Department of Neurology, Leiden University Medical Centre, PO Box 9600, 2300 RC, Leiden, The Netherlands.
Department Radiology, Leiden University Medical Centre, Leiden, The Netherlands.
J Headache Pain. 2023 Aug 30;24(1):118. doi: 10.1186/s10194-023-01651-9.
Central sensitisation is an important mechanism in migraine chronification. It is presumed to occur in second and third order neurons sequentially, resulting in an analogous spatial distribution of cutaneous allodynia with cephalic and extracephalic symptoms. We investigated whether allodynia, and its subtypes based on spatial distribution and type of stimulus, predict response to treatment in chronic migraine patients.
This study was conducted as part of the CHARM study (NTR3440), a randomized, double-blind, placebo-controlled trial in chronic migraine patients with medication overuse. We included 173 patients. The presence of cutaneous allodynia at baseline was established with the Allodynia Symptom Checklist. Primary endpoint was reversion from chronic to episodic migraine.
Of all patients, 74.6% reported cutaneous allodynia. Absence of allodynia compared to presence of allodynia was predictive for reversion from chronic to episodic migraine, odds ratio (OR): 2.45 (95% CI: 1.03-5.84), p = 0.042. The predictive value was more pronounced when subdivided for spatial distribution, for participants without allodynia versus cephalic (OR: 4.16 (95% CI: 1.21-14.30), p = 0.024) and extracephalic (OR: 7.32 (95% CI: 1.98- 27.11), p = 0.003) allodynia. Mechanical, but not thermal, allodynia, was associated with outcome.
Cutaneous allodynia, an important marker for central sensitization, likely has predictive value for treatment response in chronic migraine.
中枢敏化是偏头痛慢性化的重要机制。它被认为依次发生在第二和第三级神经元中，导致类似的头皮和颅外症状的皮肤感觉过敏的空间分布。我们研究了感觉过敏及其基于空间分布和刺激类型的亚型是否可以预测慢性偏头痛患者对治疗的反应。
这项研究是 CHARM 研究（NTR3440）的一部分，这是一项针对药物过度使用的慢性偏头痛患者的随机、双盲、安慰剂对照试验。我们纳入了 173 名患者。基线时使用感觉过敏症状检查表确定皮肤感觉过敏的存在。主要终点是从慢性偏头痛转为发作性偏头痛。
所有患者中有 74.6%报告了皮肤感觉过敏。无感觉过敏与有感觉过敏相比，更能预测从慢性偏头痛转为发作性偏头痛，优势比（OR）：2.45（95% CI：1.03-5.84），p=0.042。当按空间分布细分时，预测价值更明显，无感觉过敏的患者与头皮（OR：4.16（95% CI：1.21-14.30），p=0.024）和颅外（OR：7.32（95% CI：1.98-27.11），p=0.003）感觉过敏相比，OR 更高。机械性但不是热感觉过敏与结果相关。
皮肤感觉过敏是中枢敏化的一个重要标志物，可能对慢性偏头痛的治疗反应具有预测价值。
