Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0018681 (headache)
 56,091 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Cutaneous allodynia, pain resulting from application of a non-noxious stimulus to normal skin, is a recently described symptom of migraine, with a potential role in directing optimal treatment for migraine attacks. Manifestations of cutaneous allodynia include discomfort when combing the hair, shaving, and wearing glasses, contact lenses, earrings or tight clothing. The exact mechanism by which a migraine attack is triggered is not known, but it has been theorised that, in some patients, once the attack has begun, central neurons can propagate information about the pain process without the need for further external stimuli. This process is termed central sensitisation. The trigeminal nerves, which innervate intracranial and extracranial tissues, account for head pain and other symptoms in migraine. The first-order neurons in the trigeminal ganglion receive input from the dural blood vessels, which is transmitted to second-order neurons in the trigeminal brain stem nuclear complex and is finally sent to the third-order neurons in the thalamus. Studies in humans and animals have shown that migraine pain progresses along this neural pathway, with throbbing head pain occurring early in the attack (sensitisation of first-order neurons), followed by central sensitisation and cutaneous allodynia within the referred pain area (second-order) and finally extracephalic allodynia (third-order). The data also indicate that once central sensitisation is established in the second- and third-order neurons, migraine treatment designed to prevent the initiation of central sensitisation can lessen the pain to some extent but cannot reverse it. Thus, treatment affecting the initiation of central sensitisation should be administered immediately after the onset of migraine pain to prevent intracranial hypersensitivity and the establishment of allodynia. The serotonin 5-HT(1B/1D) agonist anti-migraine agents (the 'triptans') block meningeal nociceptor transmission at presynaptic sites in the dorsal horn. Studies have shown that triptan therapy can abort pain prior to the development of central sensitisation, but not after allodynia has been established. Therefore, in the subset of patients who report symptoms of cutaneous allodynia with migraine attacks, early initiation of triptan therapy is currently the best intervention to achieve rapid, complete and sustained pain relief.
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PMID:Central sensitisation and cutaneous allodynia in migraine: implications for treatment. 1672 88

Cutaneous allodynia has been described in migraine. We report on a 39-year-old woman with migraine with aura who had cutaneous allodynia to both dynamic (brush) and static (pressure) mechanical stimulation between attacks. For both sensory modalities, the evoked pain on allodynia testing was located to the right frontal area (the location of her usual migraine headache), contralaterally to the stimulated skin area. There was no allodynia when the right frontal area was stimulated directly. We suggest the term 'referred allodynia' for this phenomenon and discuss possible mechanisms for its occurrence.
Cephalalgia 2005 Jan
PMID:Referred cutaneous allodynia in a migraine patient without simultaneous headache. 1560 75

Cutaneous allodynia is common in migraine. In the majority of previous studies on allodynia in migraine, only patients with episodic migraine (EM) were included. Little is known on patterns of allodynia in chronic migraine (CM). Since the presence of allodynia is associated with a poor response to triptans, a clinically practical method to test migraine patients for allodynia would be useful to the clinician. The aim of this study was to assess the prevalence of dynamic mechanical (brush) allodynia (BA) in CM, using a clinically practical method. Eighty-nine CM patients were prospectively recruited. Patients were given a structured questionnaire regarding demographic data and migraine characteristics. Allodynia was tested using a 10 x 10-cm gauze pad to brush various areas of the skin lightly. The prevalence of BA in the entire study population and in different patient subgroups was calculated. BA was present in 42.7% (38/89) of the patients. The presence of allodynia was unrelated to age, disease duration or to the occurrence of an acute headache exacerbation at the time of testing. Allodynia was positively associated with a history of migraine aura. BA was most common in the cephalic area, but was also seen in cervical dermatomes. BA is common in CM and, unlike in EM, is not significantly affected by the occurrence of an acute headache exacerbation. This suggests that central trigeminovascular neurons are chronically sensitized in patients experiencing migraine headache >15 days per month. The testing of BA in the clinical setting is possible using a simple and brief approach. It allows the clinician to determine whether the patient is sensitized, a diagnosis that affects treatment decisions.
Cephalalgia 2007 Feb
PMID:Identifying cutaneous allodynia in chronic migraine using a practical clinical method. 1725 30

