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Assessment of pain modulatory and somatosensory profiles in chronic tension-type headache patients.

OBJECTIVE
The aim of this study was to thoroughly phenotype a group of chronic tension-type headache (CTTH) patients.


METHODS
Fifteen CTTH patients diagnosed according to the ICHD-3 and 15 healthy controls were included in this study. Furthermore, 70 healthy controls were included to establish normative values. Quantitative sensory testing (QST), including temporal summation of pain (TSP), conditioned pain modulation (CPM) and psychological and sleep variables were assessed in a single session. TSP and CPM were then combined to build pain modulation profiles (PMP) for each individual.


RESULTS
No difference was found between groups for PMP, TSP and CPM. However, 10 CTTH patients showed a pronociceptive PMP, with 8 related to a deficient CPM and two to both a deficient CPM and increased TSP. Increased cold detection thresholds were the most common sensory disturbance found in CTTH patients. Significant differences were seen between groups for pain catastrophizing, depression and sleep quality although not all patient's scores were above the clinically meaningful cut-offs.


CONCLUSIONS
In summary, CTTH patients presented with different PMP. These PMP may be related to increased TSP, deficient CPM, alterations in thermal detection that may be related to autonomic dysregulation or a combination of all three. Overall, this suggests that due to their heterogeneous pathophysiology, CTTH patients should be managed according to their underlying pathophysiology and not with a one-size fits all approach.