Nociceptive blink reflex habituation biofeedback in migraine

Abstract

SummaryReduced habituation of the nociceptive blink reflex (NBR) is considered a trait marker for genetic predisposition to migraine. In this open-label randomized controlled study, we aimed to test the efficacy of a biofeedback training based on learning of habituation of the NBR (NBR biofeedback) compared with pharmacological (topiramate) treatment and NBR biofeedback plus topiramate treatment in a cohort of migraine without aura patients eligible for prophylaxis. Thirty-three migraine patients were randomly assigned to three months of treatment with: 1) NBR biofeedback, 2) NBR biofeedback plus topiramate 50 mg (b.i.d.), or 3) topiramate 50 mg (b.i.d.). Frequency of headache and disability changes were the main study outcomes. Anxiety, depression, sleep, fatigue, quality of life, allodynia and pericranial tenderness were also evaluated. NBR biofeedback reduced the R2 area, without improving R2 habituation. However, it reduced the frequency of headache and disability, similarly to the combined treatment and topiramate alone. Reduced habituation of the NBR is a stable neurophysiological pattern, scarcely modifiable by learning procedures. Training methods able to act on stress-related responses may modulate cortical mechanisms inducing migraine onset and trigeminal activation under stressful trigger factors.

Preventive Treatment With CGRP Monoclonal Antibodies Restores Brain Stem Habituation Deficits and Excitability to Painful Stimuli in Migraineurs: Results From a Prospective Case-control Study

“…Our patients revealed a treatment response that is in line with what is to be expected and enhanced their ability to improve non-pharmacological interventions (44). Unfortunately, we did not record these interventions but in a study that investigated the NSBR in the context of biofeedback, the authors did not nd a change of habituation, which found to correlate with pharmacological treatment response (35).…”

“…Comparison to previous studies investigating the blink re ex as a biomarker of preventive treatment Our literature search revealed two studies that conducted electrophysiological investigations of the blink re ex to assess central effects of a preventive treatment. Tommaso and Delussi used the NSBR and found that treatment with Topiramate had a small effect on R2a and R2h (35). Artemenko et al found that duloxetine normalized the R3 threshold and habituation of the NBR (36).…”

Migraine Prevention through Ketogenic Diet: More than Body Mass Composition Changes

“…Interestingly, excessive cortical excitability reduction has been also described to accompany clinical response in other migraine prevention therapies of well-defined efficacy such as onabotulinum toxin A [ 33 ]. Conversely, the persistence of deficit of habituation of blink reflex was also observed in patient treated by topiramate and/or biofeedback [ 34 ]. In summary, most of the effective treatments for migraine play a role at the cortical level, not at the brainstem, and this is also the case with KD.…”

Neurophysiological Features of the Nociceptive Trigeminal Pathway During Different Phases of Episodic Migraine

“…Ця аномальна обробка вхідної інформації досягає максимуму в періоді продрому і нормалізується під час нападу [13], в той час, коли сенситизація також уже може бути присутня. З фізіологічної точки зору, сенситизація відноситься до пластичних змін в нервових структурах, що призводить до зниження ноцицептивних порогів і підвищення чутливості до шкідливих і нешкідливих периферичних подразників [17,18]. Посилення висхідного больового потоку від сенситизованих сегментарних структур сприяє зміні активності нейронів супраспінальних утворень аж до сомато-сенсорних зон кори головного мозку, в умовах функціонального дефіциту гальмівних впливів ендогенної антиноцицептивної системи [19].…”