Fernández-de-Las-Peñas C, Cuadrado M L, Arendt-Nielsen L, Pareja J A
Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation of Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain.
Eur J Neurol. 2008 Feb;15(2):162-8. doi: 10.1111/j.1468-1331.2007.02020.x. Epub 2007 Dec 18.
Previous studies dealing with pressure pain sensitivity or muscle tenderness in migraine have shown conflicting results. Our aim was to explore the differences in mechanical pain sensitivity and pericranial muscle tenderness between patients with unilateral migraine and healthy controls, and to analyse side-to-side differences in both study groups. Pressure pain thresholds (PPT) at cephalic and neck points, plus local and total tenderness scores were blindly assessed in 25 patients with strictly unilateral migraine and 25 healthy subjects. For PPT in the neck there were significant differences between groups (F = 47.029; P < 0.001) and sides (F = 6.363; P < 0.01), and a significant interaction between group and side (F = 5.201; P = 0.02), while PPT in the cephalic point showed differences between groups (F = 11.774; P < 0.001), but not sides (F = 2.838; P = 0.1). The total tenderness score showed significant differences between groups (F = 6.800; P < 0.01) and sides (F = 17.699; P < 0.001), along with a significant interaction between group and side (F = 14.420; P < 0.001). Patients had lower PPT and increased pericranial tenderness on the symptomatic side as compared with the non-symptomatic side and to either side in controls (P < 0.001), whereas no significant differences were identified between the non-symptomatic side and controls (P > 0.9). In migraine patients, PPT levels and muscle tenderness scores were negatively correlated (P < 0.001). The enhancement of local tenderness scores was related to hyperesthesia of specific muscles (sternocleidomastoid, suboccipital, and temporalis) rather than a generalized pericranial tenderness. Future studies should investigate the neuro-physiological basis for the laterality of allodynic and hyperalgesic responses in unilateral migraine.
以往关于偏头痛患者压力疼痛敏感性或肌肉压痛的研究结果相互矛盾。我们的目的是探讨单侧偏头痛患者与健康对照者在机械性疼痛敏感性和颅周肌肉压痛方面的差异，并分析两个研究组两侧之间的差异。对25例严格单侧偏头痛患者和25名健康受试者进行了头部和颈部各点的压力疼痛阈值（PPT）以及局部和总压痛评分的盲法评估。颈部PPT在组间（F = 47.029；P < 0.001）和两侧（F = 6.363；P < 0.01）存在显著差异，且组与侧之间存在显著交互作用（F = 5.201；P = 0.02），而头部PPT在组间存在差异（F = 11.774；P < 0.001），但两侧之间无差异（F = 2.838；P = 0.1）。总压痛评分在组间（F = 6.800；P < 0.01）和两侧（F = 17.699；P < 0.001）存在显著差异，且组与侧之间存在显著交互作用（F = 14.420；P < 0.001）。与无症状侧及对照组的任一侧相比，患者症状侧的PPT较低且颅周压痛增加（P < 0.001），而无症状侧与对照组之间未发现显著差异（P > 0.9）。在偏头痛患者中，PPT水平与肌肉压痛评分呈负相关（P < 0.001）。局部压痛评分的增加与特定肌肉（胸锁乳突肌、枕下肌和颞肌）的感觉过敏有关，而非广泛性颅周压痛。未来的研究应调查单侧偏头痛中异常性疼痛和痛觉过敏反应偏侧性的神经生理基础。
