Does pain sensitivity change by migraine phase? A blinded longitudinal study

Abstract

Objective Studies suggest that pain thresholds may be altered before and during migraine headaches, but it is still debated if a central or peripheral dysfunction is responsible for the onset of pain in migraine. The present blinded longitudinal study explores alterations in thermal pain thresholds and suprathreshold heat pain scores before, during, and after headache. Methods We measured pain thresholds to cold and heat, and pain scores to 30 seconds of suprathreshold heat four times in 49 migraineurs and once in 31 controls. Sessions in migraineurs were categorized by migraine diaries as interictal, preictal (≤one day before attack), ictal or postictal (≤one day after attack). Results Trigeminal cold pain thresholds were decreased ( p = 0.014) and pain scores increased ( p = 0.031) in the ictal compared to the interictal phase. Initial pain scores were decreased ( p < 0.029), and the temporal profile showed less adaptation ( p < 0.020) in the preictal compared to the interictal phase. Hand cold pain thresholds were decreased in interictal migraineurs compared to controls ( p < 0.019). Conclusion Preictal heat hypoalgesia and reduced adaptation was followed by ictal trigeminal cold suballodynia and heat hyperalgesia. Our results support that cyclic alterations of pain perception occur late in the prodromal phase before headache. Further longitudinal investigation of how pain physiology changes within the migraine cycle is important to gain a more complete understanding of the pathogenic mechanisms behind the migraine attack.

Fluctuations in local and widespread mechanical sensitivity throughout the migraine cycle: a prospective longitudinal study

“…We only assessed mechanical sensitivity. Other studies revealed increased sensitivity for thermal pain thresholds throughout the migraine cycle [14,15]. However, the same fluctuations throughout the migraine cycle have not yet been demonstrated comprehensively for thermal pain thresholds [14] or conditioned pain modulation to assess descending pain inhibition systems.…”

“…But other studies revealed that people with medication overuse, episodic and chronic migraine show failed supraspinal control of pain [10][11][12]. Failure of supraspinal control may result in loss of inhibition and hyperexcitability of trigeminovascular neurons [13] leading to dysregulation of antinociceptive processing with mechanical or thermal/or thermal hyperalgesia sensitization [14].…”

Redefining migraine phases – a suggestion based on clinical, physiological, and functional imaging evidence

“…They found a significantly decreased habituation during the preictal phase, which normalized during the attack, and showed a trend towards elevation during the postictal phase (24). A study using laser-evoked potentials and targeting the pain pathway found, however, no difference across migraine phases (25).…”

Fluctuations of sensorimotor processing in migraine: a controlled longitudinal study of beta event related desynchronization

“…Migraine patients undergo transient clinical and neurophysiological changes before, during and after headache attacks. These intervals define the phases of the migraine cycle, and pain perception changes transiently between the phases [1,2]. In the days and hours preceding headache, various other symptoms including yawning, nausea, changes in mood and activity, fatigue and neck symptoms emerge [3][4][5][6][7][8][9].…”