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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, PhD, DMSc*,†,‡; Falla, Deborah PT, PhD§; Palacios-Ceña, María PT, MSc*,†,‡; Fuensalida-Novo, Stella PT, MSc*,†; Arias-Buría, Jose L. PT, PhD†,∥; Schneebeli, Alessandro PT, MSc; Arend-Nielsen, Lars DMSc; Barbero, Marco PT, PhD

doi: 10.1097/AJP.0000000000000537
Original Articles

Objective: 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.

Methods: A total of 72 women with episodic migraine completed pain drawings, which were subsequently digitized allowing pain extent to be calculated utilising novel software. Pressure pain thresholds were assessed bilaterally over the temporalis muscle (trigeminal area), the cervical spine (extratrigeminal area), and tibialis anterior muscle (distant pain-free area). Clinical features of migraine, migraine-related disability (migraine disability assessment questionnaire [MIDAS]), and anxiety and depression (Hospital Anxiety-Depression Scale [HADS]) were also assessed. Spearman ρ correlation coefficients were computed to reveal correlations between pain extent and the remaining outcomes.

Results: No significant associations were observed between pain extent and pressure pain thresholds in trigeminal, extratrigeminal or distant pain-free areas, migraine pain features, or psychological variables including anxiety or depression, and migraine-related disability.

Conclusions: Pain extent within the trigeminocervical 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.

*Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation

Cátedra de Investigación y Docencia en Fisioterapia: Terapia Manual y Punción Seca, Universidad Rey Juan Carlos, Alcorcón

Department of Physical Therapy, Universidad Francisco de Vitoria, Madrid, Spain

Department of Health Science and Technology, Center for Sensory-Motor Interaction (SMI), School of Medicine, Aalborg University, Aalborg, Denmark

§Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Birmingham, UK

Department of Business Economics, Health and Social Care, Rehabilitation Research Laboratory 2rLab, University of Applied Sciences and Arts of Southern Switzerland, Manno, Switzerland

The authors declare no conflict of interest.

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

Received May 10, 2017

Received in revised form July 3, 2017

Accepted July 10, 2017

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