Allodynia and Disability in Migraine: The Mediating Role of Stress

Abstract

Objective.-This study sought to investigate the relationship between allodynia, psychological variables, and disability among individuals with migraine. Background.-A growing body of research views migraine as a condition of stress-related physiological dysregulation. Cutaneous allodynia is one manifestation of this dysregulation and affects a majority of individuals with migraine, though it is typically discussed in the context of headache pathophysiology. Stress, like allodynia, is implicated in the development of central sensitization and migraine progression. However, the contributions of stress and related psychological factors in allodynia and resulting disability remain largely unknown. Methods.-A cross-sectional study at a Southern U.S. university queried young adults with migraine regarding headache symptoms, disability, allodynia symptom frequency, and psychological variables using validated measures. Relations among allodynia and psychological variables of relevance were examined, including the association between allodynia and disability after controlling for pain severity. Subsequently, we assessed whether stress mediated the relationship between allodynia and disability. Results.-The final sample consisted of 147 young adults (87.8% [129/147] female, mean age = 19.0 ± 2.4) with an average headache frequency of 9.9 days per month (SD = 5.9). Increases in allodynia showed small associations with increases in stress, (r = 0.26, P = .001), fear of pain (r = 0.22, P = .008), and headache-related disability (r = 0.18, P = .003); and a small association with reduced self-efficacy (r = −0.16, P = .049). Allodynia significantly predicted disability even after controlling for pain severity (∆R 2 = 0.02, P = .040), and the allodynia-disability relationship was mediated by stress (point estimate = 0.10, 95% CI [0.02-0.21]), such that as allodynia severity increased, stress increased and subsequent disability worsened. Conclusions.-This study establishes meaningful relationships between allodynia and psychological variables of importance to headache self-management and adaptive coping. Allodynia exerts some effect on disability independent of pain itself, and this relationship is partially driven by stress. This study highlights the potential role of the stress response among those with allodynia, and further research is needed to determine if migraine interventions that target maladaptive stress responses may reduce disability by impeding the feedforward loop of allostatic load.

Trigeminal and cervical sensitization during the four phases of the migraine cycle in patients with episodic migraine

“…A positive correlation was found between facilitation of the trigeminal TSP and headache-related disability in ictal EM, suggesting that during the ictal phase of the migraine cycle, those migraine patients with a higher level of disability present a more pronounced sensitization of second-order neurons in the spinal trigeminal nucleus. 70,71 Moreover, a negative correlation was found between pain intensity during the current headache attack and signs of widespread sensitization in ictal EM. Thus, patients with higher pain intensity during the current headache attack present more enhanced signs of widespread sensitization.…”

Cutaneous Allodynia in Migraine: A Narrative Review

“…Cutaneous allodynia (CA) is defined as pain resulting from application of a non-noxious stimulus to normal skin (1,2), and is classified according to either the sensory modality that is used to elicit the sensation (thermal, mechanical dynamic, and mechanical static allodynia) or by the location of the symptom (cephalic and extracephalic). The presence of CA in patients with migraine was described more than 100 years ago (3), but only recently a growing number of studies began to highlight the importance of this common and bothersome symptom (2,(4)(5)(6). Therefore, the clinician treating migraine patients must recognize CA (7) and have up-to-date knowledge of CA importance from pathophysiological, diagnostic, prognostic and therapeutic point of view.…”

Is there a causal relationship between stress and migraine? Current evidence and implications for management

“…A recent study by Avona and colleagues [ 61 ] demonstrated that stress induced in mice produced a migraine-like state of hyperalgesia with increased response to the artificial migraine trigger sodium nitroprusside and subsequent blocking by calcitonin gene related peptide monoclonal antibodies. Similarly, allodynia exerts some effect on migraine-related disability, independent of the pain itself, and the relationship is partially driven by stress [ 62 ]. Moreover, emerging research has elucidated the role of NMDA receptors and microRNA in stress-related conditions such as major depressive disorder.…”