differences in PPTs were observed for any of the points between episodic and chronic migraine (all p > 0.284). Significant differences in DPT (p < 0.01) but not in pain intensity during DPT (p > 0.292), were found between episodic and chronic migraine: women with chronic migraine exhibited bilateral lower DPTs, that is, higher deep dynamic pressure sensitivity, than those with episodic migraine.

Table 1.

Clinical and demographic characteristics of patients with migraine.

	Episodic migraine (n = 70)		Chronic migraine (n = 50)
	Mean	95%CI	Mean	95% CI
Migraine features
Time of onset (years)	17.6	(14.5–20.7)	19.9	(15.9–23.9)
Intensity (NPRS, 0–10)	7.4	(7.0–7.8)	7.3	(6.9–7.7)
Frequency (days/month) #	5.1	(4.3–5.9)	19.3	(17.8–20.8)
Duration (hours/day)	20.3	(18.4–22.2)	19.4	(18.0–20.8)
Side (right/left/side-to-side)	20 (29%)/11 (16%)/39 (55%)		12 (24%)/8 (16%)/30 (60%)
Dynamic pressure algometry
DPT (gr.) #
Affected side	865.5	(768.5–962.5)	713.0	(616.5–809.5)
Non-affected side	895.0	(787.5–1002.5)	721.0	(626.5–815.5)
Pain during DPT (0–10)
Affected side	2.9	(2.5–3.3)	3.1	(2.5–3.7)
Non-affected side	3.0	(2.6–3.4)	3.4	(2.7–4.1)
Static pressure algometry (mean side-to-side scores)
C5-C6 joint (kPa)	174.0	(155.0–193.0)	175.0	(144.0–206.0)
Temporalis muscle (kPa)	182.5	(164.0–201.0)	175.5	(146.5–204.5)
Second metacarpal (kPa)	251.5	(225.5–277.5)	235.5	(204.0–267.0)
Tibialis anterior (kPa)	331.0	(304.0–358.0)	306.5	(266.0–347.0)

NPRS: Numerical Pain Rating Scale (0–10); DPT: Dynamic Pressure Threshold.

# Significant differences between patients with episodic and chronic migraine (p < 0.01)

Consistency of roller pressure algometer

A strong significant association between left-right DPT (r = 0.769, p < 0.001) but a moderate association between right-left pain during DPT (r = 0.597; p < 0.001) was found supporting side-to-side consistency of the roller pressure algometer. In addition, DPT was negatively associated with pain evoked during DPT in both sides (−0.219 < r < −0.187).

Dynamic pressure threshold and migraine features

A significant, but small, association between pain elicited during DPT with migraine intensity (r = 0.339, p = 0.001) was observed in the total sample. No significant associations were observed between DPT and clinical features of migraine, that is, intensity, frequency or duration (all p > 0.341).

Dynamic pressure threshold and static pressure pain sensitivity

The DPT was moderately and positively associated with PPTs in all the points assessed in both right side (C5-C6 joint: r = 0.482, p < 0.001; temporalis: r = 0.358, p < 0.001; second metacarpal: r = 0.495, p < 0.001; tibialis anterior: r = 0.700, p < 0.001, Figure 3) and left side (C5-C6 joint: r = 0.364, p < 0.001; temporalis: r = 0.370, p < 0.001; second metacarpal: r = 0.369, p < 0.001; tibialis anterior: r = 0.564, p < 0.001, Figure 4): the lower the DPT, the lower the static PPTs, that is, the greater the widespread pressure pain hypersensitivity.

Figure 3.

Scatter plots of correlations between the dynamic pressure threshold (DPT) on the right side with pressure pain thresholds (PPT) over C5-C6 zygapophyseal joint (a), temporalis muscle (b), second metacarpal (c) and tibialis anterior muscle (d) in the total sample (n = 120). Note that several points are overlapping. A positive linear regression line is fitted to the data.

Figure 4.

Scatter plots of correlations between the dynamic pressure threshold (DPT) on the left side with pressure pain thresholds (PPT) over C5-C6 zygapophyseal joint (a), temporalis muscle (b), second metacarpal (c) and tibialis anterior muscle (d) in the total sample (n = 120). Note that several points are overlapping. A positive linear regression line is fitted to the data.

