发作性或慢性偏头痛患者的局部和广泛压痛敏化：系统评价和荟萃分析。

Localized and widespread pressure pain hypersensitivity in patients with episodic or chronic migraine: A systematic review and meta-analysis.

机构信息

Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos (URJC), Alcorcón, Madrid, Spain.

Cátedra Institucional en Docencia, Clínica e Investigación en Fisioterapia, Terapia Manual, Punción Seca y Ejercicio Terapéutico, Universidad Rey Juan Carlos, Madrid, Spain.

出版信息

Cephalalgia. 2022 Aug;42(9):966-980. doi: 10.1177/03331024221084217. Epub 2022 Mar 25.

DOI:10.1177/03331024221084217

PMID:35332797

Abstract

OBJECTIVE

This meta-analysis compared pressure pain sensitivity in trigeminal, cervical spine and remote pain-free areas between migraine patients and headache-free controls considering diagnosis (episodic versus chronic) and sex. Electronic databases were searched for cross-sectional or prospective case-control studies comparing pressure pain thresholds between migraine and headache-free controls. Data were extracted by two reviewers. The risk of bias and methodological quality was assessed by Newcastle-Ottawa Quality Assessment Scale. Meta-analyses of trigeminal, extra-trigeminal (cervical spine) and remote pain-free areas were compared. Frequency of migraine and sex were taken into account. Mean differences (MD) and random effects were calculated.

RESULTS

Eighteen studies were included. Patients with migraine showed lower pressure pain thresholds than headache-free controls: trigeminal (MD -71.33 kPa, 95%CI -92.14 to -50.53), cervical spine (MD -68.50 kPa, 95%CI -84.67 to -52.33), and remote pain-free (MD -62.49 kPa, 95%CI -99.52 to -25.45) areas. Differences were consistently significant for episodic migraine in all locations, but only significant in the trigeminal area for chronic migraine (MD -67.36 kOPa, 95%CI -101.31 to -33.42). Overall, women had lower pressure pain thresholds than men. The methodological quality of most studies (66.7%) was good. The results showed a high heterogeneity.

CONCLUSION

This meta-analysis found low to high quality evidence showing lower pressure pain thresholds in trigeminal, extra-trigeminal, and remote pain-free areas in migraine sufferers when compared with headache-free controls. Hypersensitivity to pressure pain locally and widespread was consistently observed in episodic migraine, but locally in chronic migraine as compared to headache-free controls. Women with migraine were more sensitive than men.Registration number: https://doi.org/10.17605/OSF.IO/YJTAK.

摘要

目的

本荟萃分析比较了偏头痛患者和无头痛对照者三叉神经、颈椎和无远程疼痛区域的压痛敏感性，同时考虑了诊断（发作性与慢性）和性别。通过电子数据库检索比较偏头痛和无头痛对照者之间压痛阈值的横断面或前瞻性病例对照研究。由两名审查员提取数据。采用纽卡斯尔-渥太华质量评估量表评估偏倚风险和方法学质量。对三叉神经、三叉神经外（颈椎）和无远程疼痛区域进行荟萃分析。考虑了偏头痛的频率和性别。计算了均值差异（MD）和随机效应。

结果

纳入了 18 项研究。与无头痛对照组相比，偏头痛患者的压痛阈值较低：三叉神经（MD-71.33kPa，95%CI-92.14 至-50.53）、颈椎（MD-68.50kPa，95%CI-84.67 至-52.33）和无远程疼痛（MD-62.49kPa，95%CI-99.52 至-25.45）区域。在所有部位，发作性偏头痛的差异均具有统计学意义，但在慢性偏头痛中仅在三叉神经区域具有统计学意义（MD-67.36kPa，95%CI-101.31 至-33.42）。总体而言，女性的压痛阈值低于男性。大多数研究（66.7%）的方法学质量良好。结果显示高度异质性。

结论

本荟萃分析发现，与无头痛对照者相比，偏头痛患者三叉神经、三叉神经外和无远程疼痛区域的压痛阈值较低，证据质量为低到高。在发作性偏头痛中，局部和广泛的压痛敏化始终存在，但与无头痛对照者相比，在慢性偏头痛中仅局部存在。偏头痛女性比男性更敏感。注册号：https://doi.org/10.17605/OSF.IO/YJTAK。