Cooke Lara, Eliasziw Michael, Becker Werner J
Department of Clinical Neuroscience, University of Calgary, Calgary, Canada.
Headache. 2007 Apr;47(4):531-9. doi: 10.1111/j.1526-4610.2006.00717.x.
There is growing evidence that central sensitization plays a role in migraine pathogenesis, and that cutaneous allodynia is its clinical correlate. In headache research, allodynia has largely been studied in episodic migraine. The purpose of this investigation was to determine whether cutaneous allodynia occurs in transformed migraine, using individuals without headaches as controls.
Fifteen patients with a diagnosis of transformed migraine and 15 control subjects with no history of headaches were included. All subjects were females between 18 and 50. Similar to the methods of Burstein et al, Von Frey hairs (VFH) were sequentially applied to territories supplied by divisions of the trigeminal nerve, cervical paraspinal muscles, trapezius muscles, ventral forearm, and lower leg to determine a pain threshold. As a milder stimulus, a cotton swab was stroked in the same locations. Each trial was repeated 3 times on 2 occasions. Group comparisons were made using the Student's t-test.
Mean pain thresholds were lower among migraine patients than control subjects across all test areas. The thresholds were statistically significantly lower in migraine patients than in control subjects for the 1st division of the trigeminal nerve (34.0 g versus 115.8 g, P= .035) and for the 2nd division (23.5 g versus 97.6 g, P= .039). Six patients found a cotton swab-stroke painful, compared to zero control subjects. Using a quantitative definition of allodynia, 75% of patients had allodynia to mechanical stimuli.
This study is the first to demonstrate allodynia in transformed migraine patients using a headache-free control population and supports the hypothesis that central sensitization plays a role in the evolution of transformed migraine.
越来越多的证据表明，中枢敏化在偏头痛发病机制中起作用，且皮肤异常性疼痛是其临床相关表现。在头痛研究中，异常性疼痛主要在发作性偏头痛中进行研究。本研究的目的是，以无头痛个体作为对照，确定慢性偏头痛患者是否存在皮肤异常性疼痛。
纳入15例诊断为慢性偏头痛的患者和15例无头痛病史的对照者。所有受试者均为18至50岁的女性。与Burstein等人的方法类似，依次使用von Frey毛发（VFH）刺激三叉神经分支、颈旁脊柱肌肉、斜方肌、前臂腹侧和小腿所支配的区域，以确定疼痛阈值。作为一种较温和的刺激，在相同部位用棉棒轻擦。每次试验在两个时间点重复进行3次。采用Student t检验进行组间比较。
在所有测试区域，偏头痛患者的平均疼痛阈值均低于对照者。在三叉神经第一分支（34.0克对115.8克，P = 0.035）和第二分支（23.5克对97.6克，P = 0.039），偏头痛患者的阈值显著低于对照者。6例患者感觉棉棒轻擦引起疼痛，而对照者无一人有此感觉。采用异常性疼痛的定量定义，75%的患者对机械刺激存在异常性疼痛。
本研究首次使用无头痛的对照人群，证实了慢性偏头痛患者存在异常性疼痛，并支持中枢敏化在慢性偏头痛演变中起作用这一假说。