Further, pain elicited during DPT (roller-evoked pain) also showed significant negative, but small, associations with PPT in all points on the right (C5-C6 joint: r = −0.346, p < 0.001; temporalis: r = −0.255, p < 0.001; second metacarpal: r = −0.318, p = 0.014; tibialis anterior: r = −0.200, p = 0.029, Figure 5) and left (C5-C6 joint: r = −0.294, p < 0.001; temporalis: r = −0.336, p < 0.001; second metacarpal: r = −0.336, p < 0.001; tibialis anterior: r = −0.235, p = 0.01, Figure 6) sides: The higher the roller-evoked pain during the DPT, the lower the widespread PPTs, for example, the greater the pressure pain sensitivity.

Figure 5.

Scatter plots of correlations between the pain elicited during the dynamic pressure threshold (DPT) on the right side with pressure pain thresholds (PPT) over C5-C6 zygapophyseal joint (a), temporalis muscle (b), second metacarpal (c) and tibialis anterior muscle (d) in the total sample (n = 120). Note that several points are overlapping. A negative linear regression line is fitted to the data.

Figure 6.

Scatter plots of correlations between the pain elicited during the dynamic pressure threshold (DPT) on the left side with pressure pain thresholds (PPT) over C5-C6 zygapophyseal joint (a), temporalis muscle (b), second metacarpal (c) and tibialis anterior muscle (d) in the total sample (n = 120). Note that several points are overlapping. A negative linear regression line is fitted to the data.

Dynamic pressure threshold and static pressure sensitivity by frequency of headaches

When grouping by the frequency of headaches, consistent results were found. Within the episodic migraine group, DPT was also positively associated with widespread PPT in both right (C5-C6 joint: r = 0.465; temporalis: r = 0.379, second metacarpal: r = 0.406; tibialis anterior: r = 0.672, all p < 0.001) and left (C5-C6 joint: r = 0.430; temporalis: r = 0.323; second metacarpal: r = 0.386; tibialis anterior: r = 0.548; all p < 0.001) sides, whereas pain during DPT was negatively associated with PPT in both right (C5-C6 joint: r = −0.291; temporalis: r = −0.347; second metacarpal: r = −0.271; tibialis anterior: r = −0.230, all p < 0.01) and left (C5-C6 joint: r = −0.231; temporalis: r = −0.295; second metacarpal: r = −0.261; tibialis anterior: r = −0.236, all p < 0.05) sides.

Similarly, in the chronic migraine group, DPT was positively associated with widespread PPT in both right (C5-C6 joint: r = 0.673; temporalis: r = 0.632, second metacarpal: r = 0.656; tibialis anterior: r = 0.750, all p < 0.001) and left (C5-C6 joint: r = 0.501; temporalis: r = 0.590; second metacarpal: r = 0.520; tibialis anterior: r = 0.707; all p < 0.001) sides, whereas pain during DPT was negatively associated with PPT in right (C5-C6 joint: r = −0.396; temporalis: r = −0.305; second metacarpal: r = −0.294; tibialis anterior: r = −0.293, all p < 0.05) and left (C5-C6 joint: r = −0.353; temporalis: r = −0.367; second metacarpal: r = −0.395; tibialis anterior: r = −0.339, all p < 0.05) sides.

Discussion

This study supports roller pressure algometry as a new tool for assessing dynamic muscle pressure sensitivity within the trigeminal area in women with migraine. Dynamic pain thresholds and the dynamically induced pain were associated with widespread static pressure sensitivity in both episodic and chronic migraine. This supports that dynamic pressure sensitivity in the trigeminal area is consistent with widespread pressure pain sensitivity in this population, and may show further additional information related to different underlying etiologic mechanisms between statically and dynamically applied stimuli, and therefore may be clinically applied.

