Basal cutaneous pain threshold in headache patients

Maurizio Zappaterra,Anna Ferrari,Maria Michela Cainazzo,Luigi Alberto Pini,Simona Guerzoni

doi:10.1007/s10194-011-0313-9

Maurizio Zappaterra, Anna Ferrari + Show 3 more

Open Access

https://doi.org/10.1007/s10194-011-0313-9

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Abstract

The aim of this study was to analyze cutaneous pain threshold (CPT) during the interictal phase in headache patients, and the relationships between headache frequency and analgesic use. A consecutive series of 98 headache patients and 26 sex- and age-balanced controls were evaluated. Acute allodynia (AA) was assessed by Jakubowski questionnaire, and interictal allodynia (IA) by a skin test with calibrated monofilaments. AA is widely known as a symptom more present in migraine than in TTH spectrum: in our study this was confirmed only in cases of episodic attacks. When headache index rises towards chronicization, the prevalence of AA increases in both headache spectrums (χ 2 13.55; p < 0.01). AA was associated with IA only in cases of chronic headache. When headache becomes chronic, mostly in presence of medication overuse, interictal CPT decreases and IA prevalence increases (χ 2 20.44; p < 0.01), with closer association than AA. In MOH patients there were no significant differences depending on the diagnosis of starting headache (migraine or tension type headache) and, in both groups, we found the overuse of analgesics plays an important role: intake of more than one daily drug dramatically reduces the CPT (p < 0.05). Thus, when acute allodynia increases frequency, worsens or appears for the first time in patients with a long-standing history of chronic headache, it could reasonably suggest that the reduction of CPT had started, without using a specific practical skin test but simply by questioning clinical headache history. In conclusion, these results indicate that the role of medication overuse is more important than chronicization in lowering CPT, and suggest that prolonged periods of medication overuse can interfere with pain perception by a reduction of the pain threshold that facilitates the onset of every new attack leading to chronicization.

Highlights

Allodynia is an abnormal sensory condition during which normally innocuous stimuli are felt as painful
In MOH patients there were no significant differences depending on the diagnosis of starting headache and, in both groups, we found the overuse of analgesics plays an important role: intake of more than one daily drug dramatically reduces the cutaneous pain threshold (CPT) (p \ 0.05)
The aim of this study is to evaluate the relationship between CPT and headache clinical characteristic with regard to frequency, acute allodynia (AA), duration and analgesic overuse

Summary

Introduction

Allodynia is an abnormal sensory condition during which normally innocuous stimuli are felt as painful. Sensitivity changes, during headache attacks, have shown by common symptoms like, a feeling of discomfort when patients wear tight-fitting clothing, necklaces, glasses or when hair is bound; or, when exposed to excessive heat or cold Migraineurs, during their attacks, highlight a decreased pain threshold to non-noxious thermal and mechanical stimulation of skin, frequently referred as cutaneous allodynia. Using quantitative and semi-quantitative sensory testing techniques, Burstein et al have demonstrated the gradual development of cutaneous allodynia in subjects with episodic migraine after the onset of their migraine attacks [1,2,3,4] Animal studies support this hypothesis, the application of an inflammatory soup to dura, in a rat model of intracranial pain, followed by an innocuous stimulus, generates a pronounced increase in neuronal firing patterns in peripheral and central second-order neurons of the trigemino-vascular system [5].

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