Lovati C, D'Amico D, Rosa S, Suardelli M, Mailland E, Bertora P, Pomati S, Mariani C, Bussone G
Department of Clinical Sciences, L. Sacco Hospital, University of Milan, Via G.B. Grassi 74, I-20157 Milan, Italy.
Neurol Sci. 2007 May;28 Suppl 2:S220-1. doi: 10.1007/s10072-007-0781-5.
About 60% of patients complain of cutaneous allodynia during migraine episodes, often in the periorbitary region of the pain side. Pre-clinical studies have shown that the underlying mechanism is sensitisation of primary nociceptors and central trigeminovascular neurons and that patients have a lower pain threshold for mechanical stimulation compared to controls. The objective of this study was to determine the prevalence of allodynia during headache attacks in different forms of migraine. The subjects were 221 outpatients consecutively evaluated in the Headache Center of the L. Sacco Hospital in Milan: 114 had only attacks of migraine without aura (MO), 63 had also attacks with aura (MA) and 44 patients with chronic migraine with and without drug overuse (CM). Presence of head allodynia was investigated by a semistructured interview. Statistical analysis was performed by chi square test with Bonferroni correction for multiple comparisons. Forty-seven out of 114 MO patients (41.2%) complained of allodynia during headache episodes, 41 out of 63 MA patients (65.0%), and 29 out of 44 CM patients (65.9%). A higher frequency of allodynia in MA and CM with respect to MO patients was observed (p<0.01 at chi square test). Allodynia was a common complaint in migraineurs, being present in more than 40% patients of each group. A higher frequency was observed in MA and in CM patients. This observation may suggest that both frequency of attacks and presence of aura episodes may contribute to induce changes in neuronal activation threshold thought to sustain allodynia.
约60%的患者在偏头痛发作期间会出现皮肤异常性疼痛，通常发生在疼痛侧的眶周区域。临床前研究表明，其潜在机制是初级伤害感受器和中枢三叉神经血管神经元的敏化，并且与对照组相比，患者对机械刺激的疼痛阈值更低。本研究的目的是确定不同类型偏头痛发作期间异常性疼痛的患病率。研究对象为在米兰L. Sacco医院头痛中心连续接受评估的221名门诊患者：114例仅有无先兆偏头痛发作（MO），63例也有有先兆偏头痛发作（MA），44例为慢性偏头痛患者，伴有或不伴有药物滥用（CM）。通过半结构化访谈调查头部异常性疼痛的存在情况。采用卡方检验进行统计分析，并使用Bonferroni校正进行多重比较。114例MO患者中有47例（41.2%）在头痛发作期间抱怨有异常性疼痛，63例MA患者中有41例（65.0%），44例CM患者中有29例（65.9%）。观察到MA和CM患者中异常性疼痛的发生率高于MO患者（卡方检验p<0.01）。异常性疼痛是偏头痛患者的常见主诉，每组中超过40%的患者存在该症状。在MA和CM患者中观察到更高的发生率。这一观察结果可能表明，发作频率和先兆发作的存在都可能导致神经元激活阈值的变化，从而引发维持异常性疼痛的机制。
