Objective: The authors estimated the prevalence and severity of cutaneous allodynia (CA) in individuals with primary headaches from the general population.
Methods:We mailed questionnaires to a random sample of 24,000 headache sufferers previously identified from the population. The questionnaire included the validated Allodynia Symptom Checklist (ASC) as well as measures of headache features, disability, and comorbidities. We modeled allodynia as an outcome using headache diagnosis, frequency and severity of headaches, and disability as predictor variables in logistic regression. Covariates included demographic variables, comorbidities, use of preventive medication, and use of opioids.Results: Complete surveys were returned by 16,573 individuals. The prevalence of CA of any severity (ASC score ≥3) varied with headache type. Prevalence was significantly higher in transformed migraine (TM, 68.3%) than in episodic migraine (63.2%, p < 0.01) and significantly elevated in both of these groups compared with probable migraine (42.6%), other chronic daily headaches (36.8%), and severe episodic tension-type headache (36.7%). The prevalence of severe CA (ASC score ≥9) was also highest in TM (28.5%) followed by migraine (20.4%), probable migraine (12.3%), other chronic daily headaches (6.2%), and severe episodic tension-type headache (5.1%). In the migraine and TM groups, prevalence of CA was higher in women and increased with disability score. Among migraineurs, CA increased with headache frequency and body mass index. In all groups, ASC scores were higher in individuals with major depression.
Conclusions:Cutaneous allodynia (CA) is more common and more severe in transformed migraine and migraine than in other primary headaches. Among migraineurs, CA is associated with female sex, headache frequency, increased body mass index, disability, and depression.Central sensitization, an increased excitability of spinal and medullary dorsal horn neurons resulting from ongoing input from C-fiber nociceptors, may lead to cutaneous allodynia (CA), a neurologic condition characterized by pain elicited by ordinary nonnociceptive stimulation of the skin. 1,2 During migraine, facial CA is likely to be a clinical manifestation of sensitization at the level of the trigeminal nucleus caudalis. 3,4 In clinic-based studies, most migraineurs develop CA during the course of an attack. 5-8 In migraine, CA has been proposed as a predictor of poor response to triptan therapy 8 as well as a risk factor for disease progression. 9Address correspondence and reprint requests to Dr. Marcelo E. Bigal, Global Director, Scientific Affairs, Neuroscience, One Merck Drive, P.O. Box 100, Whitehouse Station, NJ 08889-0100 Marcelo_Bigal@merck.com. * Members of the AMPP Advisory Group are listed in the appendix. Here, we used the ASC-12 to assess the prevalence and severity of CA in subjects with various types of primary headaches in the general population. Because CA has been recently suggested as a risk factor for migraine progression, we hypothesized ...