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Table 2 Study characteristics

From: Pressure pain thresholds over the cranio-cervical region in headache: a systematic review and meta-analysis

Author/ year of publica-tion

Population

IHS criteria/Sjaastad

Blin-ding

Y/N

Device and outcome

PPT sites

Reported confounders

Outcome: PPT values kPa (sd) in headache versus controls

Headache type

Control, matching,Setting

Age: mean (sd)

F/M

Electronic/ mechanical

Probe size

Out-come

Relevant cervical site

Extra cephalic site

Engstrom [17]

Norway

Migraine n = 33

n = 34

Open

population

Migraine: sleep-related 39.4 (14.3)

Not sleep- related 33.9 (11.4 Controls: 39.6 (13.7)

F/M

ICHD II

Y

Electronic algometer type II, Somedic Sales AB, Sweden

1 cm2

kPa/s

trapezius muscle, splenius muscle

distal phalanx middle finger

gender, age,interictal, medication

Average mean PPT score of m. splenius, m. trapezius, M. temporalis, and distal phalanx middle finger .

Sleep- related migraine: 586 (141) p < 0.05

Not sleep-related migraine: (519) (125) p < 0.05

Controls: 661 (249)

 

Engstrom [16]

Norway

Migraine

n = 50

n = 34

Open

population

Migraine: interictal: 36.4 (12.9) pre-ictal 41.7 (11.3) post-ictal 41.1 (11.2) Controls: 39.6 (13.7)

F/M

ICHD II

Y

Electronic algometer type II,Somedic Sales AB, Sweden.

1 cm2

kPa/s

trapezius muscle, splenius muscle

distal phalanx middle finger

gender, age, fibromyalgia, ictal, medication

Average mean PPT score of m. splenius, m. trapezius, m. temporalis, and distal phalanx middle finger

Interictal migraine: 549 (135) NS

Pre-ictal migraine: 582 (194) NS

Post-ictal migraine: 539 (70) NS

Controls 661 (249)

 

Engstrom [18]

Norway

Migraine n = 53

ETTH n = 20

n = 34 Matched on age and gender, Open population

M: 38.2 (12.0) ETTH 40.9(13.5) Controls M: 39.6 (13.7) Controls ETTH 41.2 (13.6)

F/M

ICHD II

Y

Electronic Algometer type II, Somedic Sales AB, Sweden

1 cm2

kPa/s

trapezius muscle, splenius muscle

distal phalanx middle finger

gender, age, interictal, medication

Average mean PPT score of m. splenius, m. trapezius, m. temporalis, and distal phalanx middle finger

Total Migraine (n = 33) 549 (135) NS Total TTH (n = 20) 543 (191) NS

Sleep migraine (n = 15): 586 (141) NS CTTH (n-8) 506 (215) p < 0.05

Non sleep migraine (n = 18): 519 (125) p < 0.05 ETTH (n-12) 598 (144) NS

Controls (n = 34) 661 (249)

 

Fernandez de las Penas [19]

Spain

Unilateral Migraine n = 25

n = 25

Hospital

Migraine: 32 (7) Controls: 31 (9)

F/M

ICHD II

Y

A pressure algometer connected to a sensor recording pressure

1 cm2

kg/cm2

trapezius muscle

 

gender, age, interictal, medication

Trapezius muscle

Migraine; Female

Symptomatic side 137.3 (39.2) p < 0.001

Non Symptomatic side 176.5 (39.2 p < 0.01

Controls:

Symptomatic side 235.4 (39.2)

Non-symptomatic side 235.4 (49)

Migraine,; Male

Symptomatic side 186.3 (58.8) p < 0.001

Non symptomatic side235.4 (58.8) p < 0.01

Controls

Symptomatic side 264.8 (39.2)

Non symptomatic side274.6 (39.2)

 

Fernandez de las Penas [20]

Spain

Unilateral Migraine n = 20

CTTH n = 20

n = 20 Matched on age and gender, Hospital

Unilateral migraine: 37.9

CTTH: 39. 8 Controls: 37.8

F

ICHD II

Y

Electronic algometer (Somedico type 2, Sollentuna, Sweden)

1 cm2

kPa/s

trapezius muscle, sub-occipital insertions, levator scapula muscle

 

gender, age, interictal, medication, fibromyalgia/WAD

Trapezius muscle

CTTH

Left: 246.3 (58.5) p < 0.001

Right: 257.5 (56.9) p < 0.001

Migraine

Symptomatic side 276.1 (53.4)p < 0.001

Non-symptomatic side287.1 (84.3)p < 0.001

Controls

Left:337.5 (33.1)

Right: 338.3 (29.9)

