Search tips
Search criteria 


Logo of headpainSpringerOpen.comSubmit OnlineRegisterThis journalThis article
J Headache Pain. 2008 October; 9(5): 295–300.
Published online 2008 August 9. doi:  10.1007/s10194-008-0061-7
PMCID: PMC3452198

Evidence of persistent central sensitization in chronic headaches: a multi-method study


The aim of this study was to investigate central sensitization (CS) in chronic headaches and compare this phenomenon between chronic migraine (CM) and chronic tension-type headache (CTTH). We recruited 69 patients with chronic headaches and 18 control subjects. Questionnaires of headache history, allodynia and the Hospital Anxiety and Depression scale were administered. We recorded thresholds for pinprick and pressure pain, blink (BR) and nociceptive flexion reflex (NFR) R3 component coupled with wind-up ratios. Thresholds for pressure and pinprick pain, BR and NFR R3 were lower and wind-up ratios higher in patients. No differences of CS parameters between CM and CTTH were observed. CS is persistent and prevalent in patients with various types of chronic headache. CS levels are unrelated to the predominant side of pain, disease duration or depression. Neither is CS related to the headache type, suggesting similar mechanisms of headache chronification and chronicity maintaining and possibly explaining clinical similarity of various forms of chronic headache.

Keywords: Allodynia, Chronic headache, Central sensitization, Pressure algometry, Electrophysiology

