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

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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