Central pain processing in chronic tension-type headache

Kim Lindelof; Jens Ellrich; Rigmor Jensen; Lars Bendtsen; Kim Lindelof; Jens Ellrich; Rigmor Jensen; Lars Bendtsen

doi:10.1016/j.clinph.2009.04.013

Central pain processing in chronic tension-type headache

Kim Lindelof, Jens Ellrich, Rigmor Jensen, Lars Bendtsen, Kim Lindelof, Jens Ellrich, Rigmor Jensen, Lars Bendtsen

16 Citations (Scopus)

Abstract

OBJECTIVE: Chronic tension-type headache (CTTH) affects 3% of the population. Directly and indirectly it causes high costs and considerable loss of quality of life. The mechanisms of this disorder are poorly understood and the treatment possibilities are therefore limited. The blink reflex (BR) reflects neuronal excitability due to nociceptive input in the brainstem. The aim of this study was to investigate nociceptive processing at the level of the brainstem in an experimental pain model of CTTH symptoms. METHODS: The effect of conditioning pain, 5 min infusion of hypertonic saline into the neck muscles, was investigated in 20 patients with CTTH and 20 healthy controls. In addition, a pilot study with isotonic saline was performed with 5 subjects in each group. The BR was elicited by electrical stimuli with an intensity of four times the pain threshold, with a superficial concentric electrode. We measured the BR, sensibility to pressure and electrical pain scores before, during and 25 min after the saline infusion. RESULTS: The pain rating of the electrical stimuli and the pain score of the hypertonic saline infusion were significantly higher in CTTH patients than in healthy volunteers. The primary endpoint was the relative change of the blink reflex integral immediately after hypertonic saline infusion. It was significantly smaller in CTTH patients on the contralateral side (-24.5% +/-7.0 (sem)) compared to healthy volunteers (0.4% +/-6.8), (p<0.05, Holm-Sidak), while there was no significant difference on the ipsilateral side (-5.9% +/-3.2 vs. -3.4% +/-3.0, n.s., Holm-Sidak). CONCLUSION: There was no robust difference in BR integral after conditioning tonic neck pain between CTTH patients and healthy volunteers, but CTTH patients were more sensitive to nociceptive stimuli. SIGNIFICANCE: A combined homotopic and heterotopic effect of the conditioning pain onto the blink reflex could account for this finding.

Original language	English
Journal	Clinical Neurophysiology
Volume	120
Issue number	7
Pages (from-to)	1364-70
Number of pages	6
ISSN	1388-2457
DOIs	https://doi.org/10.1016/j.clinph.2009.04.013 https://doi.org/10.1016/j.clinph.2009.04.013
Publication status	Published - 2009

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@article{eb32ca70a92611df928f000ea68e967b,

title = "Central pain processing in chronic tension-type headache",

abstract = "OBJECTIVE: Chronic tension-type headache (CTTH) affects 3% of the population. Directly and indirectly it causes high costs and considerable loss of quality of life. The mechanisms of this disorder are poorly understood and the treatment possibilities are therefore limited. The blink reflex (BR) reflects neuronal excitability due to nociceptive input in the brainstem. The aim of this study was to investigate nociceptive processing at the level of the brainstem in an experimental pain model of CTTH symptoms. METHODS: The effect of conditioning pain, 5 min infusion of hypertonic saline into the neck muscles, was investigated in 20 patients with CTTH and 20 healthy controls. In addition, a pilot study with isotonic saline was performed with 5 subjects in each group. The BR was elicited by electrical stimuli with an intensity of four times the pain threshold, with a superficial concentric electrode. We measured the BR, sensibility to pressure and electrical pain scores before, during and 25 min after the saline infusion. RESULTS: The pain rating of the electrical stimuli and the pain score of the hypertonic saline infusion were significantly higher in CTTH patients than in healthy volunteers. The primary endpoint was the relative change of the blink reflex integral immediately after hypertonic saline infusion. It was significantly smaller in CTTH patients on the contralateral side (-24.5% +/-7.0 (sem)) compared to healthy volunteers (0.4% +/-6.8), (p<0.05, Holm-Sidak), while there was no significant difference on the ipsilateral side (-5.9% +/-3.2 vs. -3.4% +/-3.0, n.s., Holm-Sidak). CONCLUSION: There was no robust difference in BR integral after conditioning tonic neck pain between CTTH patients and healthy volunteers, but CTTH patients were more sensitive to nociceptive stimuli. SIGNIFICANCE: A combined homotopic and heterotopic effect of the conditioning pain onto the blink reflex could account for this finding.",

author = "Kim Lindelof and Jens Ellrich and Rigmor Jensen and Lars Bendtsen and Kim Lindelof and Jens Ellrich and Rigmor Jensen and Lars Bendtsen",

note = "Keywords: Adult; Blinking; Brain Stem; Case-Control Studies; Electric Stimulation; Endpoint Determination; Female; Headache Disorders; Humans; Male; Neck Muscles; Neck Pain; Nociceptors; Pain Threshold; Pilot Projects; Saline Solution, Hypertonic; Tension-Type Headache",

