{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,11]],"date-time":"2026-03-11T06:51:04Z","timestamp":1773211864705,"version":"3.50.1"},"reference-count":41,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2026,3,10]],"date-time":"2026-03-10T00:00:00Z","timestamp":1773100800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Background\/Objectives: Pressure pain thresholds (PPTs) are commonly used to quantify mechanical hyperalgesia in migraine and tension-type headache (TTH), but the discriminatory performance of PPTs across neural and muscular sites remains unclear. This study compared nerve- and muscle-related PPTs between migraine and frequent episodic TTH and explored site-specific ROC-derived cut-off values as complementary classification markers. Methods: In this cross-sectional case-group discrimination study, participants with migraine (n = 33) and frequent episodic TTH (n = 31) underwent bilateral PPT assessment (electronic algometry) over the temporalis and tibialis anterior muscles, C5\/C6 zygapophyseal joints, peripheral nerves (greater occipital, median, ulnar, radial, posterior tibial, common peroneal), and the second metacarpal region. Results: PPTs were generally lower in the migraine group than in the TTH group. After adjustment for sex and age, the most consistent between-group differences remained at the temporalis muscles bilaterally (left: adjusted mean difference 0.49 kg\/cm2, 95% CI 0.10 to 0.89, p = 0.015; right: 0.53 kg\/cm2, 95% CI 0.13 to 0.93, p = 0.011) and at the left tibialis anterior muscle (0.90 kg\/cm2, 95% CI 0.03 to 1.78, p = 0.044). In the main ROC analysis, the temporalis muscles showed the strongest discriminatory performance (left AUC = 0.733; right AUC = 0.707), whereas tibialis anterior and left posterior tibial nerve sites showed modest, below-threshold discrimination (AUCs &lt; 0.70 despite statistical significance in some cases). Women-only ROC analyses showed a broadly similar pattern, with slightly improved metrics at some sites, particularly the temporalis muscles. Across most sites, likelihood ratios indicated only small-to-moderate shifts in post-test probability. Conclusions: Participants with migraine showed lower PPTs than those with frequent episodic TTH across most assessed sites, with the clearest differences at the temporalis muscles. ROC and PR analyses suggest that PPTs (especially at temporalis sites) may provide complementary, hypothesis-generating discriminatory information, but their overall stand-alone discriminative utility is modest. PPT assessment should therefore be interpreted as an adjunct to clinical evaluation rather than a replacement diagnostic test.<\/jats:p>","DOI":"10.3390\/diagnostics16060823","type":"journal-article","created":{"date-parts":[[2026,3,10]],"date-time":"2026-03-10T08:43:31Z","timestamp":1773132211000},"page":"823","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Pressure Pain Threshold Cut-Off Points at Trigeminal and Extra-Trigeminal Nervous and Musculoskeletal Structures to Discriminate Patients with Migraine from Episodic Tension-Type Headache: A Diagnostic Accuracy Study"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-5834-3385","authenticated-orcid":false,"given":"Leandro H.","family":"Caama\u00f1o-Barrios","sequence":"first","affiliation":[{"name":"Escuela Universitaria Gimbernat Cantabria, Adscrita la Universidad de Cantabria, 39300 Torrelavega, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Naiara","family":"Ben\u00edtez-Aramburu","sequence":"additional","affiliation":[{"name":"Escuela Universitaria Gimbernat Cantabria, Adscrita la Universidad de Cantabria, 39300 Torrelavega, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2165-069X","authenticated-orcid":false,"given":"Alberto","family":"Nava-Varas","sequence":"additional","affiliation":[{"name":"Escuela Internacional de Doctorado, Universidad Rey Juan Carlos, 28922 Alcorc\u00f3n, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3515-2616","authenticated-orcid":false,"given":"Fernando","family":"Gal\u00e1n-del-R\u00edo","sequence":"additional","affiliation":[{"name":"Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, 28922 Alcorc\u00f3n, Spain"},{"name":"Grupo de Investigaci\u00f3n de Alto Rendimiento en Evaluaci\u00f3n Multidimensional y Tratamiento del Dolor Cr\u00f3nico, Universidad Rey Juan Carlos, 28922 Alcorc\u00f3n, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1956-1903","authenticated-orcid":false,"given":"M\u00f3nica","family":"L\u00f3pez-Redondo","sequence":"additional","affiliation":[{"name":"Faculty