Department of Neurology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India.
Clin J Pain. 2013 Jul;29(7):577-82. doi: 10.1097/AJP.0b013e31826b130f.
There is no study on the role of prophylactic therapy on allodynia in patients with migraine. We report the predictors of allodynia in migraine and the effect of divalproate or amitriptyline in alleviating allodynia.
Four hundred forty-eight consecutive patients with migraine diagnosed as per International Headache Society criteria were prospectively included. The presence of allodynia, its type and severity, and details of headache were enquired. Two hundred twenty-seven migraineurs were randomly allocated to amitriptyline (25 to 50 mg/d) or divalproate (500 to 750 mg/d). The improvement in allodynia and headache severity was recorded at 3 and 6 months. The side effects of the drugs were noted.
The median age of the patients was 32 years (range, 10 to 62 y) and 77.6% were females. 71.4% patients had allodynia; static mechanical in 90%, dynamic in 89.1%, and thermal in 17%. The allodynia was related to the duration of illness, frequency, severity of migraine, and female gender. Both divalproate and amitriptyline significantly reduced the frequency and severity of allodynia at 3 and 6 months compared with baseline though there was no group difference. The composite side effects were similar but valproate was discontinued in 5 patients because of polycystic ovary.
71.4% migraineurs had allodynia that was related to the duration, severity, frequency of migraine, and female gender. Divalproate and amitriptyline were equally effective in relieving allodynia.
目前尚无研究探讨预防性治疗对偏头痛患者痛觉过敏的作用。我们报告偏头痛患者痛觉过敏的预测因素，以及丙戊酸钠和阿米替林缓解痛觉过敏的效果。
前瞻性纳入符合国际头痛协会标准的 448 例连续偏头痛患者。询问痛觉过敏的存在、类型和严重程度以及头痛的详细情况。将 227 例偏头痛患者随机分配至阿米替林（25 至 50mg/d）或丙戊酸钠（500 至 750mg/d）组。记录 3 个月和 6 个月时痛觉过敏和头痛严重程度的改善情况，并记录药物的不良反应。
患者的中位年龄为 32 岁（范围：10 至 62 岁），77.6%为女性。71.4%的患者有痛觉过敏，其中 90%为静态机械性痛觉过敏，89.1%为动态性痛觉过敏，17%为热痛觉过敏。痛觉过敏与疾病持续时间、发作频率、偏头痛严重程度和女性性别有关。丙戊酸钠和阿米替林在 3 个月和 6 个月时均显著降低了痛觉过敏的频率和严重程度，但与基线相比无组间差异。复合不良反应相似，但丙戊酸钠因多囊卵巢而在 5 例患者中被停用。
71.4%的偏头痛患者存在痛觉过敏，与疾病持续时间、严重程度、发作频率和女性性别有关。丙戊酸钠和阿米替林缓解痛觉过敏的效果相当。