Migraine is known to be associated to particular psychological features. Cutaneous allodynia is a painful sensation or discomfort induced by a non-noxious stimulus, and is a frequent complaint during migraine attacks. The aim of this study was to compare the personality profile of allodynic and non-allodynic migraineurs to identify possible relationships between psychological aspects and the presence of allodynia. The Symptom Check List 90-R (SCL90R), a 90-item self-report psychological symptom inventory, was used to investigate the psychological profile of our patients. The presence of allodynia was assessed by a set of semi-structured questions that investigated if the patient experienced abnormal scalp sensitiveness and/or discomfort during headache episodes. Twenty-five nonallodynic patients and 38 allodynic migraineurs were studied. No significant difference was found between the two groups in any area of the personality profile. The psychological profile seems not to affect the presence/absence of cutaneous allodynia in migraine patients. This reinforces the hypothesis that allodynia is a "somatic" symptom, not modified by psychological aspects.
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PMID:Personality profile and allodynic migraine. 1854 20

Migraine is a common disorder that often is accompanied by cutaneous allodynia. Cutaneous allodynia on the head has been linked to sensitization of neurons in the trigeminal nucleus caudalis in animal models of migraine. In addition, migraine with allodynia is refractory to acute treatment with triptans. Understanding the mechanisms of allodynia, preventing its development, and finding effective treatments have become a priority in headache research. This paper reviews recent research on the pathogenesis of headache and the generation of allodynia. We discuss the regions of the nervous system that are involved in generating and maintaining headache pain and allodynia. We also discuss recent advances in the treatment of migraine based on translation research.
Curr Pain Headache Rep 2006 Jun
PMID:Insights from experimental studies into allodynia and its treatment. 1877 78

Cutaneous allodynia is a frequent complain in headache patients, particularly in those with migraine. A stronger association is present in patients with migraine with aura and with chronic or transformed migraine. The aim of the present study was to investigate if the psychological profile may be related to the presence/absence of allodynia in a sample of headache patients. The psychological profile of patients was assessed by the SCL90R; the presence of allodynia was assessed by a set of semi-structured questions used in previous studies. For the purpose of the study, patients were divided into subgroups according to the headache type (ICDH-II diagnoses), as well as to the temporal pattern (episodic or chronic). A total of 213 consecutive headache patients were studied. Most patients had episodic migraine (116); 37 had tension-type headache. Overall, 156 patients had episodic headache forms, and 57 had chronic forms. As far as allodynia, 93 were non-allodynic; 120 presented allodynic symptoms during their headaches. No significant difference was found between allodynic and non-allodynic patients neither if studied in a whole group (t test, P = 0.10 NS) nor when patients were evaluated comparing different subgroups on the basis of headache type, and of the episodic/chronic pattern. Our results suggest that the presence/absence of allodynia may not be influenced by the psychological profile.
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PMID:Is allodynia influenced by psychological profile in headache patients? 1941 39

Cutaneous allodynia (CA) has been described in migraine and has been related to treatment failure. There are little data about the incidence of CA in other primary headache syndromes such as cluster headache (CH). The objectives of this study are to evaluate the prevalence of dynamic mechanical (brush) allodynia (BA) in CH patients attending a tertiary headache clinic, and to assess its relation to disease characteristics. Adult patients with episodic or chronic CH were recruited. We obtained demographic data and data on disease characteristics through a structured questionnaire, and tested the patients for brush allodynia BA by applying a 4 x 4 gauze pad over the V1, C2/C3 and C8 skin areas bilaterally. The prevalence of allodynia in the entire study population and in the different sub-groups was calculated. We also examined the association between CA and demographic parameters, and its association with disease characteristics. Forty-one patients were recruited (22 men, 19 women; mean age 44.9 years). Twenty-two had chronic CH (CCH) and 19 had episodic CH (ECH). Mean disease duration was 14.1 years (12.3 the CCH group and 15.7 in the ECH group). Overall, 20 (49%) patients were allodynic. There was no statistically significant association between the presence of allodynia and age, gender, diagnosis (episodic vs. chronic CH), disease duration or disease severity. In conclusion, BA was common in this CH patient sample. The therapeutic implications of the presence of BA in CH need to be further studied.
J Headache Pain 2009 Aug
PMID:Dynamic mechanical (brush) allodynia in cluster headache: a prevalence study in a tertiary headache clinic. 1942 8

