Chronic Tension-Type Headaches: Pain Extent Associated With Emotional, Physical Burden

Larger pain areas are not associated with signs of central sensitization.

Results from a study recently published in Pain Medicine indicate that greater pain extent of chronic tension-type headache (CTTH) correlates with older age and greater emotional and physical burdens in patients.¹ The study also shows that pain extent is not related to anxiety, depression, or pressure pain thresholds, suggesting larger pain areas are not associated with signs of central sensitization.

César Fernández-de-las-Peñas, PT, PhD, Dr Sci, from King Juan Carlos University, Alcorcón, Spain, and colleagues analyzed 99 participants (27% men) with CTTH, who reported their pain using 4 body charts of the head and neck. The extent and frequency of participants’ pain was reported with customized software, and the researchers analyzed associations between pain extent and the following outcomes:

• Clinical features of headache
• Burden related to headache (with the Headache Disability Inventory)
• Anxiety and depression (with the Hospital Anxiety-Depression Scale)
• Anxiety state/trait (with the State-Trait Anxiety Inventory)
• Widespread pressure sensitivity (determined by assessing pressure pain thresholds over the temporalis muscle [trigeminal area], the cervical spine [extratrigeminal area], and the tibialis anterior muscle [distant pain-free area])

The extent of patients’ pain showed significant associations with age (r_s = 0.221; P =.029) and burden of the headache (emotional burden: r_s = 0.213 [P =.030]; physical burden: r_s = 0.208 [P=.039]). However, no other significant associations were found.

“Pain extent was significantly, albeit weakly, associated with both the emotional and physical burden of headache, indicating that larger painful areas are associated with higher burden for the patient,” the researchers wrote. “Enlarged self-perceived areas of pain may be perceived as poorer health status by the patients, and therefore the emotional or physical burden of the condition would be worse.”

Clinical Applicability and Future Research

“It has been recently proposed that examination of patients with chronic pain should contain multiple domains of pain including, among others, extension, location, and distribution of pain,” the researchers noted.² “Current results suggest that pain drawings could complement other clinical pain features for better characterization of CTTH.”

Further research should study this hypothesis.

References

1. Palacios-Ceña M, Barbero M, Falla D, Ghirlanda F, Arend-Nielsen L, Fernández-de-las-Peñas C. Pain extent is associated with the emotional and physical burdens of chronic tension-type headache, but not with depression or anxiety. Pain Med. 2017;0:1-7. Fillingim RB, Loeser JD, Baron R, Edwards R. Assessment of chronic pain: Domains, methods, and mechanisms. J Pain. 2016;17:T10–20.