Sensitisation of spinal cord pain processing in medication overuse headache involves supraspinal pain control

Perrotta, Armando; Serrao, Mariano; Sandrini, Giorgio; Burstein, Rami; Sances, Grazia; Rossi, Paolo; Bartolo, Michelangelo; Pierelli, Francesco; Nappi, Giuseppe

doi:10.1111/j.1468-2982.2009.01914.x

Cited by 120 publications

(158 citation statements)

References 47 publications

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“…These results are consistent with an opioid-induced sensitization and a loss of Diffuse Noxious Inhibitory Controls (DNICs). The dysfunction of DNICs was also evidenced in patients with MOH [31]. In conclusion, opioids exposition in some predisposed migraine patients might produce neuroadaptive changes responsible for hyperexcitability of the trigeminal system and enhancement of descending facilitation throughout a loss of DNICs [28].…”

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confidence: 80%

Controversies in migraine treatment: opioids should be avoided

Casucci¹,

Cevoli

2013

Neurol Sci

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The use of opioids for migraine is still controversial. Evidence-based guidelines do not recommend opioids as first-line treatment of migraine attacks, while clinical and epidemiological surveys demonstrate that the use of opioids is associated with more severe headacherelated disability, symptomology and comorbidities, and greater health-care resource utilization. There are concerns that opioids may be misused or abused, leading to opioid abuse or dependence and migraineurs are particularly prone and at risk for the development of chronic daily headache from opioids overuse. Since clinical and preclinical studies evidence a pathophysiological role of opioids in migraine progression, opioids should be avoided in migraine patients.The role of opioids in clinical practice for migraine: the state-of-the-art Migraine is a common disabling neurologic disorder, characterized by recurrent headache attacks manifesting with unilateral location, pulsating quality, moderate or severe intensity, aggravation by routine physical activity, and association with nausea and/or photophobia and phonophobia [1]. The goals of acute migraine treatments are to treat attacks rapidly and consistently without recurrence, restore the patient's ability to function, minimize the use of back-up and rescue medications, optimize self-care and reduce subsequent use of resources, be cost-effective for overall management, and have minimal or no adverse events [2]. Acute treatments used for migraine include nonspecific agents such as aspirin, acetaminophen, non-steroidal anti-inflammatory drugs (NSAIDs), opioids, and barbiturates among others, as well as migraine-specific medications, including ergot alkaloids and triptans [2]. International guidelines recommend triptans and NSAIDs as first-line treatment of migraine attacks [2][3][4]. Use of opioids for treatment of migraine is controversial. Despite evidence-based guidelines do not recommend opioids as first-line treatment of migraine attacks [2][3][4], and no randomized controlled trial has shown any significant effect of opioids on migraine attacks when pain-free was the primary end-point of the study [5], their use in clinical practice [6][7][8] and, even more, in emergency departments (EDs) is very large, especially in USA and Canada [9,10]. Moreover, among studies about the efficacy of opioids as rescue medication for acute migraine in EDs recently revised, only one evidenced a superiority of meperidina 75 mg i.m. versus ketorolac 30 mg i.m., three reported superiority of competitors and eight reported similar results for opioids versus competitors such as DHE, metoclopramide, chlorpromazine, droperidol, and ketorolac [5]. In any case, opioids did not adequately restore the patient's ability to function. The negative impact of opioids on migrainous population is reported in several clinical and epidemiological studies. In fact, opioids use for migraine resulted associated with more severe headache-related disability, symptomology, and comorbidities (primarily, psychiatric, and cardi...

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confidence: 80%

Controversies in migraine treatment: opioids should be avoided

Casucci¹,

Cevoli

2013

Neurol Sci

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“…For example, studies of tem poral summation of the NWR in people with migraine show facilitation of temporal pain processing between attacks. 118 Administration of a nitric oxide donor, such as glyceryl trinitrate, induces transitory facilitation of tem poral summation of the NWR within 120 min in patients who will go on to develop a glyceryl trinitrate triggered migraine attack several hours later (Figure 3). 119 In individuals with chronic headache, such as MOH in the setting of episodic migraine, the threshold for temporal summation of the NWR is markedly reduced compared with that in controls or in patients with epi sodic migraine, which indicates strong facilitation in the temporal processing of pain.…”

