Agreement between single and mean of three craniofacial pressure pain threshold measurements: feasibility in healthy adults
DOI:
https://doi.org/10.48208/HeadacheMed.2026.13Keywords:
Pressure pain threshold, Agreement, Intraclass correlation coefficient, Headache, ReproducibilityAbstract
Background
Pressure pain threshold assessment is used to quantify pain sensitivity in headache disorders, reflecting peripheral and central sensitization of the nociceptive system. Traditional protocols involve multiple measurements to ensure reliability, but these protocols are time-consuming and may cause participant fatigue and discomfort.
Objective
To evaluate the agreement and reliability between a single Pressure Pain Threshold (PPT) measurement and the mean of three measurements in the craniofacial of individuals without a history of headache disorders, using a digital algometer.
Methods
Cross-sectional methodological study with ten volunteers (60% female, mean age 43±8 years) without headache history. Pressure pain threshold was assessed at eight craniofacial sites (bilateral: occipital, temporal, masseter; central: frontal, vertex) using a digital algometer. Three consecutive measurements were performed at each site with 10-minute intervals. Reliability between measurements was assessed using Intraclass Correlation Coefficient (ICC), while agreement and systematic bias were evaluated using Bland–Altman analysis.
Results
Intra-rater reliability ranged from moderate to good (ICC=0.54–0.96) across individual sites, with good-to-excellent reliability in bilateral occipital, temporal, and masseter sites (ICC=0.62–0.96). Reliability between the single measurement and the mean of three trials was uniformly excellent (ICC=0.93–0.98) Bland-Altman analysis showed minimal bias (mean differences near zero) and relatively narrow limits of agreement in peripheral sites, with wider limits observed in central regions.
Conclusion
A single pressure pain threshold measurement demonstrated agreement comparable to the mean of three measurements, supporting the potential use of simplified assessment protocols.
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Copyright (c) 2026 Rosana Tieka Miyazaki Brancucci, Vanda de Lelis, Georgia Westenhofen, Ida Fortini, Gabriel Taricani Kubota, Gianluca Coppola, Mario Fernando Prieto Peres (Author)
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