Diagnostic Accuracy of Muscle Tenderness, but Not Pressure Pain Thresholds, to Discriminate Children With Tension-Type Headache.

BACKGROUND

The aim of this study was to determine the ability of pressure pain thresholds (PPTs) and muscle tenderness to differentiate children with and without tension-type headache (TTH).

METHODS

A diagnostic accuracy study was conducted. PPTs (kPa) over the temporalis muscle, upper trapezius muscle, second metacarpal, and tibialis anterior muscle were bilaterally evaluated in 70 children with TTH and 70 age- and sex-matched healthy children. The total tenderness score (TTS) was also calculated. The area under the receiver operating characteristic (ROC) curve, the optimal cutoff point, sensitivity, specificity, and positive/negative likelihood ratios for each variable were calculated to determine the diagnostic accuracy.

RESULTS

Overall, children with TTH exhibited lower PPTs in all assessed points and higher TTS than children without TTH. Just tenderness showed an ROC score ≥ 0.7. Thus the ROC value (0.997) of muscle tenderness was indicative of good discriminatory power. Tenderness showed high sensitivity (97.1%) meaning that it accurately identified children with TTH, although its specificity was extremely low (2.9%), suggesting it could include children without TTH.

CONCLUSION

Although children with TTH exhibit pressure-pain hyperalgesia and muscle tenderness compared with healthy children, only muscle tenderness exhibited diagnostic accuracy to discriminate children with and without TTH. Further studies are now needed to clarify the clinical relevance of these findings.