Differences in Topographical Pressure Pain Sensitivity Maps of the Scalp Between Patients With Migraine and Healthy Controls

Barón, Johanna; Ruíz, Magdalena; Palacios‐Ceña, María; Madeleine, Pascal; Peral, Á.L. Guerrero; Arendt-Nielsen, Lars; Fernández‐de‐las‐Peñas, César

doi:10.1111/head.12984

Cited by 28 publications

(36 citation statements)

References 28 publications

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“…By performing a carefully conducted blinded cross-over experiment as described in Supplementary Figure S1 , we did not reveal any unilaterality, or effect of repeated stimulus application. Accordingly, we would describe the pressure sensitivity as bilateral in location, a feature of migraine headache that is not uncommon in migraine patients 27 . Typically, researchers including Oshinsky and coworkers 13 , use von Frey monofilaments to assess cutaneous mechanical hypersensitivity within the trigeminal nerve branches, including the periorbital area.…”

Section: Discussionmentioning

confidence: 99%

A unique inbred rat strain with sustained cephalic hypersensitivity as a model of chronic migraine-like pain

Munro

Petersen

Jansen‐Olesen

et al. 2018

Sci Rep

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Animal models of migraine-like pain enabling ongoing study of behaviour typically involve the systemic administration of chemical vasodilators or dural administration of inflammatory algogens. However, neither method mediates prolonged effects on behavior indicative of enduring pathophysiological changes occurring within dural or trigeminal pain circuits. We generated successive generations of a unique inbred rat strain, spontaneous trigeminal allodynia (STA) rats, previously reported to exhibit an episodic migraine-like behavioural phenotype. We show that both male and female STA rats display robust and sustained reductions in periorbital thresholds to cutaneous mechanical stimulation. Otherwise, the general behavior (e.g. locomotor, grooming) of these rats appeared normal. In female STA rats, the mechanical hypersensitivity was confined to the cephalic region, manifested after puberty through adolescence, and was sustained into adulthood recapitulating the clinical manifestation of migraine. We exploited this hitherto unidentified chronic phenotype to show that the migraine-specific drugs sumatriptan (5-HT 1B/1D receptor agonist) and olcegepant (CGRP receptor antagonist) could completely reverse cephalic hypersensitivity using a within subject cross-over paradigm. Our findings indicate that STA rats actually possess a phenotype indicative of migraine chronicity which is exquisitely sensitive to migraine therapeutics. This unique strain could prove to be an invaluable resource in preclinical migraine drug discovery.Animal models of migraine-like pain enabling evaluation of disease-relevant behaviours, typically in mice or rats, are frequently induced by chemical provocation using systemic administration of vasodilating agents such as nitric oxide (NO) donors or dural application of inflammatory mediators 1-6 . These models have variously proven to be of some value in the preclinical setting but have their limitations 7 . Crucially, even with repeated dosing, the systemic administration of NO donors (e.g. glyceryl trinitrate; GTN or isosorbide dinitrate) in rodents has never been reported to produce sustainable cephalic or extracephalic hypersensitivity lasting longer than 1-2 weeks 2,8-10 , thereby limiting their utility in long term behavioural studies.The use of genetic models of migraine-like pain in animals might be expected to partially mitigate such issues. Familial Hemiplegic Migraine is a rare monogenic migraine subtype associated with aura, characterized by weakness on one side of the body during the aura phase 11 . To date, the involvement of three genes has been confirmed in this migraine subtype of which the humanized knock in CACNA1A-related R192Q mouse is probably the best studied 12 . These mice display increased unilateral head grooming and are photosensitive in accordance with a migraine-like phenotype. An advantage of using such models is that the animals possess a pre-defined phenotype, circumventing the need for complicated dosing protocols using NO donors or surgical procedures (e.g. dural ...

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Section: Discussionmentioning

confidence: 99%

A unique inbred rat strain with sustained cephalic hypersensitivity as a model of chronic migraine-like pain

Munro

Petersen

Jansen‐Olesen

et al. 2018

Sci Rep

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“…Topographical pressure pain sensitivity maps have also been applied to investigate spatial changes in sensitivity to pressure; not just within the same muscle, but also in a particular anatomical area including the scalp, 37 , 38 shoulder, 19 , 23 elbow, 26 hand, 25 low back, 21 knee, 29 foot, 28 and the entire lower extremity. 30 These studies included different pain populations such as nummular headache, 37 migraine, 38 breast cancer survivors, 19 subacromial pain syndrome, 23 lateral elbow pain, 26 carpal tunnel syndrome, 25 knee osteoarthritis, 29 fibromyalgia syndrome, 28 and in asymptomatic adults 21 or soccer players. 30 …”