Deep dynamic mechanical sensitivity assessment

Quantitative sensory testing (QST) guidelines for neuropathic pain include the assessment of static and dynamic mechanical allodynia for cutaneous pain sensitivity, and assessment of static deep mechanical sensitivity (26), but no specific testing is proposed for assessing the dynamic mechanical musculoskeletal sensitivity of deep tissues. In fact, this was the objective for developing the roller pressure algometer: The quantitative evaluation of spatial aspects of muscle pain hyperalgesia (20). We have defined the dynamic pressure threshold (DPT) as the lowest roller force (between the fixed load levels) perceived as painful by the patient; a similar definition is used for static PPTs. The main difference between both thresholds is that PPT is a static measure on a specific point and DPT is a dynamic measure of deep sensitivity of a larger stimulated deep area. In fact, dynamic pressure algometry differs from static pressure algometry in the volume of tissue stimulated. We also found that DPTs in the temporalis muscle were inferior to PPTs over the muscle belly (almost 50%) which suggests that dynamic deep muscle sensitivity may be higher than static deep muscle sensitivity. It could be possible that DPTs provide complementary information to PPTs by different stimulation of deep nociceptors or by activating different neural networks. Further, the assessment of dynamic deep sensitivity would be also complementary to mechanical cutaneous sensitivity evaluation.

In our study, we observed strong side-to-side correlations between DPTs and moderate side-to-side correlations between the roller-evoked pain during assessment, supporting the consistency of the roller pressure algometry. In fact, strong side-to-side correlations of QST usually predict that reliability of the outside should be high (27). This hypothesis was supported by a previous study where DPT showed high reliability (ICC > 0.88) (20). Current data suggests that DPTs can exhibit similar reliability to PPTs, although further studies in different body areas are needed.

Deep dynamic mechanical sensitivity in migraine

Our study is the first one to investigate dynamic pressure pain sensitivity in women with migraine. We found no significant differences in widespread PPTs between women with chronic and episodic migraine, in agreement with previous results (13). Interestingly, women with chronic migraine exhibited bilateral lower DPTs than those with episodic migraine, suggesting that maybe the roller pressure algometer is more sensitive than static algometry for detecting differences between episodic and chronic migraine. In fact, patients with chronic migraine have shown higher prevalence of cutaneous allodynia than those with episodic migraine (28,29). Nevertheless, since no normative data for DPTs in healthy individuals is available, we cannot confirm the presence of deep dynamic pressure hyperalgesia in our sample of migraine sufferers; however, it seems that lower DPTs are related to chronicity of pain.

An important finding of our study was that DPTs showed moderate associations with PPTs in trigeminal, extra-trigeminal and distant pain-free points in both episodic and chronic migraine, suggesting that dynamic pressure assessment is a tool correlated with widespread pressure pain sensitivity in women with migraine. These findings would support the validity of roller pressure algometry for evaluating pressure pain sensitivity in headache since it may be used as an outcome of altered nociceptive pain processing. Further, dynamic pressure hyperalgesia can be also used as a simple clinical bedside test and as a quantitative tool in treatment profiling studies. It would be important to investigate dynamic pressure algometry and its relationship with static pressure pain algometry in other conditions to evaluate its predictive value for treatment outcomes.

Finally, we found a weak association between roller-evoked pain during DPT with the intensity of migraine attacks. No other association with clinical features was observed. It should be pointed out that the association of PPTs, a neuro-physiological outcome, with clinical outcomes is conflicting, since it seems that pain and disability do not exhibit a clear association with PPTs, at least, in spinal pain disorders (30).

Strengths and limitations

Although the strengths of this study include a large sample size, the inclusion of both episodic and chronic migraine groups according to the most updated diagnostic criteria, and the use of a new sensory measurement, we should recognize some potential limitations. First, only women with migraine were included. It is known that women have less efficient pain habituation, greater susceptibility to mechanical excitability, and less efficient inhibitory pathways than men (31). It is not known if the current results would be similar in men suffering from migraine. Second, women were recruited from tertiary care hospitals, which may explain why all patients were taking preventive medication on a regular basis. Therefore, our sample may represent a specific group of the general population with migraine. Third, the role of psychological variables such as anxiety, depression, or sleep disturbances, which may potentially influence pressure sensitivity, were not included in our study. Finally, the lack of a control group without headache does not permit determination of the presence of deep dynamic pressure hyperalgesia as a manifestation of central sensitization in our sample of women with migraine. Future studies assessing normative data in healthy people with the dynamic pressure algometer would help to clarify this. Future studies are now needed to further determine the clinical relevance of dynamic algometry in chronic pain conditions.

