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Allodynia in migraine: frequent random association or unavoidable consequence?
Carlo Lovati1, Domenico D'Amico, Pierluigi Bertora
1Luigi Sacco Headache Centre, Clinic of Neurology, Milan, Italy. carlo.lovati@tiscalinet.it
Expert Review of Neurotherapeutics
|March 11, 2009
Summary
Allodynia, pain from non-painful stimuli, is common in migraine, particularly chronic forms. Central sensitization in the trigeminal nerve pathway is a key mechanism, impacting treatment efficacy.
Area of Science:
- Neurology
- Pain Medicine
- Neuroscience
Background:
- Allodynia, experiencing pain from non-painful stimuli, frequently co-occurs with migraine, especially chronic migraine and migraine with aura.
- It is hypothesized to result from headache-induced nociceptor activation and central sensitization within the trigeminal nerve's central nociceptive pathway.
- Genetic, environmental, and psychological factors may contribute to the diverse pathogenetic mechanisms of allodynia.
Purpose of the Study:
- To explore the phenomenon of allodynia in migraine patients.
- To discuss the underlying pathogenetic mechanisms, including central sensitization and potential genetic, environmental, and psychological influences.
- To review assessment methods and the clinical significance of allodynia in migraine management.
Main Methods:
- Review of existing literature on allodynia and migraine.
- Discussion of neurobiological mechanisms, including central sensitization and trigeminal nerve involvement.
- Analysis of clinical presentation, including acute versus interictal and cephalic versus extracephalic allodynia.
Main Results:
- Allodynia is more prevalent during migraine attacks (acute) than between attacks (interictal).
- Acute allodynia can be localized or diffuse, with extracephalic allodynia potentially involving thalamic sensitization.
- The presence of allodynia may diminish the effectiveness of acute migraine treatments.
Conclusions:
- Allodynia is a significant migraine symptom requiring careful assessment due to its impact on quality of life and treatment outcomes.
- Understanding the mechanisms, including thalamic sensitization for extracephalic allodynia, is crucial for targeted therapeutic strategies.
- Validated instrumental and clinical tools aid in the assessment of allodynic symptoms in migraineurs.
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