[Mechanism based prevention and treatment of migraine]

Triptan therapy results in good relief of headache in 68% of the patients. For many of the patients with migraine, triptan provides complete pain relief in some attacks but not in others. A recent theory proposes that allodynia (pain sensitization) develops in the brain during migraine to increase the intensity of headache significantly. The presence of cutaneous allodynia, an exaggerated painful sensation resulting from a no noxious stimulus to normal skin, is reported in more than 70% of the patients. In our prospective study with 41 patients with migraine, 54.2% presented with skin allodynia. Triptan was effective in 77% of the patients without allodynia which was higher than the base line efficacy rate of 68% in all the patients. Our data support the hypothesis that the development and maintenance of cutaneous allodynia is propelled by sensitization of central trigeminal nucleus. It is suggested that the pain-free outcome increases drastically if triptan therapy is given before the phenomenon of allodynia develops during the attacks of migraine.