Disability, burden, and symptoms related to sensitization in migraine patients associate with headache frequency

Antonio, Stefano Di; Castaldo, Matteo; Ponzano, Marta; Bovis, Francesca; Torelli, Paola; Finocchi, Cinzia; Arendt-Nielsen, Lars

doi:10.1515/sjpain-2021-0050

Cited by 11 publications

(6 citation statements)

References 73 publications

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“…In a study consisting of 136 patients with migraine, compared with patients with low-frequency EM (1–8 headache days a month), patients with high-frequency EM (9–14 headache days a month) and CM (>14 headache days a month) had similar severe degrees of headache-related disability and CS-related symptoms. 44 A comparison of migraine patients with 15 or more headaches per month and those with 8 to 14 or more headache days per month showed no differences in parameters such as depression, anxiety, and pain scores between the two groups. 45 Becerra et al 46 investigated differences in brain metabolite in the anterior cingulate cortex during the interictal phase in EM patients using magnetic resonance spectroscopy, and concluded that the brain in EM patients is hyperexcitable during the interictal state based on the findings of alterations of metabolites, such as aspartate /Cre, N-acetyl aspartate /Cre and glutamine /Cre.…”

Section: Methodsmentioning

confidence: 89%

Central Sensitization in Migraine: A Narrative Review

Suzuki¹,

Suzuki²,

Shiina³

et al. 2022

JPR

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Central sensitization (CS) is an increase in the responsiveness of nociceptive neurons in the central nervous system to their normal afferent input. As a result, even minor irritation can induce severe pain, leading to the chronicity and severity of various diseases, such as neurological disorders. CS is associated with migraine, which is a major neurological disorder that inflicts a high disability in daily life. Specifically, CS is thought to be involved in the pathogenesis of cutaneous allodynia as well as chronification of migraine. In this article, we reviewed the association between CS and migraine, including pathophysiological aspects and evidence from clinical studies. We suggest that appropriate screening and management of CS in migraine could further improve the quality of life of migraine patients.

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Section: Methodsmentioning

confidence: 89%

Central Sensitization in Migraine: A Narrative Review

Suzuki¹,

Suzuki²,

Shiina³

et al. 2022

JPR

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“…The higher the score, the higher the disability. 32,33 Details of the assessment procedure are reported in the Supporting Information (Appendix S1).…”

Section: Headache Disability Index (Hdi)mentioning

confidence: 99%

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

et al. 2022

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Objective Assessing mechanical pain thresholds from trigeminal, cervical, and distal pain‐free areas during the four phases of a migraine cycle in patients with episodic migraine (EM). Methods This multicenter, cross‐sectional, observational study conducted in Parma and Genoa’s Headache Centers assessed quantitative sensory tests during the four migraine phases in patients with EM compared to controls. Temporal summation of pain (TSP), static pressure pain threshold (sPPT), and mechanical pinprick pain threshold (MPT) were assessed from the trigeminal area, sPPT and dynamic PPT (dPPT) from the cervical area, sPPT and MPT over the hand, and sPPT from the tibialis anterior. Results A total of 135 patients and 46 controls were included. TSP was facilitated in ictal EM (EM vs. controls: mean [standard deviation] 2.7 [2.0] vs. 1.4 [1.8]; p = 0.004); trigeminal sPPT and MPT were reduced in interictal (sPPT: 198.5 [79.3] kPa; p = 0.021; MPT: 12.6 [15.7] g; p = 0.001), preictal (sPPT: 200.6 [71.6] kPa; p = 0.033; MPT: 10.7 [12.4] g; p < 0.001), ictal (sPPT: 171.4 [95.9] kPa; p < 0.001; MPT: 7.3 [12.0] g; p < 0.001), and postictal EM (sPPT: 182.2 [76.3] kPa; p = 0.006; MPT: 10.1 [14.9] g; p = 0.001), compared to controls (sPPT: 238.3 [73.8] kPa; MPT: 21.9 [17.3] g). Cervical sPPTs and dPPT were reduced in interictal (sPPT upper cervical spine: 420.5 [176.7] kPa; p = 0.031; sPPT lower cervical spine: 458.6 [207.3] kPa; p = 0.002; dPPT: 4826.5 [2698.0] g; p < 0.001), preictal (sPPT upper cervical spine: 389.3 [133.4] kPa; p = 0.006; sPPT lower cervical spine: 450.8 [174.3] kPa; p = 0.005; dPPT: 4184.2 [2628.3] g; p < 0.001), ictal (sPPT upper cervical spine: 379.9 [205.6] kPa p = 0.003; sPPT lower cervical spine: 436.3 [271.1] kPa; p = 0.001; dPPT: 3838.3 [2638.7] g; p < 0.001), and postictal EM (sPPT upper cervical spine: 385.5 [131.6] kPa; p = 0.020; sPPT lower cervical spine: 413.0 [150.3] kPa; p = 0.002; dPPT: 4679.6 [2894.9] g; p = 0.001), compared to controls (sPPT upper cervical spine: 494.9 [171.5] kPa; sPPT lower cervical spine: 586.9 [210.8] kPa; dPPT: 7693.9 [2896.8] g). Preictal EM had reduced hand sPPT and MPT (sPPT: 248.8 [96.6] kPa vs. 319.8 [112.3] kPa; p = 0.006; MPT: 23.6 [12.2] g vs. 32.5 [14.4] g; p = 0.035), while EM in the other phases showed reduction in hand MPT (interictal: 22.3 [15.6] g vs. 32.5 [14.4] g; p = 0.002; ictal: 22.4 [17.0] g vs. 32.5 [14.4] g; p = 0.004; postictal: 24.2 [18.8] g vs. 32.5 [14.4] g; p = 0.003) without significant reduction in hand sPPT. No difference in sPPT over the tibialis anterior was found. Hand MPT was negatively correlated with longer disease duration (r = −0.25; p = 0.011) and hand sPPT was negatively correlated with higher drug usage (r = −0.31; p = 0.002). TSP during the ictal phase was positively correlated with the physical (r = 0.38; p = 0.040) and emotional headache‐related disability (r = 0.53; p = 0.003). Conclusion In all phases of the migraine cycle, patients with EM show signs of sensitization in the trigeminocervical area, with patients with t...

