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Perceived Pain Extent is Not associated with Widespread Pressure Pain Sensitivity, Clinical Features, Related-Disability, Anxiety, or Depression in Women with Episodic Migraine

Fernández-de-las-Peñas Cesar PT; Falla, Deborah PT, PhD; Palacios-Ceña, María PT, MSc; Fuensalidad-Novo, Stella PT, MSc; Arias-Buría, Jose L. PT, PhD; Schneebeli, Alessandro PT, MSc; Arend-Nielsen, Lars DMSc; Barbero, Marco PT, PhD
The Clinical Journal of Pain: Post Acceptance: July 20, 2017
doi: 10.1097/AJP.0000000000000537
Original Article: PDF Only


People with migraine present with varying pain extent and an expanded distribution of perceived pain may reflect central sensitization. The relationship between pain extent and clinical features, psychological outcomes, related-disability and pressure pain sensitivity in migraine has been poorly investigated. Our aim was to investigate whether the perceived pain extent, assessed from pain drawings, relates to measures of pressure pain sensitivity, clinical, psychological outcomes, and related-disability in women with episodic migraine.


Seventy-two women with episodic migraine completed pain drawings which were subsequently digitized allowing pain extent to be calculated utilising novel software. Pressure pain thresholds (PPT) were assessed bilaterally over the temporalis muscle (trigeminal area), the cervical spine (extra-trigeminal area) and tibialis anterior muscle (distant pain-free area). Clinical features of migraine, migraine related-disability (migraine disability assessment questionnaire, MIDAS), anxiety and depression (Hospital Anxiety-Depression Scale, HADS) were also assessed. Spearman rho correlation coefficients were computed to reveal correlations between pain extent and the remaining outcomes.


No significant associations were observed between pain extent and PPTs in trigeminal, extra-trigeminal or distant pain-free areas, migraine pain features, or psychological variables including anxiety or depression and migraine related-disability.


Pain extent within the trigemino-cervical area was not associated with any of the measured clinical outcomes and not related to the degree of pressure pain sensitization in women with episodic migraine. Further research is needed to determine if the presence of expanded pain areas outside of the trigeminal area can play a relevant role in the sensitization processes in migraine.

disclosureDisclosures: Financial disclosure statements have been obtained and no conflicts of interest have been reported by the authors or by any individuals in control of the content of this article. No conflicts of interest.

Conflict of Interest Statement: The Author(s) declare(s) that there is no conflict of interest.

Reprints: César Fernández de las Peñas, PT, Facultad de Ciencias de la Salud, Universidad Rey Juan Carlos, Avenida de Atenas s/n, 28922 Alcorcón, Madrid, SPAIN (e-mail:

Received May 10, 2017

Accepted July 10, 2017

Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.