Department of Neurology, NYU Langone Medical Center, New York University School of Medicine, New York, NY, USA.
Danish Headache Center and Department of Neurology, University of Copenhagen, Rigshospitalet Glostrup, Glostrup, Denmark.
Eur J Pain. 2018 May;22(5):904-914. doi: 10.1002/ejp.1176. Epub 2018 Jan 19.
Low back pain is common in the general population and in individuals with primary headaches. We assessed the relative frequency of self-reported back pain in persons with and without primary headaches and examined pain sensitivity.
A population of 796 individuals completed a headache interview based on ICHD criteria and provided data of interest in a self-administered questionnaire. Headache cases were classified into chronic (≥15) (CH) or episodic (<15 headache days/month) (EH). A total of 495 had a pericranial total tenderness score (TTS), and 494 had cephalic and extracephalic pressure pain thresholds (PPTs) assessed.
Adjusted for age, gender, education and poor self-rated health, 1-year relative frequency of back pain was higher in individuals with CH (82.5%) and EH (80.1%) compared to no headache group (65.7%). In persons with back pain, TTS was higher in CH, (26.3 ± 12.1) than in EH, (18.5 ± 10.0; p < 0.001) and higher in both groups than in those with no headache, 10.8 ± 8.5 (p < 0.001 and p < 0.001, respectively). In persons with back pain, temporalis PPT were lower in CH, 169.3 ± 57.8, than in EH, 225.2 ± 98.1, and in no headache group, 244.3 ± 105.4 (p = 0.02 and p = 0.01, respectively). In persons with back pain, finger PPT were lower in CH, 237.1 ± 106.7, than in EH, 291.3 ± 141.3, or in no headache group, 304.3 ± 137.4 (p = 0.02 and p < 0.001, respectively).
Back pain is highly frequent in individuals with CH, followed by EH and no headache. In persons with CH, back pain is associated with lower cephalic and extracephalic PPTs suggesting central sensitization may be a substrate or consequence of comorbidity.
We found that back pain has high relative frequency in individuals with CH followed EH and no headache. Back pain is associated with low cephalic and extracephalic PPTs in individuals with CH. Central sensitization may be a substrate or consequence of this comorbidity of back pain and CH.
腰痛在普通人群和原发性头痛患者中很常见。我们评估了有和没有原发性头痛的人群中自我报告腰痛的相对频率，并检查了疼痛敏感性。
796 名个体完成了基于 ICHD 标准的头痛访谈，并在自我管理问卷中提供了感兴趣的数据。头痛病例分为慢性（≥15）（CH）或发作性（<15 头痛天/月）（EH）。共有 495 人进行了颅周总压痛评分（TTS），494 人进行了颅部和颅外压力疼痛阈值（PPT）评估。
调整年龄、性别、教育程度和自我健康状况不佳后，CH（82.5%）和 EH（80.1%）个体 1 年腰痛的相对频率高于无头痛组（65.7%）。在有腰痛的个体中，CH 的 TTS 更高（26.3±12.1），EH 的 TTS 更低（18.5±10.0；p<0.001），两组的 TTS 均高于无头痛组（10.8±8.5；p<0.001 和 p<0.001）。在有腰痛的个体中，CH 的颞肌 PPT 较低（169.3±57.8），EH 的颞肌 PPT 较高（225.2±98.1），无头痛组的颞肌 PPT 较高（244.3±105.4）（p=0.02 和 p=0.01）。在有腰痛的个体中，CH 的手指 PPT 较低（237.1±106.7），EH 的手指 PPT 较高（291.3±141.3），无头痛组的手指 PPT 较高（304.3±137.4）（p=0.02 和 p<0.001）。
CH 患者腰痛的发生率很高，其次是 EH 和无头痛。在 CH 患者中，腰痛与较低的颅部和颅外 PPT 相关，提示中枢敏化可能是这种腰痛和 CH 共病的基础或后果。
我们发现，CH 患者的腰痛发生率较高，其次是 EH 和无头痛。腰痛与 CH 患者的低颅部和颅外 PPT 相关。中枢敏化可能是这种腰痛和 CH 共病的基础或后果。
