Wilbrink Leopoldine A, Louter Mark A, Teernstra Onno P M, van Zwet Erik W, Huygen Frank J P M, Haan Joost, Ferrari Michel D, Terwindt Gisela M
Departments of aNeurology and bPsychiatry, Leiden University Medical Centre, Leiden, the Netherlands cDepartment of Neurosurgery, Maastricht University Medical Centre, Maastricht, the Netherlands dDepartment of Medical Statistics and BioInformatics, Leiden University Medical Centre, Leiden, the Netherlands eDepartment of Anaesthesiology, Erasmus MC, Rotterdam, the Netherlands fDepartment of Neurology, Alrijne Hospital, Leiderdorp, the Netherlands.
Pain. 2017 Jun;158(6):1113-1117. doi: 10.1097/j.pain.0000000000000891.
Cutaneous allodynia is an established marker for central sensitization in migraine. There is debate whether cutaneous allodynia may also occur in cluster headache, another episodic headache disorder. Here, we examined the presence and severity of allodynia in a large well-defined nationwide population of people with cluster headache. Using validated questionnaires we assessed, cross-sectionally, ictal allodynia and comorbid depression and migraine in the nationwide "Leiden University Cluster headache neuro-Analysis" (LUCA) study. Participants with cluster headache were diagnosed according to the International Classification of Headache Disorders criteria. Multivariate regression models were used, with correction for demographic factors and cluster headache subtype (chronic vs episodic; recent attacks <1 month vs no recent attacks). In total, 606/798 (75.9%) participants with cluster headache responded; of whom, 218/606 (36%) had allodynia during attacks. Female gender (odds ratio [OR] 2.05, 95% confidence interval [95% CI] 1.28-3.29), low age at onset (OR 0.98, 95% CI 0.96-0.99), lifetime depression (OR 1.63, 95% CI 1.06-2.50), comorbid migraine (OR 1.96, 95% CI 1.02-3.79), and having recent attacks (OR 1.80, 95% CI 1.13-2.86), but not duration of attacks and chronic cluster headache, were independent risk factors for allodynia. The high prevalence of cutaneous allodynia with similar risk factors for allodynia as found for migraine suggests that central sensitization, like in migraine, also occurs in cluster headache. In clinical practice, awareness that people with cluster headache may suffer from allodynia can in the future be an important feature in treatment options.
皮肤性痛觉过敏是偏头痛中枢敏化的一个既定标志。对于丛集性头痛(另一种发作性头痛疾病)是否也会出现皮肤性痛觉过敏存在争议。在此,我们在一个全国范围内定义明确的大型丛集性头痛患者群体中检查了痛觉过敏的存在情况和严重程度。在全国性的“莱顿大学丛集性头痛神经分析”(LUCA)研究中,我们使用经过验证的问卷,对发作期痛觉过敏以及共病的抑郁症和偏头痛进行了横断面评估。丛集性头痛患者根据《头痛疾病国际分类》标准进行诊断。使用多变量回归模型,并对人口统计学因素和丛集性头痛亚型(慢性与发作性;近期发作<1个月与无近期发作)进行校正。总共798名丛集性头痛患者中有606名(75.9%)做出了回应;其中,218/606名(36%)在发作期间存在痛觉过敏。女性(比值比[OR]2.05,95%置信区间[95%CI]1.28 - 3.29)、发病年龄低(OR 0.98,95%CI 0.96 - 0.99)、终生患抑郁症(OR 1.63,95%CI 1.06 - 2.50)、共病偏头痛(OR 1.96,95%CI 1.02 - 3.79)以及近期有发作(OR 1.80,95%CI 从1.13 - 2.86),而非发作持续时间和慢性丛集性头痛,是痛觉过敏的独立危险因素。皮肤性痛觉过敏的高患病率以及与偏头痛相似的痛觉过敏危险因素表明,与偏头痛一样,中枢敏化也发生在丛集性头痛中。在临床实践中,认识到丛集性头痛患者可能患有痛觉过敏在未来可能成为治疗选择中的一个重要特征。
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