Department of Neurology

Department of Neurology Faculty Papers

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Improved identification of allodynic migraine patients using a questionnaire

Avi Ashkenazi, Thomas Jefferson University
Stephen D. Silberstein, Thomas Jefferson University
Moshe Jakubowski, Beth Israel Deaconess Medical Center
Rami Burstein, Beth Israel Deaconess Medical Center and Harvard University


Embargoed until April 2008. This article has been peer reviewed. It is the authors' final version prior to publication in Cephalalgia 27(4):325-329, April 2007. The published version is available at Copyright (c) by Blackwell Publishing Inc.


The occurrence of "scalp tenderness" during migraine was first described in 1832 (Liveing 1873) and then documented in greater detail during the 1950s-60s (Selby and Lance 1960; Wolff et al. 1953) and the 1980s (Blau 1987; Drummond 1987; Jensen 1993; Jensen et al. 1988; Jensen et al. 1993; Lous and Olesen 1982; Tfelt-Hansen et al. 1981; Waelkens 1985). Using quantitative sensory testing (QST), we found that many migraineurs exhibit decreased pain thresholds to thermal and mechanical stimulation of the skin during a migraine attack, a phenomenon we referred to as cutaneous allodynia (Burstein et al. 2000). Since the termination of migraine attacks that are associated with cutaneous allodynia requires early triptan treatment (within 20 min of attack onset) (Burstein et al. 2004), it is critical to determine whether or not the patient is allodynic during the attack.

Notwithstanding the scientific merits of QST, it is a rather impractical, cost-ineffective tool to be used routinely as it involves repeated 2-h testing in the doctor’s office: once when the patient is free of migraine, and again during a migraine attack (Burstein et al. 2004; Burstein et al. 2000). In search for an alternative simple method for identifying allodynic migraine patients (Ashkenazi and Young, The effects of greater occipital nerve block and trigger point injection on brush allodynia and pain in migraine. Headache 2005;45:350-354, LoPinto et al. Cephalalgia 2006), we developed a questionnaire and tested its validity against QST. Used interictally, the questionnaire correctly identified 76% of the patients as allodynic or non-allodynic compared to QST performed during and between migraine attacks (Jakubowski et al. 2005).

In this study we compared the incidence of markers of allodynia, as recollected interictally by the patients in the clinic, to the patients’ own observation of allodynia during an actual migraine attack at home (4 h after the onset of headache).