Full Text

The Full Text of this article is available as a PDF (205K).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.
1. Dodick D. Chronic daily headache. N Eng J Med. 2006;354:158–165. doi: 10.1056/NEJMcp042897. [PubMed] [Cross Ref]
2. D’Amico D, Usai S, Grazzi L, et al. Quality of life and disability in primary chronic daily headache. Neurol Sci. 2003;24(Suppl 2):97–100. [PubMed]
3. Ossipov MH, Lai J, Malan TP, Jr, Porreca F. Spinal and supraspinal mechanisms of neuropathic pain. Ann NY Acad Sci. 2000;909:12–24. doi: 10.1111/j.1749-6632.2000.tb06673.x. [PubMed] [Cross Ref]
4. Burstein R, Yarnitsky D. An association between migraine and cutaneous allodynia. Ann Neurol. 2000;47(5):614–624. doi: 10.1002/1531-8249(200005)47:5<614::AID-ANA9>3.0.CO;2-N. [PubMed] [Cross Ref]
5. Burstein R. Deconstructing migraine headache into peripheral and central sensitization. Pain. 2001;89:107–110. doi: 10.1016/S0304-3959(00)00478-4. [PubMed] [Cross Ref]
6. Woolf CJ. Evidence for a central component of post-injury pain hypersensitivity. Nature. 1983;306:686–688. doi: 10.1038/306686a0. [PubMed] [Cross Ref]
7. Burstein R, Cutrer M, Yarnitsky D. The development of cutaneous allodynia during a migraine attack. Clinical evidence for the sequential recruitment of spinal and supraspinal nociceptive neurons in migraine. Brain. 2000;123:1703–1709. [PubMed]
8. Bendtsen L. Central and peripheral sensitization in tension-type headache. Curr Pain Headache Rep. 2003;7(6):460–465. doi: 10.1007/s11916-003-0062-9. [PubMed] [Cross Ref]
9. Mørk H, Ashina M, Bendtsen L, Olesen J, Jensen R. Possible mechanisms of pain perception in patients with episodic tension-type headache—a new experimental model of myofascial pain. Cephalalgia. 2004;24(6):466–475. doi: 10.1111/j.1468-2982.2004.00709.x. [PubMed] [Cross Ref]
10. Cooke L, Eliasziw M, Becker WJ. Cutaneous allodynia in transformed migraine patients. Headache. 2007;47(4):531–539. [PubMed]
11. Kitaj M, Klink M. Pain thresholds in daily transformed migraine versus episodic migraine headache patients. Headache. 2005;45:992–998. doi: 10.1111/j.1526-4610.2005.05179.x. [PubMed] [Cross Ref]
12. LoPinto C, Young WB, Ashkenazi A. Comparison of dynamic (brush) and static (pressure) mechanical allodynia in migraine. Cephalalgia. 2006;26:852–856. doi: 10.1111/j.1468-2982.2006.01121.x. [PubMed] [Cross Ref]
13. Fernández-de-las-Peñas C, Ge HY, Cuadrado ML, Madeleine P, Pareja JA, Arendt-Nielsen L. Bilateral pressure pain sensitivity mapping of the temporalis muscle in chronic tension-type headache. Headache. 2008;48:1067–1075. doi: 10.1111/j.1526-4610.2007.01005.x. [PubMed] [Cross Ref]
14. Tommaso M, Sciruiccio V, Puca A. Clinical neurophysiology of chronic daily headache. J Headache Pain. 2000;1:S81–S87. doi: 10.1007/s101940070032. [Cross Ref]
15. Sandrini G, Rossi P, Milanov I, Serrao M, Cecchini AP, Nappi G. Abnormal modulatory influence of diffuse noxious inhibitory controls in migraine and chronic tension-type headache patients. Cephalalgia. 2006;26:782–789. doi: 10.1111/j.1468-2982.2006.01130.x. [PubMed] [Cross Ref]
16. Headache Classification Committee of the International Headache Society The International Classification of Headache Disorders. Cephalalgia. 2004;24(Suppl 1):1–160. [PubMed]
17. Yarnitsky D. Quantitative sensory testing. Muscle Nerve. 1997;20:198–204. doi: 10.1002/(SICI)1097-4598(199702)20:2<198::AID-MUS10>3.0.CO;2-#. [PubMed] [Cross Ref]
18. Fischer AA. Application of pressure algometry in manual medicine. J Man Med. 1990;5:145–150.
19. Ellrich J, Hopf HC. The R3 component of the blink reflex: normative data and application in spinal lesions. Electroencephogr Clin Neurophysiol. 1996;101:349–354. doi: 10.1016/0924-980X(96)95684-2. [PubMed] [Cross Ref]
20. Ellrich J, Katsarava Z, Przywara S, Kaube H. Is the R3 component of the human blink reflex nociceptive in origin? Pain. 2001;91:389–395. doi: 10.1016/S0304-3959(00)00465-6. [PubMed] [Cross Ref]
21. Ashina S, Babenko L, Jensen R, Ashina M, Magerl W, Bendtsen L. Increased muscular and cutaneous pain sensitivity in cephalic region in patients with chronic tension-type headache. Eur J Neurol. 2005;12:543–549. doi: 10.1111/j.1468-1331.2005.01023.x. [PubMed] [Cross Ref]
22. Coste J, Voisin DL, Luccarini P, Dallel R. A role for wind-up in trigeminal sensory processing: intensity coding of nociceptive stimuli in the rat. Cephalalgia. 2008;28(6):631–639. doi: 10.1111/j.1468-2982.2008.01568.x. [PubMed] [Cross Ref]
23. Hamelsky S, Lipton R. Psychiatric comorbidity of migraine. Headache. 2006;46:1327–1333. [PubMed]
24. Burstein R, Collins B, Jakubowski M. Defeating migraine pain with triptans: a race against the development of cutaneous allodynia. Ann Neurol. 2004;55:19–26. doi: 10.1002/ana.10786. [PubMed] [Cross Ref]
25. Proietti Cecchini A, Sandrini G, Fokin IV, Moglia A, Nappi G. Trigeminofacial reflexes in primary headaches. Cephalalgia. 2003;23(Suppl 1):33–41. doi: 10.1046/j.1468-2982.2003.00572.x. [PubMed] [Cross Ref]
26. Tommaso M, Guido M, Libro G, Sciruicchio V, Losito L, Difruscolo O, Puca A. The blink reflex in chronic cluster headache: a comparison with migraine patients suffering from unilateral pain. J Headache Pain. 2000;2:97–104. doi: 10.1007/s101940070049. [Cross Ref]
27. Kaube H, Katsarava Z, Kaufer T, Diener HC, Ellrich J. A new method to increase nociception specificity of the human blink reflex. Clin Neurophysiol. 2000;111:413–416. doi: 10.1016/S1388-2457(99)00295-3. [PubMed] [Cross Ref]
28. Tommaso M. Author’s reply. Cephalalgia. 2008;28(6):677–678. doi: 10.1111/j.1468-2982.2008.01594_2.x. [PubMed] [Cross Ref]
29. Langemark M, Bach FW, Jensen TS, Olesen J. Decreased nociceptive flexion reflex threshold in chronic tension-type headache. Arch Neurol. 1993;50:1061–1064. [PubMed]

Articles from The Journal of Headache and Pain are provided here courtesy of Springer