year = "2009",

doi = "10.1016/j.clinph.2009.04.013",

language = "English",

volume = "120",

pages = "1364--70",

journal = "Clinical Neurophysiology",

issn = "1388-2457",

publisher = "Elsevier Ireland Ltd",

number = "7",

}

TY - JOUR

T1 - Central pain processing in chronic tension-type headache

AU - Lindelof, Kim

AU - Ellrich, Jens

AU - Jensen, Rigmor

AU - Bendtsen, Lars

AU - Lindelof, Kim

AU - Ellrich, Jens

AU - Jensen, Rigmor

AU - Bendtsen, Lars

N1 - Keywords: Adult; Blinking; Brain Stem; Case-Control Studies; Electric Stimulation; Endpoint Determination; Female; Headache Disorders; Humans; Male; Neck Muscles; Neck Pain; Nociceptors; Pain Threshold; Pilot Projects; Saline Solution, Hypertonic; Tension-Type Headache

PY - 2009

Y1 - 2009

N2 - OBJECTIVE: Chronic tension-type headache (CTTH) affects 3% of the population. Directly and indirectly it causes high costs and considerable loss of quality of life. The mechanisms of this disorder are poorly understood and the treatment possibilities are therefore limited. The blink reflex (BR) reflects neuronal excitability due to nociceptive input in the brainstem. The aim of this study was to investigate nociceptive processing at the level of the brainstem in an experimental pain model of CTTH symptoms. METHODS: The effect of conditioning pain, 5 min infusion of hypertonic saline into the neck muscles, was investigated in 20 patients with CTTH and 20 healthy controls. In addition, a pilot study with isotonic saline was performed with 5 subjects in each group. The BR was elicited by electrical stimuli with an intensity of four times the pain threshold, with a superficial concentric electrode. We measured the BR, sensibility to pressure and electrical pain scores before, during and 25 min after the saline infusion. RESULTS: The pain rating of the electrical stimuli and the pain score of the hypertonic saline infusion were significantly higher in CTTH patients than in healthy volunteers. The primary endpoint was the relative change of the blink reflex integral immediately after hypertonic saline infusion. It was significantly smaller in CTTH patients on the contralateral side (-24.5% +/-7.0 (sem)) compared to healthy volunteers (0.4% +/-6.8), (p<0.05, Holm-Sidak), while there was no significant difference on the ipsilateral side (-5.9% +/-3.2 vs. -3.4% +/-3.0, n.s., Holm-Sidak). CONCLUSION: There was no robust difference in BR integral after conditioning tonic neck pain between CTTH patients and healthy volunteers, but CTTH patients were more sensitive to nociceptive stimuli. SIGNIFICANCE: A combined homotopic and heterotopic effect of the conditioning pain onto the blink reflex could account for this finding.

AB - OBJECTIVE: Chronic tension-type headache (CTTH) affects 3% of the population. Directly and indirectly it causes high costs and considerable loss of quality of life. The mechanisms of this disorder are poorly understood and the treatment possibilities are therefore limited. The blink reflex (BR) reflects neuronal excitability due to nociceptive input in the brainstem. The aim of this study was to investigate nociceptive processing at the level of the brainstem in an experimental pain model of CTTH symptoms. METHODS: The effect of conditioning pain, 5 min infusion of hypertonic saline into the neck muscles, was investigated in 20 patients with CTTH and 20 healthy controls. In addition, a pilot study with isotonic saline was performed with 5 subjects in each group. The BR was elicited by electrical stimuli with an intensity of four times the pain threshold, with a superficial concentric electrode. We measured the BR, sensibility to pressure and electrical pain scores before, during and 25 min after the saline infusion. RESULTS: The pain rating of the electrical stimuli and the pain score of the hypertonic saline infusion were significantly higher in CTTH patients than in healthy volunteers. The primary endpoint was the relative change of the blink reflex integral immediately after hypertonic saline infusion. It was significantly smaller in CTTH patients on the contralateral side (-24.5% +/-7.0 (sem)) compared to healthy volunteers (0.4% +/-6.8), (p<0.05, Holm-Sidak), while there was no significant difference on the ipsilateral side (-5.9% +/-3.2 vs. -3.4% +/-3.0, n.s., Holm-Sidak). CONCLUSION: There was no robust difference in BR integral after conditioning tonic neck pain between CTTH patients and healthy volunteers, but CTTH patients were more sensitive to nociceptive stimuli. SIGNIFICANCE: A combined homotopic and heterotopic effect of the conditioning pain onto the blink reflex could account for this finding.

U2 - 10.1016/j.clinph.2009.04.013

DO - 10.1016/j.clinph.2009.04.013

M3 - Journal article

C2 - 19457718

SN - 1388-2457

VL - 120

SP - 1364

EP - 1370

JO - Clinical Neurophysiology

JF - Clinical Neurophysiology

IS - 7

ER -

Central pain processing in chronic tension-type headache

Abstract

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