• Margarita Cigarán-Mendez, Juan C Pacho-Hernández, Angela Tejera-Alonso, Francisco G Palacios-Fernández, Juan Antonio Valera-Calero, Cristina Gómez, and César Fernández-de-Las-Peñas.
• Department of Psychology, Universidad Rey Juan Carlos, Alcorcón, Spain.
• Pain Med. 2025 Feb 5.

ObjectivesThe aims of this study were: 1, to determine the ability of pain thresholds to differentiate between subjects with and without tension-type headache (TTH); and 2, to determine the capability of clinical, psychological and psychophysical variables to differentiate between individuals with frequent episodic (FETTH) or chronic (CTTH) tension-type headache.MethodsA diagnostic accuracy study was conducted. Pressure pain threshold (PPTs) over the temporalis muscle, cervical spine, second metacarpal, and tibialis anterior muscle and dynamic pain thresholds (DPT) were bilaterally assessed in 100 individuals with TTH and 50 comparable non-headache subjects. Clinical headache parameters (headache diary), headache-associated burden (HDI), anxiety and depressive levels (HADS), sleep quality (PSQI), and state (STAI-S) - trait (STAI-T) anxiety levels were also evaluated. The area under the receiver operating characteristic (ROC) curve, optimal cut-off point, sensitivity, specificity, and positive and negative likelihood ratios (LR) for each variable were calculated.ResultsIndividuals with TTH exhibited lower PPTs and DPT than those without TTH. No significant differences in PPTs and DPT were found between FETTH and CTTH individuals. Overall, no clinical, psychological or psychophysical variable exhibited an acceptable ROC value (≥0.7) for identifying between TTH patients and non-headache controls or between subjects with FETTH and CTTH.ConclusionAlthough individuals with TTH exhibit widespread pressure pain hyperalgesia, neither clinical nor psychological nor psychophysical variable had proper diagnostic accuracy to discriminate between individuals with/without TTH or between those with FETTH and CTTH. Further studies should clarify the clinical relevance of these findings.© The Author(s) 2025. Published by Oxford University Press on behalf of the American Academy of Pain Medicine. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.

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