• Víctor Gómez-Mayordomo, María Palacios-Ceña, Ángel Guerrero-Peral, Stella Fuensalida-Novo, César Fernández-de-Las-Peñas, and María L Cuadrado.
• Headache Unit, Department of Neurology, Hospital Clínico San Carlos, Madrid, Spain.
• Pain Pract. 2020 Feb 1; 20 (2): 147-153.

BackgroundDiminished pressure pain thresholds (PPTs) have been found in patients with cluster headache (CH), suggesting the presence of central sensitization. However, it is not known whether sensitization persists over time during the asymptomatic periods.ObjectiveTo investigate if men with episodic CH in a long-lasting remission phase exhibit widespread pressure pain hypersensitivity.MethodsForty men with episodic CH and 40 matched controls were enrolled. PPTs were assessed bilaterally over 1 trigeminal (temporalis muscle) and 3 extra-trigeminal points (C5/C6 zygapophyseal joint, second metacarpal, tibialis anterior muscle) by a blinded assessor. Patients were assessed in a prolonged remission phase, at least 6 months after their last CH attack and without taking any medication. Depression and anxiety levels were assessed with the Hospital Anxiety and Depression Scale (HADS). For each point, differences in PPTs were evaluated with a multivariate mixed-model analysis of covariance test, with side and group as main factors and depression and anxiety levels as covariates.ResultsPPTs were significantly decreased bilaterally over the temporalis muscle (mean difference: 85 to 100 kPa), C5/C6 zygapophyseal joint (mean difference: 65 to 80 kPa), second metacarpal (mean difference: 65 to 90 kPa), and tibialis anterior muscle (mean difference: 135 to 155 kPa) in patients with CH when compared to headache-free subjects (all, P < 0.001). No effect of anxiety or depression levels was found.ConclusionsPatients with CH exhibited bilateral widespread hypersensitivity to pressure pain during long-lasting remission periods, which was not associated with depression or anxiety. These results support the persistence of central sensitization in episodic CH, even in remote asymptomatic phases.© 2019 World Institute of Pain.

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