Conclusions

This study describes roller pressure algometry as a new tool for assessing dynamic pressure sensitivity of deep tissues in the trigeminal area in women with migraine. Dynamic pressure pain thresholds and the roller-evoked pain were associated with widespread static pressure sensitivity independently of the frequency of migraine attacks. Dynamic, but not static, pressure algometry was able to differentiate between episodic and chronic migraine. Assessing static and dynamic deep somatic tissue pain sensitivity may provide a new tool for assessing treatment effects in migraine.

Key findings

This study found that dynamic pressure algometry in the temporalis muscle was associated with widespread pressure pain sensitivity in women with migraine.

Dynamic, but not static, pressure algometry was able to differentiate between episodic and chronic migraine sufferers.

Dynamic deep somatic tissue sensitivity may provide new information for treatment outcomes.

Footnotes

Acknowledgement

The authors would like to acknowledge the Shionogi Science Program.

Declaration of conflicting interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

References

Dowson

. The burden of headache: Global and regional prevalence of headache and its impact. Int J Clin Pract Suppl 2015; 182: 3–7.

GBD 2015 disease and injury incidence and prevalence collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990–2015: A systematic analysis for the Global Burden of Disease Study 2015. Lancet 2016; 388: 1545–602.

Woldeamanuel

Cowan

. Migraine affects 1 in 10 people worldwide featuring recent rise: A systematic review and meta-analysis of community-based studies involving 6 million participants. J Neurol Sci 2017; 372: 307–315.

Raggi

Leonardi

. Burden and cost of neurological diseases: A European North-South comparison. Acta Neurol Scand 2015; 132: 16–22.

de Tommaso

Sciruicchio

. Migraine and central sensitization: Clinical features, main co-morbidities and therapeutic perspectives. Curr Rheumatol Rev 2016; 12: 113–126.

Aguggia

Saracco

Cavallini

et al.

Sensitization and pain. Neurol Sci 2013; 34: S37–S40.

Kitaj

Klink

. Pain thresholds in daily transformed migraine versus episodic migraine headache patients. Headache 2005; 45: 992–998.

Florencio

Giantomassi

Carvalho

et al.

Generalized pressure pain hypersensitivity in the cervical muscles in women with migraine. Pain Med 2015; 16: 1629–1634.

Grossi

Chaves

Gonçalves

et al.

Pressure pain threshold in the cranio-cervical muscles of women with episodic and chronic migraine: A controlled study. Arq Neuropsiquiatr 2011; 69: 607–612.

10.

Bovim

. Cervicogenic headache, migraine and tension type headache. Pressure pain threshold measurements. Pain 1992; 51: 169–173.

11.

Jensen

Rasmussen

Pederken

et al.

Muscle tenderness and pressure pain threshold in headache: A population study. Pain 1993; 52: 193–199.

12.

Andersen

Petersen

Svendsen

et al.

Pressure pain thresholds assessed over temporalis, masseter, and frontalis muscles in healthy individuals, patients with tension-type headache, and those with migraine: A systematic review. Pain 2015; 156: 1409–1423.

13.

Palacios-Ceña

Lima-Florencio

Natália-Ferracini

et al.

Women with chronic and episodic migraine exhibit similar widespread pressure pain sensitivity. Pain Med 2016; 17: 2127–2133.

14.

Fernández-de-las-Peñas

Madeleine

Cuadrado

et al.

Pressure pain sensitivity mapping of the temporalis muscle revealed bilateral pressure hyper algesia in patients with strictly unilateral migraine. Cephalalgia 2009; 29: 670–676.

15.

du Jardin

Gregersen

Røsland

et al.