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“…These data were widely available in the medical records and headache frequency is a well-established measure of the disability associated with migraine. [23][24][25] CD phenomenology was assessed by descriptions charted by movement specialists and severity was assessed with the Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS). The TWSTRS score is a well-established metric to quantify dystonia and has high inter-rater reliability.…”

Section: Measurementsmentioning

confidence: 99%

“…Another limitation is the use of migraine frequency as a proxy for headache improvement after BoTNA treatment. Although it is a valid marker, [23][24][25] future studies should include measures of headache severity, disability, and impact on quality of life. Additionally, our movement specialist did not routinely use EMG guidance for toxin delivery due to the low pain tolerance of the patients.…”

Section: Con Clus Ionmentioning

confidence: 99%

Dystonia phenomenology and treatment response in migraine

et al. 2023

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ObjectiveTo describe the phenomenology of cervical dystonia (CD) in patients with migraine and the effect of its treatment on migraine frequency.BackgroundPreliminary studies demonstrate that treatment of CD with botulinum toxin in those with migraine can improve both conditions. However, the phenomenology of CD in the setting of migraine has not been formally described.MethodsWe conducted a single‐center, descriptive, retrospective case series of patients with a verified diagnosis of migraine who were referred to our movement disorder center for evaluation of co‐existing, untreated CD. Patient demographics, characteristics of migraine and CD, and effects of cervical onabotulinumtoxinA (BoTNA) injections were recorded and analyzed.ResultsWe identified 58 patients with comorbid CD and migraine. The majority were female (51/58 [88%]) and migraine preceded CD in 72% (38/53) of patients by a mean (range) of 16.0 (0–36) years. Nearly all the patients had laterocollis (57/58) and 60% (35/58) had concurrent torticollis. Migraine was found to be both ipsilateral and contralateral to the dystonia in a comparable proportion of patients (11/52 [21%] vs. 15/52 [28%]). There was no significant relationship between migraine frequency and dystonia severity. Treatment of CD with BoTNA reduced migraine frequency in most patients (15/26 [58%] at 3 months and 10/16 [63%] at 12 months).ConclusionsIn our cohort, migraine often preceded dystonia symptoms and laterocollis was the most described dystonia phenotype. The lateralization and severity/frequency of these two disorders were unrelated, but dystonic movements were a common migraine trigger. We corroborated previous reports that cervical BoTNA injections reduced migraine frequency. Providers treating patients with migraine and neck pain who are not fully responding to typical therapies should screen for possible CD as a confounding factor, which when treated can reduce migraine frequency.

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Disability, burden, and symptoms related to sensitization in migraine patients associate with headache frequency

Cited by 11 publications

References 73 publications

Central Sensitization in Migraine: A Narrative Review

Central Sensitization in Migraine: A Narrative Review

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

Dystonia phenomenology and treatment response in migraine

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