of Health Sciences, Francisco de Vitoria University, 28223 Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4522-8167","authenticated-orcid":false,"given":"Jorge","family":"Buffet-Garc\u00eda","sequence":"additional","affiliation":[{"name":"Faculty of Health Sciences, Francisco de Vitoria University, 28223 Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3271-5767","authenticated-orcid":false,"given":"Ricardo","family":"Ortega-Santiago","sequence":"additional","affiliation":[{"name":"Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, 28922 Alcorc\u00f3n, Spain"},{"name":"Grupo de Investigaci\u00f3n de Alto Rendimiento en Evaluaci\u00f3n Multidimensional y Tratamiento del Dolor Cr\u00f3nico, Universidad Rey Juan Carlos, 28922 Alcorc\u00f3n, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,3,10]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Headache Classification Committee of the International Headache Society (IHS) (2018). The International Classification of Headache Disorders, 3rd Edition. Cephalalgia, 38, 1\u2013211.","DOI":"10.1177\/0333102417738202"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1177\/03331024231209303","article-title":"The Evolutionary Meaning of Migraine","volume":"43","author":"Pensato","year":"2023","journal-title":"Cephalalgia"},{"key":"ref_3","unstructured":"de Lourdes Figuerola, M. (2014). Figuerola: Las Cefaleas, Editorial M\u00e9dica Panamericana S.A."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"56","DOI":"10.1007\/s11910-021-01138-7","article-title":"Current Understanding of the Pathophysiology and Approach to Tension-Type Headache","volume":"21","author":"Steel","year":"2021","journal-title":"Curr. Neurol. Neurosci. Rep."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"101931","DOI":"10.1016\/j.berh.2024.101931","article-title":"Cervicogenic Headache\u2014How to Recognize and Treat","volume":"38","author":"Piovesan","year":"2024","journal-title":"Best Pract. Res. Clin. Rheumatol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"A1","DOI":"10.2519\/jospt.2017.0302","article-title":"Neck Pain: Revision 2017","volume":"47","author":"Blanpied","year":"2017","journal-title":"J. Orthop. Sports Phys. Ther."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"113","DOI":"10.1179\/2042618612Y.0000000025","article-title":"Conservative Physical Therapy Management for the Treatment of Cervicogenic Headache: A Systematic Review","volume":"21","author":"Racicki","year":"2013","journal-title":"J. Man. Manip. Ther."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"761","DOI":"10.1111\/head.13323","article-title":"A Case of Complete Scotoma Following Intake of Conjugated Linoleic Acid Supplement","volume":"58","author":"Eliasson","year":"2018","journal-title":"Headache"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"102348","DOI":"10.1016\/j.xcrm.2025.102348","article-title":"Global, Regional, and National Burden of Headache Disorders, 1990\u20132021, with Forecasts to 2050: A Global Burden of Disease Study 2021","volume":"6","author":"Wijeratne","year":"2025","journal-title":"Cell Rep. Med."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"954","DOI":"10.1016\/S1474-4422(18)30322-3","article-title":"Global, Regional, and National Burden of Migraine and Tension-Type Headache, 1990\u20132016: A Systematic Analysis for the Global Burden of Disease Study 2016","volume":"17","author":"Stovner","year":"2018","journal-title":"Lancet Neurol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"24","DOI":"10.1038\/s41572-021-00257-2","article-title":"Tension-Type Headache","volume":"7","author":"Ashina","year":"2021","journal-title":"Nat. Rev. Dis. Primers"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"297","DOI":"10.1007\/s40122-024-00690-7","article-title":"The Global Burden of Migraine: A 30-Year Trend Review and Future Projections by Age, Sex, Country, and Region","volume":"14","author":"Dong","year":"2025","journal-title":"Pain Ther."