Prevalence and characteristics of allodynia in headache sufferers

Abstract

Objective: The authors estimated the prevalence and severity of cutaneous allodynia (CA) in individuals with primary headaches from the general population. Methods:We mailed questionnaires to a random sample of 24,000 headache sufferers previously identified from the population. The questionnaire included the validated Allodynia Symptom Checklist (ASC) as well as measures of headache features, disability, and comorbidities. We modeled allodynia as an outcome using headache diagnosis, frequency and severity of headaches, and disability as predictor variables in logistic regression. Covariates included demographic variables, comorbidities, use of preventive medication, and use of opioids.Results: Complete surveys were returned by 16,573 individuals. The prevalence of CA of any severity (ASC score ≥3) varied with headache type. Prevalence was significantly higher in transformed migraine (TM, 68.3%) than in episodic migraine (63.2%, p < 0.01) and significantly elevated in both of these groups compared with probable migraine (42.6%), other chronic daily headaches (36.8%), and severe episodic tension-type headache (36.7%). The prevalence of severe CA (ASC score ≥9) was also highest in TM (28.5%) followed by migraine (20.4%), probable migraine (12.3%), other chronic daily headaches (6.2%), and severe episodic tension-type headache (5.1%). In the migraine and TM groups, prevalence of CA was higher in women and increased with disability score. Among migraineurs, CA increased with headache frequency and body mass index. In all groups, ASC scores were higher in individuals with major depression. Conclusions:Cutaneous allodynia (CA) is more common and more severe in transformed migraine and migraine than in other primary headaches. Among migraineurs, CA is associated with female sex, headache frequency, increased body mass index, disability, and depression.Central sensitization, an increased excitability of spinal and medullary dorsal horn neurons resulting from ongoing input from C-fiber nociceptors, may lead to cutaneous allodynia (CA), a neurologic condition characterized by pain elicited by ordinary nonnociceptive stimulation of the skin. 1,2 During migraine, facial CA is likely to be a clinical manifestation of sensitization at the level of the trigeminal nucleus caudalis. 3,4 In clinic-based studies, most migraineurs develop CA during the course of an attack. 5-8 In migraine, CA has been proposed as a predictor of poor response to triptan therapy 8 as well as a risk factor for disease progression. 9Address correspondence and reprint requests to Dr. Marcelo E. Bigal, Global Director, Scientific Affairs, Neuroscience, One Merck Drive, P.O. Box 100, Whitehouse Station, NJ 08889-0100 Marcelo_Bigal@merck.com. * Members of the AMPP Advisory Group are listed in the appendix. Here, we used the ASC-12 to assess the prevalence and severity of CA in subjects with various types of primary headaches in the general population. Because CA has been recently suggested as a risk factor for migraine progression, we hypothesized ...

12 item Allodynia Symptom Checklist/Brasil: cross-cultural adaptation, internal consistency and reproducibility

“…Since no question was removed, the score and the classification of ASC-12/Brasil were the same, as follows: "It does not apply to me", "No, never" and "Rarely" (0 points), "At times yes and at times no" (1 point) and "Most of the times" (2 points); without allodynia (0-2) or with mild (3-5), moderate (6)(7)(8) or severe allodynia (9 or more) 4 . Although it appears to be an erroneous translation of the English term "severe", the term "severa" was chosen to classify instead of "grave", because, although the two terms are synonyms, the second denotes a risk of fatality within the spectrum of the Brazilianportuguese health conceptions 25 .…”

“…Cutaneous allodynia (CA), defined as pain in response to a non-nociceptive stimulus 1 when the stimulus is applied to normal skin 2 , has been attracting more interest by having been recognized as a signal of central sensitization during migraine attacks [3][4][5] and having been suggested as a risk factor for migraine chronification 2,6,7 . The relation of CA with migraine is believed to be due to a change in the central modulation of nociceptive pathways 8 because of central sensitization, which provokes hyperexcitability of first-, second-and third-order neurons respectively located at the periphery, in the caudal nucleus of the trigeminus and in the thalamus 5,9 .…”

“…The relation of CA with migraine is believed to be due to a change in the central modulation of nociceptive pathways 8 because of central sensitization, which provokes hyperexcitability of first-, second-and third-order neurons respectively located at the periphery, in the caudal nucleus of the trigeminus and in the thalamus 5,9 . Clinical and population studies have reported that CA affects approximately two thirds of migraine patients 9,10 and have pointed out as risk factors for its development female sex, obesity, depression, temporomandibular disorders and greater severity and frequency of attacks 6,10,11 . In addition, it has been suggested that CA can have a negative influence on the response to treatment with triptans 12 .…”

“…The gold standard for an objective and quantitative evaluation of CA during specific periods is the Quantitative Sensory Test (QST) 6 , a tool capable of evaluating the pain threshold for thermal and mechanical stimuli extensively used in patients with sensory symptoms of central and peripheral origin 13,14 . However, since the application of the QST requires specialized equipment and training of the rater 10 , despite its efficacy, its use is expensive and at times not viable in clinical routine and in epidemiological studies 6,10 .…”

“…However, since the application of the QST requires specialized equipment and training of the rater 10 , despite its efficacy, its use is expensive and at times not viable in clinical routine and in epidemiological studies 6,10 . An alternative to this impasse is the application of reliable questionnaires, which are simple and rapid tools.…”