Central Sensitisation Phenomena in Primary Headaches: Overview of a Preventive Therapeutic Approach

Abstract

Central sensitisation phenomena have been well recognized in the development of migraine attacks and tension type headache. It is also known that headache frequency is related to sensitization. Though some studies have focused on the effects of symptomatic treatment on allodynia, few reports have described the action of preventive agents on the facilitating factors for central sensitisation. In this study we aim to review the factors concurrent with an increase in central sensitisation, in view of the choice of preventive agents for primary headaches. Central sensitisation phenomena are increased in pain syndromes with psycho-pathological co-morbidities. For instance, sleep disorders are a frequent symptom in headache, prevailing in chronic forms and in patients with psychiatric comorbidity. Sleep deprivation is also a factor producing hyperalgesic changes. It is known that symptoms attributable to central sensitization are diffusely pronounced in fibromyalgic (FMS) patients, and that FMS co-morbidity is frequent in primary headaches and associated with higher frequency and poorer quality of life. We report our preliminary experience in a group of 20 chronic migraine patients, treated with duloxetine 60 mg/die vs a self-management program including stretching (relaxation training) and exercise (cervical-dorsal flexion and rotation) to decrease strength and flexibility of muscles of cervical and dorsal spine headache patients. Both the treatments were effective on headache frequency and pericranial tenderness, although FMS comorbidity significantly reduced their efficacy on migraine and quality of life. The whole spectrum of action of pharmacological and non pharmacological treatments on central sensitisation mechanisms, and on their facilitating factors, should be taken into account for the best preventive therapeutic approach of primary headaches.

Frequency of Migraine Headaches in Patients With Fibromyalgia

“…Several of these factors include alterations in neuroendocrine function, vascular changes, immunomodulation, neuronal plasticity, central and peripheral modulation of nociceptive neurons, hormonal influences, and neurochemical alterations . Separate studies utilizing functional magnetic resonance imaging in migraine and fibromyalgia have demonstrated a similar pattern of cortical hyperactivation to experimentally induced painful stimuli . Although this shared pattern of activation requires further exploration, both disorders seem to share some component of central sensitization.…”

“…17,18 Separate studies utilizing functional magnetic resonance imaging in migraine and fibromyalgia have demonstrated a similar pattern of cortical hyperactivation to experimentally induced painful stimuli. 19,20 Although this shared pattern of activation requires further exploration, both disorders seem to share some component of central sensitization.…”

Clinical features of headache patients with fibromyalgia comorbidity

“…The mutual comorbidity between headache and FM reserves much attention, in view of common pathophysiological basis [10] and problems connected with therapeutical approach [11]. …”

Migraine and Fibromyalgia

“…The occurrence of musculoskeletal pain, as the first symptom of FM, justifies its clinical management by rheumatologists, although the functional abnormalities of neuronal circuits elaborating multimodal stimuli and specifically pain require more attention by neurologists by individualized therapeutic approaches. Further, the frequent occurrence of FM comorbidity as an aggravating factor of chronic headaches suggests the opportunity for headache specialists to evaluate the occurrence of these syndromes, which may compromise the effect of therapies on quality of life and global disability 31 . As primary headaches are more common in FM, colleagues in primary care and rheumatology need to be further educated about the risk of medication overuse in FM patients from frequent use of analgesics.…”