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

AIM: Identify values that could predict the presence of increased pressure-pain sensitivity independent of the migraine cycle through a single assessment.

METHODS: This was a secondary analysis of a previous study in which 198 episodic and chronic migraine patients were assessed during all phases of the migraine cycle. Pressure pain threshold (PPT) was assessed over the temporalis, cervical spine, hand, and leg. Migraine patients were divided into two sub-groups: patients with increased pressure-pain sensitivity (IPS) and with No IPS (No-IPS). A Chi-squared Automatic Interaction Detection decision tree analysis was used to identify predictors to be included in the IPS or NoIPS group. To assess the internal validity of the model, a tenfold cross-validation was applied.

RESULTS: 161 (81%) patients were included in the IPS group, while 37 (19%) in the NoIPS group. Migraine patients with: (1) Temporalis PPT ≤ 130 kPa; (2) Temporalis PPT > 130 kPa and ≤ 197.5 kPa and hand PPT ≤ 347.33 kPa; (3) Temporalis PPT > 197.5 kPa and hand PPT ≤ 315 kPa; were correctly included in the IPS group with a sensitivity of 96%, a specificity of 81%, a positive predictive value of 96%, and a negative predictive value of 81%. The accuracy of the model and the cross-validation analysis were respectively 93% and 92%.

CONCLUSION: The high internal validity suggests that our model could precisely predict the presence of IPS independently by the phase in which the assessment occurred. Trigeminal and hand PPT cut-off values could be used to identify patients with IPS.