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"60","DOI":"10.1111\/head.14024","article-title":"The Prevalence and Impact of Migraine and Severe Headache in the United States: Updated Age, Sex, and Socioeconomic-specific Estimates from Government Health Surveys","volume":"61","author":"Burch","year":"2021","journal-title":"Headache J. Head Face Pain"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1202","DOI":"10.1097\/j.pain.0000000000001231","article-title":"Quantitative Sensory Testing in Patients with Migraine: A Systematic Review and Meta-Analysis","volume":"159","author":"Shefi","year":"2018","journal-title":"Pain"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1186\/s10194-018-0833-7","article-title":"Pressure Pain Thresholds over the Cranio-Cervical Region in Headache: A Systematic Review and Meta-Analysis","volume":"19","author":"Castien","year":"2018","journal-title":"J. Headache Pain"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"656","DOI":"10.1097\/PHM.0000000000001603","article-title":"Pressure Pain Threshold in Patients With Chronic Pain: A Systematic Review and Meta-Analysis","volume":"100","author":"Amiri","year":"2021","journal-title":"Am. J. Phys. Med. Rehabil."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"4525","DOI":"10.1007\/s00415-022-11039-5","article-title":"Understanding the Interaction between Clinical, Emotional and Psychophysical Outcomes Underlying Tension-Type Headache: A Network Analysis Approach","volume":"269","author":"Cuadrado","year":"2022","journal-title":"Journal of Neurology"},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Cigar\u00e1n-Mendez, M., Pacho-Hern\u00e1ndez, J.C., Fern\u00e1ndez-Palacios, F.G., Tejera-Alonso, \u00c1., Valera-Calero, J.A., G\u00f3mez-Calero, C., Ord\u00e1s-Bandera, C., and Fern\u00e1ndez-de-las-Pe\u00f1as, C. (2024). Can Clinical, Psychophysical or Psychological Variables Help in Discriminating Women with Migraines from a Tertiary Center? A Diagnostic Accuracy Study. Diagnostics, 14.","DOI":"10.3390\/diagnostics14242805"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"321","DOI":"10.1093\/pm\/pnaf009","article-title":"Are Clinical, Psychophysical, or Psychological Variables Helpful for Discriminating Patients with Tension Type Headache? A Diagnostic Accuracy Study","volume":"26","year":"2025","journal-title":"Pain Med."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"h5527","DOI":"10.1136\/bmj.h5527","article-title":"STARD 2015: An Updated List of Essential Items for Reporting Diagnostic Accuracy Studies","volume":"351","author":"Bossuyt","year":"2015","journal-title":"BMJ"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"a718","DOI":"10.1136\/bmj.a718","article-title":"Enhancing the Quality and Transparency of Health Research","volume":"337","author":"Groves","year":"2008","journal-title":"BMJ"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"580","DOI":"10.1212\/01.wnl.0000172918.74999.8a","article-title":"Prognosis of Migraine and Tension-Type Headache: A Population-Based Follow-up Study","volume":"65","author":"Lyngberg","year":"2005","journal-title":"Neurology"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1073","DOI":"10.1016\/j.jpainsymman.2010.08.016","article-title":"Studies Comparing Numerical Rating Scales, Verbal Rating Scales, and Visual Analogue Scales for Assessment of Pain Intensity in Adults: A Systematic Literature Review","volume":"41","author":"Hjermstad","year":"2011","journal-title":"J. Pain Symptom Manag."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"760","DOI":"10.1097\/AJP.0b013e318154b6ae","article-title":"Interrater Reliability of Algometry in Measuring Pressure Pain Thresholds in Healthy Humans, Using Multiple Raters","volume":"23","author":"Chesterton","year":"2007","journal-title":"Clin. J. Pain"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1016\/j.jmpt.2013.12.006","article-title":"Intraexaminer and Interexaminer Reliability of Manual Palpation and Pressure Algometry of the Lower Limb Nerves in Asymptomatic Subjects","volume":"37","author":"Fingleton","year":"2014","journal-title":"J. Manip. Physiol. Ther."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"644","DOI":"10.2519\/jospt.2011.3666","article-title":"Reliability, Standard Error, and Minimum Detectable Change of Clinical Pressure Pain Threshold Testing in People with and without Acute Neck Pain","volume":"41","author":"Walton","year":"2011","journal-title":"J. Orthop. Sports Phys. Ther."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"192","DOI":"10.1016\/j.math.2006.06.010","article-title":"Evaluation of Repeatability of Pressure Algometry on the Neck Muscles for Clinical Use","volume":"12","author":"Ylinen","year":"2007","journal-title":"Man. Ther."