Get access

Identifying cutaneous allodynia in chronic migraine using a practical clinical method

Authors

  • A Ashkenazi,

    Corresponding author
    1. Department of Neurology, Thomas Jefferson University and Jefferson Headache Center, Jefferson University Hospital, Philadelphia, PA and
      Avi Ashkenazi MD, Department of Neurology, Jefferson Headache Center, Jefferson University Hospital, 111 South 11th Street, Suite 8130, Philadelphia, PA 19107, USA. E-mail avi.ashkenazi@jefferson.edu
    Search for more papers by this author
  • M Sholtzow,

    1. Department of Neurology, Thomas Jefferson University and Jefferson Headache Center, Jefferson University Hospital, Philadelphia, PA and
    Search for more papers by this author
  • JW Shaw,

    1. Department of Neurology, Thomas Jefferson University and Jefferson Headache Center, Jefferson University Hospital, Philadelphia, PA and
    Search for more papers by this author
  • R Burstein,

    1. Department of Anesthesia and Critical Care, Beth Israel Deaconess Medical Center and Program in Neuroscience, Harvard Medical School, Boston, MA, USA
    Search for more papers by this author
  • WB Young

    1. Department of Neurology, Thomas Jefferson University and Jefferson Headache Center, Jefferson University Hospital, Philadelphia, PA and
    Search for more papers by this author

Avi Ashkenazi MD, Department of Neurology, Jefferson Headache Center, Jefferson University Hospital, 111 South 11th Street, Suite 8130, Philadelphia, PA 19107, USA. E-mail avi.ashkenazi@jefferson.edu

Abstract

Cutaneous allodynia is common in migraine. In the majority of previous studies on allodynia in migraine, only patients with episodic migraine (EM) were included. Little is known on patterns of allodynia in chronic migraine (CM). Since the presence of allodynia is associated with a poor response to triptans, a clinically practical method to test migraine patients for allodynia would be useful to the clinician. The aim of this study was to assess the prevalence of dynamic mechanical (brush) allodynia (BA) in CM, using a clinically practical method. Eighty-nine CM patients were prospectively recruited. Patients were given a structured questionnaire regarding demographic data and migraine characteristics. Allodynia was tested using a 10 × 10-cm gauze pad to brush various areas of the skin lightly. The prevalence of BA in the entire study population and in different patient subgroups was calculated. BA was present in 42.7% (38/89) of the patients. The presence of allodynia was unrelated to age, disease duration or to the occurrence of an acute headache exacerbation at the time of testing. Allodynia was positively associated with a history of migraine aura. BA was most common in the cephalic area, but was also seen in cervical dermatomes. BA is common in CM and, unlike in EM, is not significantly affected by the occurrence of an acute headache exacerbation. This suggests that central trigeminovascular neurons are chronically sensitized in patients experiencing migraine headache >15 days per month. The testing of BA in the clinical setting is possible using a simple and brief approach. It allows the clinician to determine whether the patient is sensitized, a diagnosis that affects treatment decisions.

Get access to the full text of this article

Ancillary