Section: Processing Of Noxious Stimulimentioning

confidence: 99%

“…119 In individuals with chronic headache, such as MOH in the setting of episodic migraine, the threshold for temporal summation of the NWR is markedly reduced compared with that in controls or in patients with epi sodic migraine, which indicates strong facilitation in the temporal processing of pain. 118 In patients with MOH, the pain suppressing effect of supraspinal diffuse noxious inhibitory control (pain inhibition by hetero topic painful stimulation) on temporal summation of the NWR is deficient. 118 This effect, which in humans is termed conditioned pain modulation, 120 can be tested by heterotopic application of a painful cold stimulus.…”

Section: Processing Of Noxious Stimulimentioning

confidence: 99%

“…118 In patients with MOH, the pain suppressing effect of supraspinal diffuse noxious inhibitory control (pain inhibition by hetero topic painful stimulation) on temporal summation of the NWR is deficient. 118 This effect, which in humans is termed conditioned pain modulation, 120 can be tested by heterotopic application of a painful cold stimulus. 119 The deficits in conditioned pain modulation or supra spinal diffuse noxious inhibitory control and facilitation of temporal summation of the NWR normalize after drug withdrawal, which could be related to the reduc tion in activity of anandamide hydrolase (also known as fatty acid amide hydrolase) and, hence, slowing of the degradation of endocannabinoids.…”

Section: Processing Of Noxious Stimulimentioning

confidence: 99%

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Altered processing of sensory stimuli in patients with migraine

et al. 2014

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| Migraine is a cyclic disorder, in which functional and morphological brain changes fluctuate over time, culminating periodically in an attack. In the migrainous brain, temporal processing of external stimuli and sequential recruitment of neuronal networks are often dysfunctional. These changes reflect complex CNS dysfunction patterns. Assessment of multimodal evoked potentials and nociceptive reflex responses can reveal altered patterns of the brain's electrophysiological activity, thereby aiding our understanding of the pathophysiology of migraine. In this Review, we summarize the most important findings on temporal processing of evoked and reflex responses in migraine. Considering these data, we propose that thalamocortical dysrhythmia may be responsible for the altered synchronicity in migraine. To test this hypothesis in future research, electrophysiological recordings should be combined with neuroimaging studies so that the temporal patterns of sensory processing in patients with migraine can be correlated with the accompanying anatomical and functional changes.

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“…rs connectivity caudate-insula; % putamen-insula [132] % activation dorsolateral pons [47] %% iron content PAG and globus pallidus (T2) [29,31] ! central pain modulation [133,134] no % of posterior circulation infarcts [104] Medication overuse headache ! metabolism and tissue density orbitofrontal cortex [48,50] !…”

Section: Episodic Migraine (Interictal)mentioning

confidence: 99%

Diagnosis, pathophysiology and management of chronic migraine: a proposal of the Belgian Headache Society

Paemeleire

Louis²,

Magis

et al. 2014

Acta Neurol Belg

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Chronic migraine (CM) is a disabling neurological condition affecting 0.5-2 % of the population. In the current third edition of the International Classification of Headache Disorders, medication overuse is no longer an exclusion criterion and CM is diagnosed in patients suffering from at least 15 headache days per month of which at least eight are related to migraine. CM is difficult to treat, and preventive treatment options are limited. We provide a pathogenetic model for CM, integrating the latest findings from neurophysiological and neuroimaging studies. On behalf of the Belgian Headache Society, we present a management algorithm for CM based on the international literature and adapted to the Belgian situation. Pharmacological treatment options are discussed, and recent data on transcranial and invasive neuromodulation studies in CM are reviewed. An integrated multimodal treatment programme may be beneficial to refractory patients, but at present, this approach is only supported by a limited number of observational studies and quite variable between centres

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Sensitisation of spinal cord pain processing in medication overuse headache involves supraspinal pain control

Cited by 120 publications

References 47 publications

Controversies in migraine treatment: opioids should be avoided

Controversies in migraine treatment: opioids should be avoided

Altered processing of sensory stimuli in patients with migraine

Diagnosis, pathophysiology and management of chronic migraine: a proposal of the Belgian Headache Society

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