An association between migraine and cutaneous allodynia

Abstract

Recent animal studies on the mechanism of migraine show that intracranial pain is accompanied by increased periorbital skin sensitivity. 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 (ie, sensitization) of central pain neurons that process information arising from intracranial structures and skin. The purpose of this study was to determine whether the increased skin sensitivity observed in animal also develops in humans during migraine attacks. Repeated measurements of mechanical and thermal pain thresholds of periorbital and forearm skin areas in the absence of, and during, migraine attacks enabled us to determine the occurrence of cutaneous allodynia during migraine. Cutaneous allodynia is pain resulting from a nonnoxious stimulus to normal skin. In 79% of the patients, migraine was associated with cutaneous allodynia as defined, and in 21% of the patients it was not. The cutaneous allodynia occurred either solely within the referred pain area on the ipsilateral head, or within and outside the ipsilateral head. Cutaneous allodynia in certain well‐defined regions of the skin during migraine is an as yet unreported neurological finding that points to hyperexcitability of a specific central pain pathway that subserves intracranial sensation. Ann Neurol 2000;47:614–624

Update on the genetics of migraine

“…Migraine is a genetically complex and clinically heterogeneous class of craniofacial pain disorders whose features can include alterations in sensory sensitivity (Burstein et al 2000;de Tommaso et al 2003), autonomic dysfunction (Peroutka 1997), dysregulation of mood (Merikangas and Stevens 1997), and spreading neurologic disturbance representing both positive and negative "aura" phenomena. Migraine disorders are broadly categorized as migraine with aura (MA) or migraine without aura (MO), but clinical overlap between these common varieties among individual migraineurs and among migraineurs within families can make it difficult precisely to group affected individuals for genetic studies.…”

Pathophysiologie der Migräne im klinischen Kontext

“…Bei gastrointestinalen Symptomen und Gähnen sowie orthosta tischer Hypotension wird auch eine do paminerge Überaktivität vermutet [33]. Muskelschmerzen und Überempfindlich keit (Alldoynie) legen eine zentrale Über erregbarkeit nahe [8].…”

“…Die Fehlfunktion im trige minalen System drückt sich durch zwei Eigenschaften aus -Chemosensitivität und Sensitisierung [8,39] [34].…”

Should magnesium be given to every migraineur? No

“…A key element of the attack is the activation of the trigeminovascular system (TS), with the release of neuropeptides (Goadsby et al 1988) and the appearance of sterile inflammation in the dura mater (Williamson et al 1997), leading to peripheral sensitization of the trigeminal nociceptors (Strassman et al 1996) Activation of the TS also involves the second-order nociceptors, which may contribute to a central sensitization process in migraineurs (Burstein et al 1998(Burstein et al , 2000, resulting in the appearance of cutaneous allodynia. The central trigeminal pathways are connected with distinctive brain stem centers such as the nucleus tractus solitarius, which may be responsible for the nausea and vomiting during the attack.…”