Suboccipital region

=suboccipital insertions

CTTH

Left 164.6 (33.1) p < 0.001

Right 172.3 (38.5) p < 0.001

Migraine

Symptomatic 240.3 (50.5) p > 0.001

Non-symptomatic side

253.5 (54.1) p < 0.001

Controls

Left 333.2 (42.8)

Right 344.3 (41.4)

Filatova [6]

Russia

chronic migraine n = 25

CTTH n = 25

Mixed headache

n = 19

n = 18

Headache Center

CTTH+

chronic migraine + mixed headache

:40.1 (12.3)

Controls: 43.1(18.1)

F/M

ICHD II

N

Hand-held pressure algometer (Commander Algo-meterTM, JTech)

not repor-

ted

lb/cm

trapezius muscle, C2

 

gender, age, ictal, medication, fibromyalgia/WAD

Average mean PPT score of forehead V1, temple, parietal area, posterior neck/C2, shoulder/trapezius

CTTH + Chronic migraine): 284.4 (88.3) p < 0.005

Controls: 362.8 (117.7)

 

Florencio [21]

Brazil

Migraine n = 30

n = 30

Matched on gender

(females)

Headache Center

Migraine: 37

Controls: 32

F

ICHD III

Y

Digital manual dynamo-meter(DDK-10 Kratos)

1 cm2

kg/cm2

trapezius muscle, SCM muscle, sub-occipital muscles, levator scapula muscle, scaleni muscle

 

gender, age, interictal, medication, fibromyalgia/WAD

Trapezius muscle

Migraine:

Both sides 245.2 (9.8) p = 0.046

Controls

Both sides 274.6 (19.6)

Suboccipital region

=suboccipital muscles

Migraine

Both sides: 156.9 (9.8) p < 0.05

Controls

Both sides: 235.4 (9.8)

Grossi [22]

Brazil

Episodic migraine n = 15 Chronic migraine n = 14

n = 15

Headache Center

Episodic migraine: 36.3 (10.3) Chronic Migraine: 38.0 (10.4) controls: 39.9 (10.5)

F

ICHD II

Y

Digital manual dynamometer (DDK-10, Kratos)

1 cm2

kg/cm2

trapezius muscle, trapezius insertion SCM,

 

gender, age, medication, fibromyalgia/WAD

Trapezius muscle

Episodic migraine

Left 250 (91.2) p < 0.05

Right 263.8 (99)) p < 0.05

Chronic migraine

Left 260.9 (82.4) p < 0.05

Right 290.3 (93.2) NS

Controls

Left 325.6 (95.1)

Right 342.3 (81.4)

Suboccipital region

(=trapezius insertion)

Episodic migraine

Left 224.6 (68.7) NS

Right 222.6 (92.2) NS

Chronic migraine

Left 241.2 (79.4)NS

Right 257.9 (85.3)NS

Controls

Left283.4 (72.6)

Right285.4 (87.3)

Uthaikhup [23]

Australia

Migraine n = 26

ETTH n = 10

CeH n = 24 unclassifiablen = 33

n = 44

Open population and University Community

Migraine: 66.6 (4.8) ETTH: 65.3 (4.5) CeH: 65.4 (4.7) Unclassifiable: 66.2 (4.4) controls: 66.4 (4.1)

F/M

ICHD II and Sjaastad

not reported

Electronic algometer (Somedic AB, Farsta, Sweden)

1 cm2

kPa/s

bilaterally over the articular pillars of the cervical segment C2–3

tibialis anterior

gender, age, medication, fibromyalgia

The articular pillars of the cervical segment C2–3

Migraine: ETTH:

238.2 (104) NS180.7 (85) NS

CeH: Unclassifiable headache:

242.4 (105.0)NS 210.6 (113.9) NS

Controls:

243.2 (105.9)

 

Zito [24].

Australia

Migraine n = 25

CeH n = 27

n = 25

Hospital, GP, PT and controls in open population

Migraine: 22.9 (3.5)

CeH: 25.3 (3.9)

Controls:

22.9(3.5),

F

ICHD II and Sjaastad

Y

Pressure algometer (PD&T—Italy)

1 cm2

kg/cm2

C2 the trans-verse process of C4 and the C2/3 zygapophyseal joint

 

gender, age, interictal

C2 GONTransverse process C4C2/3 zygapoph. Joint

Migraine:294.2 (107.9) NS441.3 (196.1) NS 372.7 (117.7) p < 0.05323.6 (117.7) NS

CeH:323.6 (107.9) NS 421.7 (137.3) NS 382.5 (107.9) p < 0.05333.4 (98.1) NS

Controls: 313.8 (98.1) 480.5 (156.9) NS 441.3 (117.7) 353 (107.9)

Ashina [25]

Denmark

CTTH n = 20

n = 20 Matched on age, gender, body weight and height, blood pressure

Hospital

CTTH: 46 (11) (26–63) Controls: 46 (12) (26–62)

F/M

ICHD II

N

Electronic algometer Somedic AB, Horby, Sweden

0.5 cm2

kPa/s.

trapezius muscle

tibialis anterior

gender, age, ictal, medication

Trapezius muscle.

