The development of cutaneous allodynia during a migraine attack clinical evidence for the sequential recruitment of spinal and supraspinal nociceptive neurons in migraine.
TLDR
The way in which cutaneous allodynia develops by measuring the pain thresholds in the head and forearms bilaterally at several time points during a migraine attack in a 42-year-old male is studied and calls for early use of anti-migraine drugs that target peripheral nociceptors, before the development of central sensitization.Abstract:
Recently, we showed that most migraine patients exhibit cutaneous allodynia inside and outside their pain-referred areas when examined during a fully developed migraine attack. In this report, we studied the way in which cutaneous allodynia develops by measuring the pain thresholds in the head and forearms bilaterally at several time points during a migraine attack in a 42-year-old male. Prior to the headache, he experienced visual, sensory, motor and speech aura. During the headache, he experienced photo-, phono- and odour-phobia, nausea and vomiting, worsening of the headache by coughing or moving his head, and cutaneous pain when shaving, combing his hair or touching his scalp. Comparisons between his pain thresholds in the absence of migraine and at 1, 2 and 4 h after the onset of migraine revealed the following. (i) After 1 h, mechanical and cold allodynia started to develop in the ipsilateral head but not in any other site. (ii) After 2 h, this allodynia increased on the ipsilateral head and spread to the contralateral head and ipsilateral forearm. (iii) After 4 h, heat allodynia was also detected while mechanical and cold allodynia continued to increase. These clinical observations suggest the following sequence of events along the trigeminovascular pain pathway of this patient. (i) A few minutes after the initial activation of his peripheral nociceptors, they became sensitized; this sensitization can mediate the symptoms of intracranial hypersensitivity. (ii) The barrage of impulses that came from the peripheral nociceptors activated second-order neurons and initiated their sensitization; this sensitization can mediate the development of cutaneous allodynia on the ipsilateral head. (iii) The barrage of impulses that came from the sensitized second-order neurons activated and eventually sensitized third-order neurons; this sensitization can mediate the development of cutaneous allodynia on the contralateral head and ipsilateral forearm at the 2-h point, over 1 h after the appearance of allodynia on the ipsilateral head. This interpretation calls for an early use of anti-migraine drugs that target peripheral nociceptors, before the development of central sensitization. If central sensitization develops, the therapeutic rationale is to suppress it. Because currently available drugs that aim to suppress central sensitization are ineffective, this study stresses the need to develop them for the treatment of migraine.read more
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References
More filters
Journal ArticleDOI
Evidence for a central component of post-injury pain hypersensitivity
TL;DR: An animal model is developed where changes occur in the threshold and responsiveness of the flexor reflex following peripheral injury that are analogous to the sensory changes found in man, and shows that it in part arises from changes in the activity of the spinal cord.
Journal ArticleDOI
Prevalence of migraine headache in the United States. Relation to age, income, race, and other sociodemographic factors.
TL;DR: The magnitude and distribution of the public health problem posed by migraine in the United States is described by examining migraine prevalence, attack frequency, and attack-related disability by gender, age, race, household income, geographic region, and urban vs rural residence.
Journal ArticleDOI
Response of cutaneous sensory units with unmyelinated fibers to noxious stimuli.
P Bessou,Edward R. Perl +1 more
TL;DR: In an attempt to learn more about the range of behavior associated with the terminals of cutaneous C fibers, a number of randomly sele,cted units were surveyed for responses to a variety of graded stimuli.
Journal ArticleDOI
An association between migraine and cutaneous allodynia
Rami Burstein,Rami Burstein,David Yarnitsky,Itay Goor-Aryeh,Bernard J. Ransil,Zahid H. Bajwa +5 more
TL;DR: These findings suggest that the pathophysiology of migraine involves not only irritation of meningeal perivascular pain fibers but also a transient increase in the responsiveness of central pain neurons that process information arising from intracranial structures and skin.
Journal ArticleDOI
Method for quantitative estimation of thermal thresholds in patients.
TL;DR: A quantitative method for the examination of thermal sensibility was applied in 26 normal subjects and in patients with various neurological disorders, and the resulting temperature curve enables a quantitative description of the subject's Thermal sensibility and of the degree of impairment displayed by neurological patients.