Scalp Tenderness and Sensitivity to Pain in Migraine and Tension Headache

SYNOPSIS Pressure‐pain threshold was assessed in the forehead, temples, occiput and neck of 102 patients with migraine or tension headache, and in 35 nonheadache control subjects of similar age and sex distribution. Pain sensitivity to the application of a weighted blade to the fingers was also assessed. Tenderness was greater in patients than in controls, particularly at the site of migraine or tension headache, and to a lesser extent in other areas of the scalp. Scalp tenderness persisted for several days after headache had subsided. The threshold for pain in the fingers was greater during headache than during the headache‐free interval but did not differ from pain threshold in control subjects. Pain in the fingers increased more rapidly in patients with episodically‐recurring tension headaches than in other patient categories or control subjects. These findings demonstrate that scalp tenderness is not due to a general increase in sensitivity to pain during migraine. In contrast, diffuse disruption of central pain modulating systems may be involved in the pathophysiology of episodically‐recurring tension headaches.