1. 2020;23;219-227Dynamic Pressure Pain Hypersensitivity as Assessed by Roller Pressure Algometry in Episodic Cluster Headache
   Case Control Study
   Maria Palacios-Cena, PT, PhD, Victor Gomez-Mayordomo, MD, David Garcia-Azorin, MD, Nuria Gonzalez-Garcia, MD, Maria L. Cuadrado, MD, PhD, Cesar Fernandez-de-las-Penas, PT, PhD, Dr Med Sci, Lars Arendt-Nielsen, PhD, Dr Med Sci, and Angel L. Guerrero, MD, PhD.

BACKGROUND: A method for assessing dynamic muscle hyperalgesia (dynamic pressure algometry) has been developed and applied in tension-type and migraine headaches.

OBJECTIVES: To investigate differences in dynamic pressure pain assessment over the trigeminal area between men with cluster headache (CH) and headache-free controls, and the association between dynamic and static pressure pain sensitivity.

STUDY DESIGN: A case-control study.

SETTING: Tertiary urban hospital.

METHODS: Forty men with episodic CH and 40 matched controls participated. Dynamic pressure pain sensitivity was assessed with a dynamic pressure algometry set consisting of 8 rollers with different fixed levels (500, 700, 850, 1,350, 1,550, 2,200, 3,850, and 5,300 g). Each roller was moved at a speed of 0.5 cm/sec over a diagonal line covering the temporalis muscle from an anterior to posterior direction. The dynamic pressure threshold (DPT; load level of the first painful roller) and the pain intensity perceived at the DPT level (roller-evoked pain) were assessed. Static pressure pain thresholds (PPT) were also assessed with a digital pressure algometer applied statically over the mid-muscle belly of the temporalis. Patients were assessed in a remission phase, at least 3 months from the last cluster attack, and without preventive medication.

RESULTS: Side-to-side consistency between DPTs (r = 0.781, P < 0.001), roller-evoked pain on DPT (r = 0.586; P < 0.001), and PPTs (r = 0.874; P < 0.001) were found in men with CH. DPT was moderately, bilaterally, and side-to-side associated with PPTs (0.663 > r > 0.793, all P < 0.001). Men with CH had bilateral lower DPT and PPT and reported higher levels of roller-evoked pain (all P < 0.001) than headache-free controls.

LIMITATIONS: Only men with episodic CH were included.

CONCLUSIONS: This study supports that a dynamic pressure algometry is as valid as a static pressure algometry for assessing pressure pain sensitivity in patients with CH. Assessing both dynamic and static pain sensitivity may provide new opportunities for differentiated diagnostics.

KEY WORDS: Cluster headache, dynamic pressure pain, pressure pain threshold