An association between migraine and cutaneous allodynia

Annals of NeurologyVolume 47, Issue 5 p. 614-624 Original Article An association between migraine and cutaneous allodynia Rami Burstein PhD, Corresponding Author Rami Burstein PhD Department of Anesthesia and Critical Care, Beth Israel Deaconess Medical Center, Boston, MA Department of Neurobiology, Harvard Medical School, Boston, MA Program in Neuroscience, Harvard Medical School, Boston, MADepartment of Anesthesia and Critical Care, Harvard Institutes of Medicine, Room 830, 77 Avenue Louis Pasteur, Boston, MA 02115Search for more papers by this authorDavid Yarnitsky MD, David Yarnitsky MD Department of Anesthesia and Critical Care, Beth Israel Deaconess Medical Center, Boston, MA Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MASearch for more papers by this authorItay Goor-Aryeh MD, Itay Goor-Aryeh MD Department of Anesthesia and Critical Care, Beth Israel Deaconess Medical Center, Boston, MASearch for more papers by this authorBernard J. Ransil PhD, MD, Bernard J. Ransil PhD, MD Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MASearch for more papers by this authorZahid H. Bajwa MD, Zahid H. Bajwa MD Department of Anesthesia and Critical Care, Beth Israel Deaconess Medical Center, Boston, MA Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MASearch for more papers by this author Rami Burstein PhD, Corresponding Author Rami Burstein PhD Department of Anesthesia and Critical Care, Beth Israel Deaconess Medical Center, Boston, MA Department of Neurobiology, Harvard Medical School, Boston, MA Program in Neuroscience, Harvard Medical School, Boston, MADepartment of Anesthesia and Critical Care, Harvard Institutes of Medicine, Room 830, 77 Avenue Louis Pasteur, Boston, MA 02115Search for more papers by this authorDavid Yarnitsky MD, David Yarnitsky MD Department of Anesthesia and Critical Care, Beth Israel Deaconess Medical Center, Boston, MA Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MASearch for more papers by this authorItay Goor-Aryeh MD, Itay Goor-Aryeh MD Department of Anesthesia and Critical Care, Beth Israel Deaconess Medical Center, Boston, MASearch for more papers by this authorBernard J. Ransil PhD, MD, Bernard J. Ransil PhD, MD Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MASearch for more papers by this authorZahid H. Bajwa MD, Zahid H. Bajwa MD Department of Anesthesia and Critical Care, Beth Israel Deaconess Medical Center, Boston, MA Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MASearch for more papers by this author First published: 03 May 2001 https://doi.org/10.1002/1531-8249(200005)47:5<614::AID-ANA9>3.0.CO;2-NCitations: 744AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onEmailFacebookTwitterLinkedInRedditWechat Abstract Recent animal studies on the mechanism of migraine show that intracranial pain is accompanied by increased periorbital skin sensitivity. These findings suggest that the pathophysiology of migraine involves not only irritation of meningeal perivascular pain fibers but also a transient increase in the responsiveness (ie, sensitization) of central pain neurons that process information arising from intracranial structures and skin. The purpose of this study was to determine whether the increased skin sensitivity observed in animal also develops in humans during migraine attacks. Repeated measurements of mechanical and thermal pain thresholds of periorbital and forearm skin areas in the absence of, and during, migraine attacks enabled us to determine the occurrence of cutaneous allodynia during migraine. Cutaneous allodynia is pain resulting from a nonnoxious stimulus to normal skin. In 79% of the patients, migraine was associated with cutaneous allodynia as defined, and in 21% of the patients it was not. The cutaneous allodynia occurred either solely within the referred pain area on the ipsilateral head, or within and outside the ipsilateral head. Cutaneous allodynia in certain well-defined regions of the skin during migraine is an as yet unreported neurological finding that points to hyperexcitability of a specific central pain pathway that subserves intracranial sensation. Ann Neurol 2000;47:614–624 References 1 Strassman AM, Raymond SA, Burstein R. Sensitization of meningeal sensory neurons and the origin of headaches. Nature 1996; 384: 560–564 2 Burstein R, Yamamura H, Malick A, Strassman AM. Chemical stimulation of the intracranial dura induces enhanced responses to facial stimulation in brain stem trigeminal neurons. J Neurophysiol 1998; 79: 964–982 3 Yamamura H, Malick A, Chamberlin NL, Burstein R. Cardiovascular and neuronal responses to head