271: Association Between Pain Threshold and Headache Phenotype in Migraine Patients

Topic: Clinical Science
Subtopic: Pain category (ICD-11), Chronic primary headache, Assessment and Measurement of Pain/Nociception

Background and Aims: In 2023, Ashina et al. reported that the facial mechanical pain threshold assessed by the von Frey test during the interictal period in patients with episodic cluster headache (defining <60 g as mechanical hypersensitivity) was useful in predicting treatment response to galcanezumab. To our knowledge, there have been no reports in Japan evaluating facial pain thresholds using the von Frey test in patients with migraine. Therefore, we conducted the present study.

Methods: We measured facial mechanical pain thresholds using the von Frey test in 58 patients who were diagnosed with migraine by headache specialists at our institution according to the International Classification of Headache Disorders, 3rd edition (ICHD-3). We examined the associations between pain threshold and age, sex, migraine subtype (chronic or episodic), allodynia score, HIT-6, GAD-7, PHQ-9, and MIDAS. In patients with episodic migraine, testing was performed during the interictal period; in patients with chronic migraine, testing was conducted in the absence of moderate or severe headache. Pain thresholds were also compared with those of 31 healthy controls.

Results: In patients with migraine, the median pain threshold was 4 g (95% CI: 2.6–6.6 g), and 52 patients (89%) showed mechanical hypersensitivity (<60 g). In healthy controls, the median pain threshold was 2 g (95% CI: 1.2–3.8 g), and all controls exhibited values <60 g. Compared with patients with migraine, healthy controls had significantly lower pain thresholds (p = 0.018). Among migraine patients, higher pain thresholds were significantly associated with higher HIT-6 and MIDAS scores and lower allodynia scores (p = 0.016, p = 0.018, and p = 0.020, respectively). No significant associations were observed with age, sex, migraine subtype, GAD-7, or PHQ-9.

Conclusions: Compared with previous reports, the mechanical pain threshold in Japanese patients was lower. These findings suggest that mechanically induced pain thresholds may vary substantially according to race, ethnicity, or cultural background.

References: 1. Ashina S, Melo-Carrillo A, Szabo E, Borsook D, Burstein R. Pre-treatment non-ictal cephalic allodynia identifies responders to prophylactic treatment of chronic and episodic migraine patients with galcanezumab: A prospective quantitative sensory testing study (NCT04271202). Cephalalgia. 2023 43:3331024221147881.

Presenting Author: Noboru Imai
Submitting Author: Noboru Imai

Senior Author: Noboru Imai

IASP 2026 Global Year theme of Neuropathic Pain: No

• Akane Kanda - Department of Neurology and Headache Center, Japanese Red Cross Shizuoka Hospital
• Tatsuro Yamazaki - Department of Neurology and Headache Center, Japanese Red Cross Shizuoka Hospital
• Akihiro Tsuchida - Department of Neurology and Headache Center, Japanese Red Cross Shizuoka Hospital
• Saki Iguchi - Department of Neurology and Headache Center, Japanese Red Cross Shizuoka Hospital
• Asami Moriya - Department of Neurology and Headache Center, Japanese Red Cross Shizuoka Hospital
• Rieko Suzuki - Department of Neurology and Headache Center, Japanese Red Cross Shizuoka Hospital
• Nobuyasu Yagi - Department of Neurology, Japanese Red Cross Shizuoka Hospital
• Takashi Konishi - Department of Neurology, Japanese Red Cross Shizuoka Hospital
• Masahiro Serizawa - Department of Neurology, Japanese Red Cross Shizuoka Hospital