Using the method for determining the nociceptive flexion reflex in patients with tension-type headache

Yu.I. Romanenko


Background. Tension-type headache is the most common type of headaches in the population. It occurs in almost 80 % of people. A recent study of the burden of headaches showed that maladaptation and socio-economic losses associated with tension-type headache are higher than that of migraines. The purpose of this work was to study the characteristics of the nociceptive flexion reflex in patients with tension-type headache. Materials and methods. A total of 108 patients (55 men, 53 women) diagnosed with frequent episodic tension-type headache (group I, n = 64) and chronic tension-type headache (group II, n = 44) were examined. Clinical neurological examination was carried out, subjective severity of headache was determined with visual analogue scale, McGill pain questionnaire was used to characterize the headache, and a study of nociceptive flexion reflex was performed (indicators of pain threshold (PT), reflex threshold (RT), PT/RT ratio were identified). Results. Data of the visual analogue scale in both clinical groups did not differ significantly, the values were moderate. PT in group I was Me (Q1-Q3) = 7.6 (6.03–9.55), in group II — 7.25 (5.93–8.20), in group of healthy subjects — 8.95 (8.1–9.6) mA. RT was 9.6 (8.03–10.68), 8.80 (7.05–10.65) and 10.3 (9.78–11.1) mA, respectively. PT/RT ratio was 0.85 (0.76–0.94), 0.80 (0.76–0.86) and 0.88 (0.81–0.91), respectively. There was a significant decrease of RT in group I, in group II — of PT and PT/RT ratio compared to the group of healthy subjects, significant differences in these indicators between patients of groups I and II, group I and control group were not found. In group I, a statistically significant negative correlation was found between PT and the rank pain index on the sensory scale (r = –0.721, p = 0.008), between RT and the rank pain index on the sensory scale (r = –0.624, p = 0.03), between PT/RT ratio and pain severity on the evaluation scale (r = –0.817, p = 0.001). Conclusions. Compared to healthy subjects, patients with episodic tension-type headache have significantly lower RT, and patients with chronic tension-type headache — significantly lower PT and PT/RT ratio. To assess the functional activity of nociceptive and antinociceptive systems and to indentify a tendency to chronic headache, it is advisable to use the methodology for determining nociceptive flexion reflex.


episodic tension-type headache; chronic tension-type headache; visual analog scale; McGill pain questionnaire; nociceptive flexion reflex


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