stimulation reflect central sensitization and cutaneous allodynia in a rat model of migraine. J Neurophysiol 1999; 81: 479–493 4 Headache Classification Committee of the International Headache Society. Classification and diagnosis criteria for headache disorders, cranial neuralgia and facial pain. Cephalalgia 1988; 8(Suppl 7): 1–92 5 Yarnitsky D, Sprecher E, Zaslansky R, Hemli JA. Heat pain thresholds: normative data and repeatability. Pain 1995; 60: 329–332 6 Fruhstorfer H, Lindblom U, Schmidt WC. Method for quantitative estimation of thermal thresholds in patients. J Neurol Neurosurg Psychiatry 1976; 39: 1071–1075 7 Yarnitsky D. Quantitative sensory testing. Muscle Nerve 1997; 20: 198–204 8 Tukey JW. Explorative data analysis. Reading, MA: Addison-Wesley, 1977 9 Tfelt-Hansen P, Lous I, Olesen J. Prevalence and significance of muscle tenderness during common migraine attacks. Headache 1981; 21: 49–54 10 Lous I, Olesen J. Evaluation of pericranial tenderness and oral function in patients with common migraine, muscle contraction headache and “combination headache”. Pain 1982; 12: 385–393 11 Drummond PD. Scalp tenderness and sensitivity to pain in migraine and tension headache. Headache 1987; 27: 45–50 12 Jensen K, Tuxen C, Olesen J. Pericranial muscle tenderness and pressure-pain threshold in the temporal region during common migraine. Pain 1988; 35: 65–70 13 Gobel H, Ernst M, Jeschke J, et al. Acetylsalicylic acid activates antinociceptive brain-stem reflex activity in headache patients and in healthy subjects. Pain 1992; 48: 187–195 14 Jensen R, Rasmussen BK, Pedersen B, et al. Prevalence of oromandibular dysfunction in a general population. J Orofacial Pain, 1993; 7: 175–182 15 Jensen K. Extracranial blood flow, pain and tenderness in migraine: clinical and experimental studies. Acta Neurol Scand Suppl 1993; 147: 1–27 16 Anthony M, Rasmussen BK. Migraine without aura. In: J Olesen, P Tfelt-hansen, MA Welch, eds. The headaches. New York, Raven Press, 1993: 255–261 17 Cervero F, Janig W. Visceral nociceptors: a new world order? Trends Neurosci 1992; 15: 374–378 18 Schmidt R, Schmelz M, Forster C, et al. Novel classes of responsive and unresponsive C nociceptors in human skin. J Neurosci 1995; 15: 333–341 19 Michaelis M, Habler HJ, Janig W. Silent afferents: a separate class of primary afferents? Clin Exp Pharmacol Physiol 1996; 23: 99–105 20 Woolf CJ, Wall PD. Relative effectiveness of C primary afferent fibers of different origins in evoking a prolonged facilitation of the flexor reflex in the rat. J Neurosci 1986; 6: 1433–1442 21 Berkley KJ, Guilbaud G, Benoist JM, Gautron M. Responses of neurons in and near the thalamic ventrobasal complex of the rat to stimulation of uterus, cervix, vagina, colon, and skin. J Neurophysiol 1993; 69: 557–568 22 Bruggemann J, Shi T, Apkarian AV. Squirrel monkey lateral thalamus. II. Viscerosomatic convergent representation of urinary bladder, colon, and esophagus. J Neurosci 1994; 14: 6796–6814 23 Guilbaud G, Kayser V, Benoist JM, Gautron M. Modifications in the responsiveness of rat ventrobasal thalamic neurons at different stages of carrageenin-produced inflammation. Brain Res 1986; 385: 86–98 24 Guilbaud G, Benoist JM, Jazat F, Gautron M. Neuronal responsiveness in the ventrobasal thalamic complex of rats with an experimental peripheral mononeuropathy. J Neurophysiol 1990; 64: 1537–1554 25 Langemark M, Olesen J. Pericranial tenderness in tension headache: A blind, controlled study. Cephalalgia 1987; 7: 249–255 26 Langemark M, Jensen K, Jensen TS, Olesen J. Pressure pain thresholds and thermal nociceptive thresholds in chronic tension-type headache. Pain 1989; 38: 203–210 27 Schoenen J, Bottin D, Hardy F, Gerard P. Cephalic and extracephalic pressure pain thresholds in chronic tension-type headache. Pain 1991; 47: 145–149 28 Schoenen J, Gerard P, De Pasqua V, Sianard-Gainko J. Multiple clinical and paraclinical analyses of chronic tension-type headache associated or unassociated with disorder of pericranial muscles. Cephalalgia 1991; 11: 135–139 29 Gobel H, Weigle L, Kropp P, Soyka D. Pain sensitivity and pain reactivity of pericranial muscles in migraine and tension-type headache. Cephalalgia 1992; 12: 142–151 30 Jensen R, Rasmussen BK, Pedersen B, Olesen J. Muscle tenderness and pressure pain thresholds in headache: a population study. Pain 1993; 52: 193–199 31 Sandrini G, Antonaci F, Pucci E, et al. Comparative study with EMG, pressure algometry and manual palpation in tension-type headache and migraine. Cephalalgia 1994; 14: 451–457; discussion 1994; 14: 394–395 Citing Literature Volume47, Issue5May 2000Pages 614-624 ReferencesRelatedInformation