Quantitative sensory testing in children and adolescents with tension type headache: changes in nociceptive processing are not specific for migraine

Aims: The sensitization of central pain pathways is described both as a consequence and as a risk factor for the development and maintenance of chronic headache. Recent studies have shown that already children with migraine have an increased sensitization to painful mechanical stimuli. However, studies in children with tension type headache had inconsistent findings. This study examines (1) whether sensitization presents only in children with migraine or also in children with pure forms of tension-type headache (TTH), and (2) if the processing of painful mechanical stimuli is specific, or if the processing of painful thermal stimuli and nonpainful stimuli is affected also.

Methods: A total of 192 children and adolescents (aged between 8 and 17 years; 62% female) with chronic headaches, including 111 with TTH and 81 with tension-type headache plus migraine headaches (TTH + M) were tested with the quantitative sensory testing following the protocol of the German research network of neuropathic pain. Results were compared with existing reference data of healthy children.

Results: No differences were found between TTH + M and TTH patients. Compared with healthy controls, subjects with TTH + M as well as children with TTH showed lower pain thresholds for pressure pain, mechanical pain threshold, mechanical pain sensitivity, and wind-up ratio. There were no differences in the processing of thermal pain perception and nonpainful thermal and mechanical perception between patients and controls.

Conclusion: Overall, the results confirm the relevance of central sensitization processes in chronic headaches. However, it remains unclear why these are limited to mechanical stimuli and whether they are more of a risk factor or a consequence of chronic headaches. Further studies, if possible with longitudinal designs, are necessary to specify the relationship between chronic pain and central sensitization processes.