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


  • Yu.I. Romanenko Ukrainian Scientific and Practical Center for Endocrine Surgery, Transplantation of Endocrine Organs and Tissues of the Ministry of Health of Ukraine, Kyiv, Ukraine



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


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.


Download data is not yet available.


Lyngberg A.C., Rasmussen B.K., Jørgensen T., Jensen R. Has the prevalence of migraine and tension-type headache changed over a 12-year period? A Danish population survey. Eur. J. Epidemiol. 2005. 20(s3). 243-9. Available from: https://www.sprin­ = article&issn = 0393-2990&vo­lume = 20&issue = 3&spage = 243; doi: 10.1007/s10654-004-6519-2.

Bigal M.E., Lipton R.B. Tension-type headache: classification and diagnosis. Curr. Pain. Headache Rep. 2005 Dec. 9(6). 423-9. doi: 10,1007/s11916-005-0022-7.

Russell M.B., Levi N., Saltyte-Benth J., Fenger K. Tension-type headache in adolescents and adults: a population based study of 33,764 twins. Eur. J. Epidemiol. 2006. 21(2). 153-160. doi: 10.1007/s10654-005-6031-3.

Yu S., Han X. Update of chronic tension-type headache. Curr. Pain Headache Rep. 2015 Jan. 19(1). 469. doi: 10.1007/s11916-014-0469-5.

Stovner L.J., Hagen K., Jensen R. et al. The global burden of headache: a decimation of headache prevalence and disability wordwide. Cephalalgia. 2007. 27. 193-210. Available from:; doi: 10,1111/j.1468-2982.2007.01288.x.

Headache Classification Committee of the International Headache Society (IHS). The International Classification of Headache Disorders, 3rd edition (beta version). Cephalalgia. 2013. 33(9). 629-808. Available from: = Z39.88-2003&rfr_id = = cr_pub%3dpubmed; doi: 10.1177/0333102413485658.

Saylor D., Steiner T.J. The Global Burden of Headache. Semin. Neurol. 2018. 38(2). 182-90. Available from: ucts/ejournals/abstract/ 10.1055/s-0038-1646946; doi: 10.1055/s-0038-1646946.

Fuensalida-Novo S., Palacios-Ceña M., Fernández-Muñoz J.J., Castaldo M., Wang K., Catena A., Arendt-Nielsen L., Fernández-de-Las-Peñas C. The burden of headache is associa­ted to pain interference, depression and headache duration in chronic tension type headache: a 1-year longitudinal study. J. Headache Pain. 2017. 18(1). 119. doi: 10.1186/s10194-017-0829-8.

Sandrini G., Serrao M., Rossi P., Romaniello A., Cruc­cu G., Willer J.C. The lower limb flexion reflex in humans. Progress in neurobiology. 2005. 77. 353-95. doi: 10.1016/j.pneurobio.20 05.11.003.

Skljarevski V., Ramadan N.M. The nociceptive flexion reflex in humans — review article. Pain. 2002. 96(1–2). 3-8. doi: 10.1016/s0304-3959(02)00018-0.

Campbell C.M., France C.R., Robinson M.E., Logan H.L., Geffken G.R., Fillingim R.B. Ethnic differences in the nociceptive flexion reflex (NFR). Pain. 2008. 134(1–2). 91-96.

Dhondt E., Oosterwijck S., Coppieters I., Danneels L., Oosterwijck J. Effects of Conditioned Pain Modulation on the Nociceptive Flexion Reflex in Healthy People: A Systematic Review. The Clinical Journal of Pain. 2019. 35(9). 794-807. doi: 10.1097/AJP.0000000000000724.

Skljarevski V., Ramadan N.M. The nociceptive flexion reflex in humans — review article. Pain. 2002. 96(1–2). 3-8. doi: 10.1016/s0304-3959(02)00018-0.

Bartolo M., Serrao M., Gamgebeli Z. et al. Modulation of the human nociceptive flexion reflex by pleasant and unpleasant odors. Pain. 2013. 154(10). 2054-9. doi: 10.101 6/j.pain.2013.06.032.

Rhudy J.L., France C.R. Defining the nociceptive flexion reflex (NFR) threshold in human participants: a comparison of different scoring criteria. Pain. 2007. 128(3). 244-53. doi: 10.1016/j.pain.2006.09.024.

Slepian M., France C., Hall O., Hain S., Walkowski S., Chappell C. Pain resilience is positively correlated with nociceptive flexion reflex threshold. The Journal of Pain. 2015. 16(4). S2. doi: 10.1016/j.jpain.2015.01.021.

Breivik H., Borchgrevink P.C., Allen S.M. et al. Assessment of pain. Br. J. Anaesth. 2008. 101(1). 17-24. Available from:

Hawker G., Mian H., Kendzerska T., French M. Measures of adult pain: Visual Analog Scale for Pain (VAS Pain), Numeric Rating Scale for Pain (NRS Pain), McGill Pain Questionnaire (MPQ), Short-Form McGill Pain Questionnaire (SF-MPQ), Chronic Pain Grade Scale (CPGS), Short Form-36 Bodily Pain Scale (SF-36 BPS), and Measure of Intermittent and Constant Osteoarthritis Pain (ICOAP). Arthritis Care Res (Hoboken). 2011 Nov. 63 Suppl 11. S240-52. doi: 10.1002/acr.20543.

Guinmand F., Dupont X., Brasseur L., Chauvin M., Bouhassira D. The effects of ketamine on the temporal summation (wind-up) of the RIII nociceptive reflex and pain in humans. Anesth. Analg. 2000. 90. 408-414. doi: 10,1097/00000539-200002000-00031.

Sandrini G., Antonaci F., Lanfranchi S., Milanov I., Danilov A., Nappi G. Asymmetrical reduction of the nociceptive flexion reflex threshold in cluster headache. Cephalalgia. 2000. 20(7). 647-652. doi: 10.1111/j.1468-2982.2000.00096.x.



How to Cite

Romanenko, Y. (2021). Using the method for determining the nociceptive flexion reflex in patients with tension-type headache. EMERGENCY MEDICINE, (8.103), 53–57.



Original Researches