Dynamic mechanical (brush) allodynia in cluster headache: a prevalence study in a tertiary headache clinic

Abstract

Cutaneous allodynia (CA) has been described in migraine and has been related to treatment failure. There are little data about the incidence of CA in other primary headache syndromes such as cluster headache (CH). The objectives of this study are to evaluate the prevalence of dynamic mechanical (brush) allodynia (BA) in CH patients attending a tertiary headache clinic, and to assess its relation to disease characteristics. Adult patients with episodic or chronic CH were recruited. We obtained demographic data and data on disease characteristics through a structured questionnaire, and tested the patients for brush allodynia BA by applying a 4 × 4 gauze pad over the V1, C2/C3 and C8 skin areas bilaterally. The prevalence of allodynia in the entire study population and in the different sub-groups was calculated. We also examined the association between CA and demographic parameters, and its association with disease characteristics. Forty-one patients were recruited (22 men, 19 women; mean age 44.9 years). Twenty-two had chronic CH (CCH) and 19 had episodic CH (ECH). Mean disease duration was 14.1 years (12.3 the CCH group and 15.7 in the ECH group). Overall, 20 (49%) patients were allodynic. There was no statistically significant association between the presence of allodynia and age, gender, diagnosis (episodic vs. chronic CH), disease duration or disease severity. In conclusion, BA was common in this CH patient sample. The therapeutic implications of the presence of BA in CH need to be further studied.

Bilateral Widespread Mechanical Pain Hypersensitivity as Sign of Central Sensitization in Patients With Cluster Headache

“…The main finding of the current study was a bilateral and widespread pressure hypersensitivity in patients with CH as compared with healthy controls, which suggest the presence of central sensitization. Our results agree with previous studies suggesting that mechanical hyperalgesia and allodynia are manifestations of central sensitization in CH 3‐6,9,10 …”

Differences in clinical characteristics and frequency of accompanying migraine features in episodic and chronic cluster headache

“…In our patient cohort, allodynia was reported more frequently in CH patients with comorbid migraine. There was no difference between eCH and cCH in occurrence of allodynia, which confirms the data of Marmura et al (16). Allodynia was detected with a testing for brush allodynia in 40-49% of CH patients (16,17).…”

“…There was no difference between eCH and cCH in occurrence of allodynia, which confirms the data of Marmura et al (16). Allodynia was detected with a testing for brush allodynia in 40-49% of CH patients (16,17). Allodynia might be a clinical feature of peripheral or central sensitization.…”

Dynamic Mechanical Allodynia—One Clinical Sign, Several Mechanisms: Five Illustrative Cases

“…Several clinical conditions are characterized by far‐field DMA, and it is well known that diseases involving deep tissues can generate DMA . A common example of this type of DMA is headache, particularly migraine and cluster headache …”