Cutaneous allodynia (CA), pain in response to innocuous cutaneous stimuli, is recognized as a sign of central sensitization during migraine episodes. It is either restricted within the pain area on the ipsilateral head, or extends within and outside the head. Moreover, CA can be elicited in response to thermal (heat or cold) and/or mechanical stimuli. This raises the question as to whether cephalic and extracephalic CAs share the same properties. We assessed cephalic and extracephalic CAs in migraine episodic patients using a questionnaire completed at home during migraine attacks. A total of 67 episodic migraine patients (58 women, nine men; 4013 years old) addressed all questions in the questionnaire. Forty-nine patients (73%) cited one or more allodynic symptoms during or immediately after the migraine attack. Almost all 49 patients reported cephalic CA, whereas 24 (49%) also reported extracephalic CA. Occurrence and extension of CA correlated (P = 0.005) with headache intensity. Modalities of cephalic and extracephalic CA were different (chi2 = 12.03; P = 0.002), extracephalic CA being mostly thermal (75%) whereas cephalic CA was mostly mechanical (92%). This suggests that cephalic and extracephalic CAs involve different mechanisms.
Cephalalgia 2010 Jul
PMID:Are there differences between cephalic and extracephalic cutaneous allodynia in migraine patients? 1974 Jan 24

Cutaneous allodynia (CA), the perception of pain when a non-noxious stimulus is applied to normal skin, has been described in various pain syndromes. The pathophysiology of CA in headache is thought to be related to central sensitization of brainstem, and possibly thalamic, neurons. The recognition of CA in cluster headache (CH) is recent, and available data are scant. Some studies suggest the occurrence of CA in a significant proportion of CH patients. However, one study that examined sensory thresholds in CH failed to confirm this. CA in CH is characterized by rapid onset and termination, suggesting different mechanisms compared with CA in migraine. CA in CH is common in trigeminal areas but may spread to cervical dermatomes and beyond. The relations between the type of CH (episodic vs chronic) and CA are unknown. Further studies are needed to determine the mechanism of CA in CH, and its clinical implications.
Curr Pain Headache Rep 2010 Apr
PMID:Allodynia in cluster headache. 2042 3

Cutaneous allodynia is a frequent complaint in migraine patients, possibly induced by central sensitisation of trigeminal nucleus. The objective of this study is to investigate if sleep quality is related to the presence of migraine-associated allodynia. A total of 175 consecutive migraineurs were included, 124 with episodic and 51 with chronic forms. As control group, 73 subjects free from any kind of headache were included (HC). The presence of allodynia and sleep disturbances was assessed by a set of semi-structured questions. Chi-square test was applied to compare frequencies among groups. Sleep quality was worse among migraineurs with respect to controls for each sleep item analysed. This difference was significant for all items but one (i.e. frequency in drug use to induce sleep). The frequency of sleep disturbances was higher than in controls in both allodynic and non-allodynic migraineurs, although statistical analysis showed that all these differences were still significant in allodynic migraineurs (also in this case for all the sleep items but one, i.e. frequency in drug use to induce sleep), whilst non-allodynic migraineurs were significantly different from controls only for one item (frequency of initial insomnia). These results suggest that allodynia is strongly related to sleep quality, in a bi-directional way: sleep disturbances may favour central sensitisation, and, in turn, allodynia may impair sleep.
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PMID:Correlation between presence of allodynia and sleep quality in migraineurs. 2046 10


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