CTTH: 390 (39) P < 0.05

Controls: 519 (38)

 

Engstrom [26]

Norway

CTTH n = 12

ETTH n = 8

n = 20 Matched on age and gender

Open population

TTH: 41.2 (13.6) Controls: 40.9 (13.5)

F/M

ICHD II

Y

Electronic Algometer type II, Somedic Sales AB, Sweden

1 cm2

kPa/s

trapezius muscle, splenius muscle

distal phalanx middle finger

gender, age, ictal, medication, fibromyalgia

Average mean PPT score of m. splenius, m. trapezius, m. temporalis, and distal phalanx middle finger

CTTH: 506 (215) p < 0.05

ETTH: 598 (144) NS

Controls 678 (251)

 

Fernandez de las Penas [28] Spain

CTTH n = 20

n = 20 Matched on age and gender Hospital

CTTH: 36 (11)), controls: 35 (9)

F/M

ICHD II

Y

Mechanical pressure algometer

1 cm2

kg/cm2.

trapezius muscle

 

gender, age, ictal, medication

Trapezius muscle

CTTH

Left 147.1 (39.2)

Right 137.3 (39.2)

Controls

Left 245.2 (49) p < 0.001

Right 255 (49) p < 0.001

Fernandez de las Penas [27]

Spain

CTTH n = 25

n = 25

Hospital

CTTH: 41 (14) Controls 39 (13)

F/M

ICHD II

Y

Mechanical pressure algometer

1 cm2

kg/cm2

trapezius muscle

 

gender, age, ictal, medication

Trapezius muscle

CTTH

Left 147.1 (49) p < 0.001

Right 142.2 (49) p < 0.001

Controls

Left 235.4 (49)

Right 254.2 (39.2)

 

Peddireddy [29]

Denmark

CTTH n = 30

n = 30 Matched on age and gender

Open Population

CTTH male 48.4 (7.9) female 44.8 (3.2)

Controls: male 50.8 (1.4) and female 44.8 (2.2)

F/M

ICHD II

Y

Electronic algometer (Somedic AB, Stockholm, Sweden)

1 cm2

kPa/s

splenius capitis muscle

 

gender, age, ictal, medication

No exact PPT retrievable from text, figures or tables.

The PPT of scalenus muscle did not significantly differ between CTTH and controls

 

Tüzün [30]

Turkey

CTTH n = 35

n = 70 Matched on gender

University students

CTTH: 18.9 (1.2) Controls: 19.2 (1.7)

F/M

ICHD II

N

Handheld algometer (Pain Diagnostic and Thermo-graphy,USA)

1 cm2

kg/cm2

trapezius muscle, sub-occipital muscles

 

gender, age, interictal, medication

Trapezius muscle

CTTH:

left: 470.7 (166.7) p = 0.002

Right: 529.5 (176.5) p < 0.001

Controls:

Left 666.8 (284.3)

Right 686.4 (284.3)

Suboccipital region

=suboccipital muscles

CTTH:

Left 264.8 (68.7) p < 0.001

Right 294.2 (88.3) p < 0.0001

Controls:

Left 353 (112.8)

Right 372.7 (107.9)

Chua [31]

Nether-lands

CeH n = 17

Non CeH n = 10

n = 27 Matched on age and gender

Hospital

CeH: 50.6 (11.1)

Non CeH:54.5 (7.9)

Pain free:52.1 (10.4)

F/M

Sjaastad

Y

Electronic algometer Somedic Production AB, Farsta, Sweden

1 cm2

kPa/s

sterno-cleido- mastoideas greater occipital nerve, C4–5 zygopo-physisial joint

 

gender, age fibromyalgie, medication

Average mean PPT score of sterno-cleido- mastoideas, greater occipital nerve, and C4–5 zygopo-physisial joint

CeH painful side 935 (256) non painful side 937 (332) p < 0.001

Non CeH painful side 1109 (465) non painful side 1114 (522) p < 0.001

Controls 497 (215)

 
  1. PPT pressure pain threshold, IHS International Headache Society, ETTH episodic tension-type headache, CTTH chronic tension-type headache, CeH cervicogenic headache, NS not significant, p > 0.05