Abnormal Habituation of ‘nociceptive’ Blink Reflex in Migraine-Evidence for Increased Excitability of Trigeminal Nociception

Abstract

We studied the habituation of the 'nociceptive' blink reflex (nBR) in 15 healthy subjects and 17 migraine patients interictally as well as during unilateral migraine headache within six hours of onset and after treatment. In healthy volunteers the mean regression coefficient (MRC) was - 3.9 following right sided and - 4.9 left sided stimulation. This equals an amplitude loss of 19.5% (5 x -3.9) and 24.5% (5 x -4.9), respectively, across five consecutive sweeps. An augmentation of nBR responses was found in migraine patients interictally: MRC = 3.3 following stimulation of the headache side (HA) and MRC = 4.0 of the non-headache side (non-HA). The differences were statistically significant (anova: d.f. = 1, F = 25.8, P < 0.001). During the migraine attack MRCs were negative both before (-5.0, HA and - 4.0, non-HA) and after treatment (-2.6, HA and - 1.9 non-HA) and significantly differed from those outside the migraine attack (anova: d.f. = 2, F = 12.4, P < 0.001). The demonstrated lack of habituation of the nBR responses indicates an abnormal trigeminal nociceptive processing in migraine patients outside the migraine attack.

Migraine and motion sickness: What is the link?

“…Temporal summation to painful mechanical stimulation of the supraorbital region was found to be greater in migraine sufferers than controls, consistent with induction of wind-up in second-order trigeminal nociceptive neurons (Weissman-Fogel et al, 2003). Moreover, trigeminal nociceptive blink reflexes were hyperexcitable in migraine sufferers during the headache-free interval (Sandrini et al, 2002;Katsarava et al, 2003), and demonstrated evidence of sensitization during attacks (Kaube et al, 2002).…”

Altered processing of sensory stimuli in patients with migraine

“…Migraine is characterized by an interictal deficit of nBR habituation during both short 74 and long 38 series of stimuli. nBR habituation normal izes during migraine attacks, 74 and individuals at risk of developing migraine lack nBR habituation deficits, 86 whereas habituation of nociceptive laser evoked poten tials (LEPs, discussed further below) remains deficient. 75 Patients with migraine also show temporal summation of the nBR.…”

Defensive reflexes in people with pain – a biomarker of the need to protect? A meta-analytical systematic review

“…There were 19 studies that met the inclusion criteria for the review but could not be included in the meta-analyses because raw data could not be extracted (Peters et al, 1992;Leroux et al, 1995;Knost et al, 1997;de Tommaso et al, 2000;Nappi et al, 2002;Desmeules et al, 2003;Katsarava et al, 2003;Banic et al, 2004;Lang et al, 2005;Ayzenberg et al, 2006;Carleton et al, 2006;Sandrini et al, 2006;Al-Azzawi et al, 2008;Filatova et al, 2008;Mendak et al, 2010;Neziri et al, 2010;Biurrun Manresa et al, 2013a,b;Desmeules et al, 2014). We were unable to obtain a meaningful outcome relevant to our research question for eight studies (see Table 2 for details).…”

“…For example, for five studies, the authors were unable to access their data (Peters et al, 1992;Knost et al, 1997;Nappi et al, 2002;Katsarava et al, 2003;Sandrini et al, 2006), two considered that it was inappropriate to use their data and declined to share their results (Carleton et al, 2006;Biurrun Manresa et al, 2013a,b), and the authors of nine studies did not respond to several enquiries about their data (Leroux et al, 1995;de Tommaso et al, 2000;Desmeules et al, 2003Desmeules et al, , 2014Banic et al, 2004;Lang et al, 2005;Ayzenberg et al, 2006;Al-Azzawi et al, 2008;Mendak et al, 2010). As noted in the peer review process of the current review, this does reflect a kind of bias -towards papers the authors of which are willing and able to share their data for the purposes of the meta-analysis.…”