Young William B
William B. Young, MD Department of Neurology, Thomas Jefferson University Hospital, Jefferson Headache Center, 111 South Eleventh Street, Gibbon Building, Suite #8130, Philadelphia, PA 19107, USA.
Curr Treat Options Neurol. 2009 Jan;11(1):3-9. doi: 10.1007/s11940-009-0001-0.
Allodynia is a normal part of the untreated migraine attack in most people with episodic migraine and is prevalent in chronic migraine. The extent to which allo-dynia contributes to the pain and disability of migraine attacks is unclear, as is its clinical importance. The presence of allodynia correlates with the severity and other features of migraine, including aura, migraine-associated symptoms, and motor symptoms. The development of allodynia is associated with resistance to triptan treatment. It is uncertain whether this treatment resistance is due to the accompanying increase in headache severity or whether the development of allo-dynia is the fundamental biologic event causing the new treatment-refractory state. Animal models support the relationship to allodynia. Intravenous ketorolac may be effective at treating migraine with allodynia several hours after the development of the throbbing pain, but prior treatment with opioid analgesics may confer treatment resistance. Occipital nerve blocks rapidly treat migraine pain and allodynia. Uncontrolled studies have successfully used dihydroergotamine to treat episodic and chronic migraine with allodynia.
在大多数发作性偏头痛患者中，痛觉过敏是未经治疗的偏头痛发作的常见表现，在慢性偏头痛中也很普遍。痛觉过敏对偏头痛发作的疼痛和残疾的影响程度尚不清楚，其临床重要性也不明确。痛觉过敏的存在与偏头痛的严重程度及其他特征相关，包括先兆、偏头痛相关症状和运动症状。痛觉过敏的发生与曲坦类药物治疗耐药有关。尚不确定这种治疗耐药是由于伴随的头痛严重程度增加，还是痛觉过敏的发生是导致新的治疗难治状态的根本生物学事件。动物模型支持与痛觉过敏的关系。静脉注射酮咯酸可能在搏动性疼痛出现数小时后对伴有痛觉过敏的偏头痛有效，但预先使用阿片类镇痛药可能会导致治疗耐药。枕神经阻滞可迅速缓解偏头痛疼痛和痛觉过敏。非对照研究已成功使用双氢麦角胺治疗伴有痛觉过敏的发作性和慢性偏头痛。
