Istanbul University, Institute of Health Sciences, Aziz Sancar Institute of Experimental Medicine, Department of Neuroscience, Istanbul, Turkey; Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training Research Hospital, Istanbul, Turkey.
Bezmialem Vakif University, Faculty of Medicine, Department of Neurology, Istanbul, Turkey; Istanbul University, Istanbul Faculty of Medicine, Departments of Neurology and Clinical Neurophysiology, Istanbul, Turkey.
Clin Neurol Neurosurg. 2022 Sep;220:107357. doi: 10.1016/j.clineuro.2022.107357. Epub 2022 Jun 30.
Cutaneous allodynia (CA) is a common symptom in migraine. Its incidence is more frequent in the chronic migraine (CM). CA usually occurs during pain attacks. However, it can also be interictal and its frequency and severity seem to be correlated with the duration of the disease. Several quantitative sensory testing (QST) studies have revealed variable results about mechanical and thermal allodynia accompanying migraine. This study aimed to investigate the effects of CA and onabotulinumtoxinA (BoNT-A) injection on the thermal thresholds measured by QST in patients with CM. The effects of BoNT-A on headaches, CA, and other accompanying symptoms of migraine were also evaluated.
Single BoNT-A injections were performed in 22 female cases (mean age: 38.1 ± 7.2 years) with CM. Patients were evaluated at 1-7 days before, 28-35, and 84-91 days after the injection. The 22 healthy women in the control group (mean age: 36.6 ± 7.6 years) were examined once. Headache and its characteristics, medication intake, allodynia, presence of anxiety, and depression symptoms were evaluated through relevant scales. The heat (HDT) and cold (CDT) detection thresholds on the forehead and hand were measured bilaterally with QST. The presence of brush allodynia for patients was examined by applying a 4 × 4 gauze pad over the same areas.
The patients in the CM group had migraine for an average of 22.5 ± 6.1 years and CM for 6.1 ± 3.2 years. The average number of painful days per month was 22.1 ± 4.0 days. All the patients had migraine attacks with CA (mean 5.6/month). The average allodynia symptom checklist (ASC-12) score was 7.8 ± 6.2. Thermal thresholds measured in the patients with CM were similar to those of the controls. Thermal thresholds did not show significant differences between the symptomatic and the asymptomatic sides at the last migraine attack. There was also no correlation between the allodynia revealed by the physical examination and the thermal thresholds detected by QST. The ASC-12 score decreased significantly with BoNT-A injection (p = 0.030), but no significant change was observed in thermal thresholds after this treatment.
There was no significant correlation between CA and thermal thresholds. BoNT-A was successful in relieving headache and other associated symptoms, including CA, but had no significant effect on QST parameters.
皮肤感觉过敏（CA）是偏头痛的常见症状。其在慢性偏头痛（CM）中更为常见。CA 通常在疼痛发作期间发生。然而，它也可能是间歇性的，其频率和严重程度似乎与疾病的持续时间有关。几项定量感觉测试（QST）研究表明，偏头痛伴有的机械性和热感觉过敏的结果存在差异。本研究旨在探讨 CA 和肉毒毒素 A（BoNT-A）注射对 CM 患者 QST 测量的热阈值的影响。还评估了 BoNT-A 对头痛、CA 和偏头痛的其他伴随症状的影响。
对 22 例女性 CM 患者（平均年龄：38.1±7.2 岁）进行单次 BoNT-A 注射。患者在注射前 1-7 天、28-35 天和 84-91 天进行评估。22 名健康女性（平均年龄：36.6±7.6 岁）作为对照组，仅进行一次检查。通过相关量表评估头痛及其特征、药物摄入、感觉过敏、焦虑和抑郁症状。使用 QST 双侧测量额部和手部的热（HDT）和冷（CDT）检测阈值。用 4×4 纱布垫在同一区域检查患者是否存在触须感觉过敏。
CM 组患者偏头痛平均 22.5±6.1 年，CM 平均 6.1±3.2 年。每月疼痛天数平均为 22.1±4.0 天。所有患者均有偏头痛伴 CA（平均每月 5.6 次）。平均感觉过敏症状检查表（ASC-12）评分为 7.8±6.2。CM 患者的热阈值与对照组相似。在最后一次偏头痛发作时，症状侧和无症状侧的热阈值无显著差异。体格检查发现的感觉过敏与 QST 检测到的热阈值之间也没有相关性。BoNT-A 注射后 ASC-12 评分显著降低（p=0.030），但治疗后热阈值无明显变化。
CA 与热阈值之间无显著相关性。BoNT-A 治疗成功缓解了头痛和其他相关症状，包括 CA，但对 QST 参数无显著影响。
