Blink Reflex in Episodic and Chronic Migraine
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Published on: June 13, 2011
Burcu Polat1, Fikret Aysal1, Musa Öztürk2
1Department of Neurology, İstanbul Medipol University, İstanbul, Turkey.
Introduction:
Activation of the trigeminovascular system and sensitization of brainstem trigeminal nuclei play a significant role in the physiopathology of migraine. Our aim was to investigate blink reflex (BR) and its recovery in episodic and chronic migraine patients.
Methods:
Twenty-eight chronic migraine patients, thirty-two episodic migraine without aura patients and thirty healthy controls were included in the study. The study was performed using a portable electromyography device with a software specifically prepared for BR. Blink reflex assessments were performed in patients during the pain-free period and in healthy controls using the 'standard method - double stimulation' technique in 200 ms, 500 ms, 1000 ms, 2000 ms, and 5000 ms intervals.
Results:
Blink reflex recovery was significantly increased in both patient groups as compared to the control group in 200 ms interstimulus interval (ISI) on both sides (p<0.005). Moreover, when it was compared to the control group, recovery was also significantly increased in the chronic migraine group in 2000 ms ISI on the right side and in 5000 ms ISI on the left side as well as in 500 and 1000 ms ISIs on the left side in the migraine without aura group (p<0.002, p<0.003). R2 recovery curve was noted to be higher in both patient groups as compared to the control group, although could not be demonstrated statistically in all intervals. A statistically significant increase was observed in the migraine group without auras compared with the controls (p <0,037, p <0,011) in the left side at 500 and 1000 ms ISIs. For all intervals in our study, although the increase in recovery was not statistically significant, it was noted that the R2 recovery curve was higher in the patient groups, with respect to the normals. The increase in R2 recovery noted in both patient groups suggested increased sensitization of the trigeminal structures. Significantly increased recovery in low ISI (200 ms) in the two patient groups as compared to the control group raised the thought that the migraine brain goes through two different excitability periods (ictal and interictal).
Conclusion:
In conclusion, similar to the previous studies, the findings of this study suggested that there was a reduction in central inhibitory mechanisms during interictal period in migraine patients.
Insights
Migraine patients show increased blink reflex recovery, suggesting reduced central inhibitory mechanisms between attacks. This indicates altered brain excitability in both episodic and chronic migraine sufferers.
Area of Science:
- Neuroscience
- Clinical Neurology
- Pain Research
Background:
- Migraine pathophysiology involves trigeminovascular system activation and trigeminal nuclei sensitization.
- Investigating blink reflex (BR) and its recovery offers insights into migraine mechanisms.
Purpose of the Study:
- To investigate blink reflex (BR) recovery in episodic and chronic migraine patients.
- To compare BR recovery between migraineurs and healthy controls.
Main Methods:
- Blink reflex assessments were conducted on 28 chronic migraine patients, 32 episodic migraine without aura patients, and 30 healthy controls.
- A portable electromyography device with specialized software was used for BR testing.
- The 'standard method - double stimulation' technique was applied at various interstimulus intervals (ISIs) during pain-free periods.
Main Results:
- Blink reflex recovery was significantly increased in both migraine groups compared to controls at a 200 ms ISI.
- Elevated recovery was observed in chronic migraine patients at 2000 ms (right) and 5000 ms (left) ISIs.
- Episodic migraine patients showed increased recovery at 500 ms and 1000 ms ISIs on the left side.
- Increased R2 recovery curves in patient groups suggest heightened trigeminal structure sensitization.
- Significantly increased recovery at low ISIs suggests distinct ictal and interictal brain excitability periods in migraine.
Conclusions:
- Findings suggest reduced central inhibitory mechanisms during the interictal period in migraine patients.
- The results align with previous studies indicating altered neural excitability in migraine.
- Blink reflex recovery patterns may serve as a biomarker for migraine pathophysiology.
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