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1315","DOI":"10.1097\/JTO.0b013e3181ec173d","article-title":"Receiver Operating Characteristic Curve in Diagnostic Test Assessment","volume":"5","author":"Mandrekar","year":"2010","journal-title":"J. Thorac. Oncol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"45","DOI":"10.4103\/0301-4738.37595","article-title":"Understanding and Using Sensitivity, Specificity and Predictive Values","volume":"56","author":"Parikh","year":"2008","journal-title":"Indian J. Ophthalmol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1016\/0304-3959(92)90007-X","article-title":"Cervicogenic Headache, Migraine without Aura and Tension-Type Headache. Diagnostic Blockade of Greater Occipital and Supra-Orbital Nerves","volume":"51","author":"Bovim","year":"1992","journal-title":"Pain"},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Lee, J., Park, W., Choi, J., Lee, G., Ma, S., Lee, S., and Park, S. (2023). Effect of Repeated Greater Occipital Nerve Block in Patients with Ocular Neuropathic Pain: A Retrospective Observational Study. J. Clin. Med., 12.","DOI":"10.21203\/rs.3.rs-2558098\/v1"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1335","DOI":"10.1136\/jnnp-2021-326433","article-title":"Greater Occipital Nerve Block Modulates Nociceptive Signals within the Trigeminocervical Complex","volume":"92","author":"Hoffmann","year":"2021","journal-title":"J. Neurol. Neurosurg. Psychiatry"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1408","DOI":"10.1093\/pm\/pnz146","article-title":"Widespread Pressure Pain Sensitivity over Nerve Trunk Areas in Women with Frequent Episodic Tension-Type Headache as a Sign of Central Sensitization","volume":"21","year":"2020","journal-title":"Pain Med."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"S44","DOI":"10.1016\/j.pain.2013.07.021","article-title":"Migraine Pathophysiology: Anatomy of the Trigeminovascular Pathway and Associated Neurological Symptoms, CSD, Sensitization and Modulation of Pain","volume":"154","author":"Noseda","year":"2013","journal-title":"Pain"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"775","DOI":"10.2174\/1389450120666190131114244","article-title":"Insight into Pain Modulation: Nociceptors Sensitization and Therapeutic Targets","volume":"20","author":"Khan","year":"2019","journal-title":"Curr. Drug Targets"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"1661","DOI":"10.1177\/0333102418786261","article-title":"Current Understanding of Trigeminal Ganglion Structure and Function in Headache","volume":"39","author":"Messlinger","year":"2019","journal-title":"Cephalalgia"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"431","DOI":"10.1007\/s00702-020-02161-7","article-title":"Cross-Talk Signaling in the Trigeminal Ganglion: Role of Neuropeptides and Other Mediators","volume":"127","author":"Messlinger","year":"2020","journal-title":"J. Neural Transm."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"256","DOI":"10.1177\/0333102420958384","article-title":"Evidence of Localized and Widespread Pressure Pain Hypersensitivity in Patients with Tension-Type Headache: A Systematic Review and Meta-Analysis","volume":"41","author":"Olesen","year":"2021","journal-title":"Cephalalgia"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"966","DOI":"10.1177\/03331024221084217","article-title":"Localized and Widespread Pressure Pain Hypersensitivity in Patients with Episodic or Chronic Migraine: A Systematic Review and Meta-Analysis","volume":"42","year":"2022","journal-title":"Cephalalgia"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"e4787","DOI":"10.1002\/ejp.4787","article-title":"Cut-Off Values Able to Identify Migraine Patients With Increased Pressure-Pain Sensitivity Independent of the Migraine Cycle Through a Single Assessment: A Secondary Analysis of a Multicentre, Cross-Sectional, Observational Study","volume":"29","author":"Castaldo","year":"2025","journal-title":"Eur. J. Pain"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.pediatrneurol.2025.05.004","article-title":"Diagnostic Accuracy of Muscle Tenderness, but Not Pressure Pain Thresholds, to Discriminate Children with Tension-Type Headache","volume":"169","year":"2025","journal-title":"Pediatr. Neurol."}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/16\/6\/823\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,10]],"date-time":"2026-03-10T09:04:59Z","timestamp":1773133499000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/16\/6\/823"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,10]]},"references-count":41,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2026,3]]}},"alternative-id":["diagnostics16060823"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics16060823","relation":{},"ISSN":["2075-4418"],"issn-type":[{"value":"2075-4418","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,10]]}}}