Are clinical, psychophysical, or psychological variables helpful for discriminating patients with tension type headache? A diagnostic accuracy study.

Abstract

Importance: Diagnosis of tension-type headache (TTH) is a challengue for clinicians.

Objective: The aims of this study were: (1) to determine the ability of pain thresholds to differentiate between subjects with and without TTH; and (2) to determine the capability of clinical, psychological and psychophysical variables to differentiate between individuals with frequent episodic (FETTH) or chronic (CTTH) tension-type headache.

Design: A diagnostic accuracy study.

Setting: An urban hospital in Madrid (Spain).

Participants: One hundred (n = 100) individuals with TTH and 50 comparable non-headache subjects.

Main outcomes: Pressure pain threshold (PPTs) over the temporalis muscle, cervical spine, second metacarpal, and tibialis anterior muscle and dynamic pain thresholds (DPT) were bilaterally assessed. Clinical headache parameters (headache diary), headache-associated burden (HDI), anxiety and depressive levels (HADS), sleep quality (PSQI), and state (STAI-S)-trait (STAI-T) anxiety levels were also evaluated. The area under the receiver operating characteristic (ROC) curve, optimal cut-off point, sensitivity, specificity, and positive and negative likelihood ratios (LR) for each variable were calculated.

Results: Individuals with TTH exhibited lower PPTs and DPT than those without TTH. No significant differences in PPTs and DPT were found between FETTH and CTTH individuals. Overall, no clinical, psychological or psychophysical variable exhibited an acceptable ROC value (≥0.7) for identifying between TTH patients and non-headache controls or between subjects with FETTH and CTTH.

Conclusion: Although individuals with TTH exhibit widespread pressure pain hyperalgesia, neither clinical nor psychological nor psychophysical variable had proper diagnostic accuracy to discriminate between individuals with/without TTH or between those with FETTH and CTTH.

Relevance: Pressure pain thresholds should not be used at this stage as diagnostic tool for TTH. Further studies should clarify the clinical relevance of these findings.