Assessment of pain response in capsaicin-induced dynamic mechanical allodynia using a novel and fully automated brushing device. Pain Res 2012; 18: 6–10.

16.

Samuelsson

Leffler

Johansson

et al.

The influence of brushing force and stroking velocity on dynamic mechanical allodynia in patients with peripheral neuropathy. Eur J Pain 2011; 15: 389–394.

17.

Misra

Kalita

Bhoi

. Allodynia in migraine: Clinical observation and role of prophylactic therapy. Clin J Pain 2013; 29: 577–582.

18.

Lipton

Bigal

Ashina

et al.

Cutaneous allodynia in the migraine population. Ann Neurol 2008; 63: 148–158.

19.

LoPinto

Young

Ashkenazi

. Comparison of dynamic (brush) and static (pressure) mechanical allodynia in migraine. Cephalalgia 2006; 26: 852–856.

20.

Finocchietti

Graven-Nielsen

Arendt-Nielsen

. Dynamic mechanical assessment of muscle hyperalgesia in humans: The dynamic algometer. Pain Res Manag 2015; 20: 29–34.

21.

Headache Classification Subcommittee of the International Headache Society (IHS). The International Classification of Headache Disorders (ICHD-III), 3rd edn (beta version). Cephalalgia 2013; 33: 629–808.

22.

Nie

Arendt-Nielsen

Andersen

et al.

Temporal summation of pain evoked by mechanical stimulation in deep and superficial tissue. J Pain 2005; 6: 348–355.

23.

Walton

Macdermid

Nielson

et al.

Reliability, standard error, and minimum detectable change of clinical pressure pain threshold testing in people with and without acute neck pain. J Orthop Sports Phys Ther 2011; 41: 644–650.

24.

Chesterson

Sim

Wright

et al.

Inter-rater reliability of algometry in measuring pressure pain thresholds in healthy humans, using multiple raters. Clin J Pain 2007; 23: 760–766.

25.

Dancey CP and Reidy J. Statistics without maths for psychology: Using SPSS for Windows. New York: Prentice Hall, 2004.

26.

Rolke

Andrews Campbell

Magerl

et al.

Quantitative sensory testing: A comprehensive protocol for clinical trials. Eur J Pain 2006; 10: 77–88.

27.

Geber

Klein

Azad

et al.

Test-retest and inter-observer reliability of quantitative sensory testing according to the protocol of the German Research Network on Neuropathic Pain (DFNS): A multi-centre study. Pain 2011; 152: 548–556.

28.

Chou

Fuh

et al.

Comparison of self-reported cutaneous allodynia and brushing allodynia during migraine attacks. Cephalalgia 2010; 30: 682–685.

29.

Bigal

Ashina

Burstein

et al.

Prevalence and characteristics of allodynia in headache sufferers: A population study. Neurology 2008; 70: 1525–1533.

30.

Hübscher

Moloney

Leaver

et al.

Relationship between quantitative sensory testing and pain or disability in people with spinal pain: A systematic review and meta-analysis. Pain 2013; 154: 1497–1504.

31.

Racine

Tousignant-Laflamme

Kloda

et al.

A systematic literature review of 10 years of research on sex/gender and experimental pain perception – part 1: Are there really differences between women and men?

Pain 2012; 153: 602–618.

Roller pressure algometry as a new tool for assessing dynamic pressure sensitivity in migraine

Abstract

Objectives

Methods

Results

Conclusions

Keywords

Introduction

Methods

Participants

Deep dynamic pressure pain sensitivity

Static pressure pain sensitivity

Sample size calculation

Statistical analysis

Results

Clinical data of the sample

Differences between episodic and chronic migraine

Consistency of roller pressure algometer

Dynamic pressure threshold and migraine features

Dynamic pressure threshold and static pressure pain sensitivity

Dynamic pressure threshold and static pressure sensitivity by frequency of headaches

Discussion

Deep dynamic mechanical sensitivity assessment

Deep dynamic mechanical sensitivity in migraine

Strengths and limitations

Conclusions

Key findings

Footnotes

Acknowledgement

Declaration of conflicting interests

Funding

References