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Enhanced Trigemino-Cervical-Spinal Reflex Recovery Cycle in Pain-Free Migraineurs


  • Mariano Serrao MD, PhD,

  • Armando Perrotta MD,

  • Michelangelo Bartolo MD,

  • Giancarlo Fiermonte MD,

  • Flavia Pauri MD,

  • Paolo Rossi MD, PhD,

  • Leoluca Parisi MD,

  • Francesco Pierelli MD

  • From the Department of Neurology and Otolaryngology, University of Rome, Rome, Italy (Drs. Serrao, Bartolo, Fiermonte, Pauri, Parisi, Perrota); IRCCS, Neuromed, Pozzilli (IS), Italy (Dr. Pierelli); and INI, Headache Clinic, Grottaferrata, Rome, Italy (Dr. Rossi).

Address all correspondence to Dr. Mariano Serrao, Department of Neurology and Otolaryngology, University “La Sapienza,” Rome, Italy, Viale dell'Università 30, 00185, Rome, Italy.


Objective.—To evaluate trigemino-cervical-spinal reflexes (TCSRs) in a group of migraine patients during the pain-free period.

Background.—TCRSs are part of a complex nocifensive response involving the cervical and the upper limb muscles, and are modulated by supraspinal inhibitory pathways; it may, thus, be possible to use TCRSs to explore the trigeminal system in migraineurs.

Methods.—A total of 43 migraine patients without aura (MWoA, 32 patients) or with typical aura (MWA, 11 patients) and 30 age- and sex-matched healthy subjects took part in the study. TCRSs were obtained by stimulating the supraorbital nerve and recorded from the semispinalis capitis muscle and the biceps brachii. The latency (L, msec), area (A, mVms) and recovery cycle of the reflexes were recorded. The effects of heterotopic painful stimulation on the neurophysiological parameters were studied by a validated cold pressor test (CPT).

Results.—No significant changes were found between either migraine patients and controls or MWoA and MWA patients in the mean values in the L and A of TCRSs (t-test, P > .05). The recovery curve of the trigemino-cervical reflexes (TCRs) was significantly faster in migraine patients than in controls, while no differences were found in the trigemino-spinal reflexes (TSRs) (t-test, P < .01). Activation of the diffuse inhibitory controls through the CPT induced a significant reduction in the TCRs and TSRs area in both migraine patients and controls (paired t-test, P < .01), though the extent of this reduction did not differ significantly between migraineurs and controls (t-test, P > .05).

Comments.—Our data suggest that the pain-free period in migraine patients is characterized by a hyperexcitability of the trigeminal pathways and of their anatomical and functional connections with the upper cervical cord neurons, and that this abnormal hyperexcitability does not appear to be due to a lack of a supraspinal inhibitory modulation.