Section: Studies Reporting Topographical Pressure Pain Mapsmentioning

confidence: 99%

“…For instance, it has been found that the anterior part of the scalp is more sensitive to pressure than the middle and posterior parts in both headache patients and asymptomatic controls. 37 , 38 In the elbow area, topographical pressure pain sensitivity maps have shown that the extensor carpi radialis brevis is the most sensitive muscle of the wrist extensors in both adults with unilateral epicondylalgia and asymptomatic controls. 26 Similarly, topographical pressure pain sensitivity maps supported that the medial side of the knee joint 29 or the vastus medialis muscle 30 are the most sensitive areas of the lower extremity in both patients with painful knee osteoarthritis and professional soccer players.…”

Section: Studies Reporting Topographical Pressure Pain Mapsmentioning

confidence: 99%

Spotlight on topographical pressure pain sensitivity maps: a review

Alburquerque‐Sendín¹,

Madeleine²,

Fernández‐de‐las‐Peñas³

et al. 2018

JPR

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Mechanical hyperalgesia defined as decreased pressure pain thresholds (PPTs) is commonly associated with pain. In this narrative review, we report the current state of the art within topographical pressure sensitivity maps. Such maps are based on multiple PPT assessments. The PPTs are assessed by an a priori defined grid with special focus on both spatial and temporal summation issues. The grid covers the muscle or the body region of interest using absolute or relative values determined from anatomical landmarks or anthropometric values. The collected PPTs are interpolated by Shepard or Franke and Nielson interpolation methods to create topographical pressure sensitivity maps. This new imaging technique has proven to be valuable in various disciplines including exercise physiology, neurology, physical therapy, occupational medicine, oncology, orthopedics, and sport sciences. The reviewed papers have targeted different body regions like the scalp, low back, neck–shoulder, and upper and lower extremities. The maps have delineated spatial heterogeneity in the pressure pain sensitivity underlining the different extents of pressure pain hyperalgesia in both experimentally induced and disease-associated pain conditions. Furthermore, various intervention studies have proven the utility of topographical pressure pain sensitivity maps. Topographical pressure pain sensitivity maps have contributed to revealing the efficacy of therapeutic, ergonomic, or training interventions that aim at reducing pain.

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“…However, the pathophysiology of CH is complex, and the underlying mechanisms are not completely understood. It is known that other primary headaches, such as migraine and tension‐type headache, are associated with hyperalgesic and allodynic responses to different stimuli. In CH, previous studies have also reported the presence of cutaneous allodynia and decreased pressure and thermal pain thresholds within the cephalic region.…”

Section: Introductionmentioning

confidence: 99%

Widespread Hypersensitivity to Pressure Pain in Men With Cluster Headache During Prolonged Remission Is Not Related to the Levels of Depression and Anxiety

et al. 2019

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Background Diminished pressure pain thresholds (PPTs) have been found in patients with cluster headache (CH), suggesting the presence of central sensitization. However, it is not known whether sensitization persists over time during the asymptomatic periods. Objective To investigate if men with episodic CH in a long‐lasting remission phase exhibit widespread pressure pain hypersensitivity. Methods Forty men with episodic CH and 40 matched controls were enrolled. PPTs were assessed bilaterally over 1 trigeminal (temporalis muscle) and 3 extra‐trigeminal points (C5/C6 zygapophyseal joint, second metacarpal, tibialis anterior muscle) by a blinded assessor. Patients were assessed in a prolonged remission phase, at least 6 months after their last CH attack and without taking any medication. Depression and anxiety levels were assessed with the Hospital Anxiety and Depression Scale (HADS). For each point, differences in PPTs were evaluated with a multivariate mixed‐model analysis of covariance test, with side and group as main factors and depression and anxiety levels as covariates. Results PPTs were significantly decreased bilaterally over the temporalis muscle (mean difference: 85 to 100 kPa), C5/C6 zygapophyseal joint (mean difference: 65 to 80 kPa), second metacarpal (mean difference: 65 to 90 kPa), and tibialis anterior muscle (mean difference: 135 to 155 kPa) in patients with CH when compared to headache‐free subjects (all, P < 0.001). No effect of anxiety or depression levels was found. Conclusions Patients with CH exhibited bilateral widespread hypersensitivity to pressure pain during long‐lasting remission periods, which was not associated with depression or anxiety. These results support the persistence of central sensitization in episodic CH, even in remote asymptomatic phases.

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Differences in Topographical Pressure Pain Sensitivity Maps of the Scalp Between Patients With Migraine and Healthy Controls

Cited by 28 publications

References 28 publications

A unique inbred rat strain with sustained cephalic hypersensitivity as a model of chronic migraine-like pain

A unique inbred rat strain with sustained cephalic hypersensitivity as a model of chronic migraine-like pain

Spotlight on topographical pressure pain sensitivity maps: a review

Widespread Hypersensitivity to Pressure Pain in Men With Cluster Headache During Prolonged Remission Is Not Related to the Levels of Depression and Anxiety

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