Applied Neurophysiology and Pain, ANP- Unit, Bari Aldo Moro University, Bari, Italy,
Experimental Bionedical and Clinical Neuroscience Department (BioNeC), Palermo University, Palermo, Italy.
Eur Neurol. 2019;81(1-2):37-46. doi: 10.1159/000499764. Epub 2019 Apr 23.
Onabotulinumtoxin A (OBT-A) is a treatment option for chronic migraine (CM), though the possible effect on central sensitization and allodynia is still unknown.
The present study aimed to evaluate (1) the long-term outcome of allodynia in a group of CM treated with OBT-A (2) if the presence and severity of allodynia could predict the long-term effect of OBT-A (3) if the improvement of allodynia, could contribute to the clinical efficacy of OBT-A.
This was an observational, open-label, cohort study conducted on 99 CM patients treated for 1 year and 44 patients treated for 2 years with periodic OBT-A 155-195 U injections. In basal condition (T0), after 1 year (T1) and 2 years (T2) treatment, allodynia, migraine disability, and headache frequency were the main variables. Anxiety, depression and sleep deprivation were also considered potentially correlated factors to allodynia.
Allodynia decreased after 1 year (Student t test p = 0.0001), and decreased further after the second year of treatment (p = 0.015). There was a relationship between allodynia severity at T0 and reduced headache frequency change at T1 (r = 0.22) and T2 (r = 0.37). The effect of OBT-A on allodynia correlated with the reduction of MIDAS score after 1 year (r = 0.4) and 2 years (r = 0. 63) of treatment.
OBT-A seems to have an effect on central sensitization, expressed by allodynia. This action could be exerted by modulating nociceptive transmission, and reducing the global burden of migraine. Patients with more severe allodynia display a limited long-term effect on headache frequency. The modulation of central sensitization could reduce migraine disability, in spite of the persistence of frequent headache.
肉毒杆菌毒素 A（OBT-A）是治疗慢性偏头痛（CM）的一种选择，但其对中枢敏化和痛觉过敏的可能影响仍不清楚。
本研究旨在评估：（1）一组接受 OBT-A 治疗的 CM 患者痛觉过敏的长期结局；（2）痛觉过敏的存在和严重程度是否能预测 OBT-A 的长期效果；（3）痛觉过敏的改善是否有助于 OBT-A 的临床疗效。
这是一项观察性、开放性、队列研究，共纳入 99 例 CM 患者，接受 OBT-A 155-195U 注射治疗 1 年，44 例患者接受 OBT-A 治疗 2 年。在基础状态（T0）、治疗 1 年（T1）和 2 年后（T2），痛觉过敏、偏头痛残疾和头痛频率是主要变量。焦虑、抑郁和睡眠剥夺也被认为是与痛觉过敏相关的潜在因素。
痛觉过敏在治疗 1 年后（Student t 检验，p=0.0001）减轻，在治疗 2 年后进一步减轻（p=0.015）。T0 时痛觉过敏的严重程度与 T1（r=0.22）和 T2（r=0.37）时头痛频率变化减少相关。OBT-A 对痛觉过敏的影响与治疗 1 年（r=0.4）和 2 年（r=0.63）后 MIDAS 评分降低相关。
OBT-A 似乎对痛觉过敏有作用，这一作用可能通过调节伤害性传递来发挥，从而减轻偏头痛的整体负担。痛觉过敏更严重的患者头痛频率的长期效果有限。中枢敏化的调节可以降低偏头痛残疾，尽管频繁头痛仍持续存在。
