Are there differences between cephalic and extracephalic cutaneous allodynia in migraine patients?

Abstract

Cutaneous allodynia (CA), pain in response to innocuous cutaneous stimuli, is recognized as a sign of central sensitization during migraine episodes. It is either restricted within the pain area on the ipsilateral head, or extends within and outside the head. Moreover, CA can be elicited in response to thermal (heat or cold) and/or mechanical stimuli. This raises the question as to whether cephalic and extracephalic CAs share the same properties. We assessed cephalic and extracephalic CAs in migraine episodic patients using a questionnaire completed at home during migraine attacks. A total of 67 episodic migraine patients (58 women, nine men; 4013 years old) addressed all questions in the questionnaire. Forty-nine patients (73%) cited one or more allodynic symptoms during or immediately after the migraine attack. Almost all 49 patients reported cephalic CA, whereas 24 (49%) also reported extracephalic CA. Occurrence and extension of CA correlated (P = 0.005) with headache intensity. Modalities of cephalic and extracephalic CA were different (chi2 = 12.03; P = 0.002), extracephalic CA being mostly thermal (75%) whereas cephalic CA was mostly mechanical (92%). This suggests that cephalic and extracephalic CAs involve different mechanisms.

The characteristics of head pain in response to an experimental cold stimulus to the palate: An observational study of 414 volunteers

“…This may also explain a longer duration of the pain induced by ice and, perhaps, its pulsatile nature, since vascular arterial involvement and allodynia may both occur (19)(20)(21)(22).…”

12 item Allodynia Symptom Checklist/Brasil: cross-cultural adaptation, internal consistency and reproducibility

“…Cutaneous allodynia (CA), defined as pain in response to a non-nociceptive stimulus 1 when the stimulus is applied to normal skin 2 , has been attracting more interest by having been recognized as a signal of central sensitization during migraine attacks [3][4][5] and having been suggested as a risk factor for migraine chronification 2,6,7 . The relation of CA with migraine is believed to be due to a change in the central modulation of nociceptive pathways 8 because of central sensitization, which provokes hyperexcitability of first-, second-and third-order neurons respectively located at the periphery, in the caudal nucleus of the trigeminus and in the thalamus 5,9 .…”

Differential Development of Facial and Hind Paw Allodynia in a Nitroglycerin-Induced Mouse Model of Chronic Migraine: Role of Capsaicin Sensitive Primary Afferents

“…Modalities of cephalic and extracephalic cutaneous allodynia were also different, extracephalic cutaneous allodynia being mostly thermal whereas cephalic cutaneous allodynia was mostly mechanical. 26) These findings including our current study suggest that peripheral hypersensitivities in patients with migraine may differ based on the physical location and the stimulus modality, and these cephalic and extracephalic cutaneous hypersensitivities involved different mechanisms.…”

“…28) In the clinical study, Guy et al reported that among 67 episodic migraine patients, 73% patients cited one or more allodynic symptoms during or immediately after the migraine attack. 26) These patients reported cephalic cutaneous allodynia, whereas 24 patients also reported extracephalic cutaneous allodynia. Modalities of cephalic and extracephalic cutaneous allodynia were also different, extracephalic cutaneous allodynia being mostly thermal whereas cephalic cutaneous allodynia was mostly mechanical.…”

“…25) In clinical observations of migraine patients, skin hypersensitivity occurs in trigeminal, as well as extracephalic sites. [26][27][28] We utilized a mouse migraine model to measure pain hypersensitivity in both the hind paw and facial region. Our results indicate that NTG induces hypersensitivities to different pain modalities, and that the hypersensitivities vary depending on the site of measurement (hind paw versus face).…”