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Comparison of generalized & localized hyperalgesia in patients with recurrent headache & fibromyalgia (FM)

  [ 43 votes ]   [ Discuss This Article ] • November 6, 1999

OBJECTIVES: Research suggests that dysregulated pain
modulation may play an important role in recurrent headaches
and fibromyalgia syndrome (FMS). The primary objective of this
study was to investigate algesic responses in localized
cervical and pericranial regions (ie, headache-specific areas)
and distal locations (ie, trochanter and gluteal) in patients
with primary headaches (tension-type and migraine). The
headache patients' algesic responses were compared with those
of a sample of patients with musculoskeletal pain who report
generalized hyperalgesia, or FMS.

METHODS: Seventy patients
with mixed headache diagnoses and 66 patients with FMS
underwent a standardized examination of generalized
hyperalgesia based on American College of Rheumatology

RESULTS: Twenty-eight of the 70 headache patients
reported the presence of widespread TP pain, suggesting
generalized hyperalgesia. Headache diagnosis was unrelated to
the presence or absence of generalized hyperalgesia. The
subset of headache patients with generalized hyperalgesia did
not differ from the FMS patients in pain sensitivity in the
cervical and pericranial areas. Regression analyses revealed
that pressure pain sensitivity was significantly related to
self-reported pain only in the headache patients with
generalized hyperalgesia.

CONCLUSIONS: These results suggest
that extensive dysregulation in pain modulation is important
for a substantial minority of recurrent headache patients, who
seem to be quite similar to FMS patients. Differential
treatment planning targeting generalized hyperalgesia may be
useful in treating headache patients exhibiting generalized
hyperalgesia more effectively.

Okifuji A, Turk DC, Marcus DA

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