Department of Neurology Faculty Papers
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Identifying cutaneous allodynia in chronic migraine using a practical clinical method
Avi Ashkenazi, Thomas Jefferson University
Melissa Sholtzow, Thomas Jefferson University
Rami Burstein, Beth Israel Deaconess Medical Center and Harvard University
James W. Shaw, Thomas Jefferson University
William B. Young, Thomas Jefferson University
DOCUMENT TYPE: Article
Embargoed until February 2008. This article has been peer reviewed. It is the authors' final version prior to publication in Cephalalgia 27(2):111-117, February 2007. The published version is available at http://dx.doi.org/10.1111/j.1468-2982.2006.01255.x . Copyright (c) by Blackwell Publishing Inc.
Background: Cutaneous allodynia is common in migraine. Since the presence of allodynia during an acute migraine attack is associated with poor response to triptans, a clinically practical method to test migraine patients for allodynia would be useful to the clinician.
Objective: To assess the prevalence of dynamic mechanical (brush) allodynia in chronic migraine, using a clinically practical method.
Methods: Eighty-nine chronic migraine patients were prospectively recruited. Patients were given a structured questionnaire regarding migraine characteristics and skin sensitivity. Allodynia testing was performed by lightly brushing a 4x4-inch gauze pad on various areas of the skin. The prevalence of brush allodynia in the entire study population and in different patient sub-groups was calculated.
Results: Brush allodynia was present in 38 of 89 patients (42.7% of the entire study population). The presence of allodynia was unrelated to the occurrence of an acute migraine attack at the time of testing. Allodynia was positively associated with a history of migraine aura (p=0.03). It was most common in the cephalic area, but it was also often seen in cervical dermatomes. The intensity of allodynia was positively correlated with the intensity of headache pain at the time of testing (p=0.048). However, the laterality of allodynia was unrelated to that of the headache pain.
Conclusion: Allodynia is common in chronic migraine patients and is not significantly affected by the occurrence of an acute migraine attack. This suggests a state of ongoing neuronal sensitization in chronic migraine. We present a clinically practical method of testing migraine patients for cutaneous allodynia that may help physicians identify and make appropriate treatment decisions for allodynic migraine patients in a clinical setting.