Somatosensory Profiling of Patients With Cluster Headache: A Systematic Review and Meta-analysis

• Published in: The journal of pain Vol. 25; no. 8; p. 104498
• Main Authors: Bertotti, Gabriele, Gil-Martínez, Alfonso, Matesanz-García, Luis, Angulo-Díaz-Parreño, Santiago, Rodríguez-Vico, Jaime, Díaz-de-Terán, Javier, Elizagaray-García, Juan Ignacio
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.08.2024
• Subjects: central sensitization; Cluster headache; Cluster Headache - diagnosis; Cluster Headache - physiopathology; Humans; hyperalgesia; meta-analysis; Pain Threshold - physiology; quantitative sensory testing; meta-analysis; central sensitization; Cluster headache; hyperalgesia; quantitative sensory testing
• ISSN: 1526-5900; 1528-8447; 1528-8447
• DOI: 10.1016/j.jpain.2024.02.012

The objectives were 1) to synthesize quantitative sensory testing results in cluster headache (CH) patients and to identify somatosensory differences from healthy subjects (HS), and 2) between symptomatic and asymptomatic sides in CH patients. Two independent reviewers conducted a literature search in MEDLINE, EMBASE, Web of Science, and CINAHL databases. Studies with observational designs were included. Methodological quality and risk of bias were assessed with the Newcastle Ottawa Scale. The selected studies underwent qualitative and quantitative analyses. The qualitative analysis showed inconsistent findings among multiple studies. Meta-analysis showed lower pressure pain thresholds (PPTs) on the symptomatic side of CH patients than HS in V2 (standardized mean difference [SMD] −1.01 [95% confidence interval (CI) −1.79, −.23], P = .01, I2 = 73%, n = 114), V3 (SMD −1 [95% CI −1.54, .45], P < .01, I2 = 82%, n = 354), and cervical region (SMD −1.25 [95% CI −2.07, −.44], P < .01, I2 = 84%, n = 194). Furthermore, lower PPTs than those detected in HS were found on the asymptomatic side in V3 (SMD −.77 [95% CI −1.27, −.27], P < .01, I2 = 79%, n = 354) and in the cervical region (SMD −1.13 [95% CI −1.97, −.3], P < .01, I2 = 85%, n = 194). However, no differences were found in V1 or the extratrigeminal points between these groups. No significant changes were found between symptomatic and asymptomatic sides in trigeminal and extratrigeminal regions. Mechanical hyperalgesia in the trigemino-cervical region of patients with CH could suggest the presence of central pain mechanisms. These results are of clinical relevance because their presence could be associated with a poorer prognosis, chronification, and treatment response. This study provides consistent findings on the somatosensory profile characterizing patients with CH. Clinicians should assess PPTs and other quantitative sensory testing variables in the trigeminal and extratrigeminal (cervical) regions. •Mechanical hyperalgesia is present in patients with cluster headache (CH).•Lower pressure pain thresholds were found in both trigeminal and extratrigeminal regions.•Central mechanisms might explain the CH somatosensory profile. But contradictory signs are present.