Habituation to Pain in “Medication Overuse Headache”: A CO2 Laser-Evoked Potential Study

Authors

  • Diana Ferraro MD,

    1. From the Department of Neurosciences, Catholic University, Rome, Italy (D. Ferraro, D. Virdis, C. Pazzaglia, and G. Di Trapani); Headache Centre, Neurology Division, Pediatric Hospital “Bambino Gesù” IRCCS, Rome, Italy (C. Vollono, R. Miliucci, S. Tarantino, M. Balestri, and M. Valeriani); IRCCS San Raffaele Pisana, Tosinvest Sanità, Rome, Italy (L. De Armas and D. Le Pera); Centre for Sensory-Motor Interaction, Aalborg University, Aalborg, Denmark (M. Valeriani); Department of Neurosciences, University of Modena and Reggio Emilia, Modena, Italy (D. Ferraro).
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  • Catello Vollono MD, PhD,

    1. From the Department of Neurosciences, Catholic University, Rome, Italy (D. Ferraro, D. Virdis, C. Pazzaglia, and G. Di Trapani); Headache Centre, Neurology Division, Pediatric Hospital “Bambino Gesù” IRCCS, Rome, Italy (C. Vollono, R. Miliucci, S. Tarantino, M. Balestri, and M. Valeriani); IRCCS San Raffaele Pisana, Tosinvest Sanità, Rome, Italy (L. De Armas and D. Le Pera); Centre for Sensory-Motor Interaction, Aalborg University, Aalborg, Denmark (M. Valeriani); Department of Neurosciences, University of Modena and Reggio Emilia, Modena, Italy (D. Ferraro).
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  • Roberto Miliucci MSc,

    1. From the Department of Neurosciences, Catholic University, Rome, Italy (D. Ferraro, D. Virdis, C. Pazzaglia, and G. Di Trapani); Headache Centre, Neurology Division, Pediatric Hospital “Bambino Gesù” IRCCS, Rome, Italy (C. Vollono, R. Miliucci, S. Tarantino, M. Balestri, and M. Valeriani); IRCCS San Raffaele Pisana, Tosinvest Sanità, Rome, Italy (L. De Armas and D. Le Pera); Centre for Sensory-Motor Interaction, Aalborg University, Aalborg, Denmark (M. Valeriani); Department of Neurosciences, University of Modena and Reggio Emilia, Modena, Italy (D. Ferraro).
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  • Daniela Virdis MSc,

    1. From the Department of Neurosciences, Catholic University, Rome, Italy (D. Ferraro, D. Virdis, C. Pazzaglia, and G. Di Trapani); Headache Centre, Neurology Division, Pediatric Hospital “Bambino Gesù” IRCCS, Rome, Italy (C. Vollono, R. Miliucci, S. Tarantino, M. Balestri, and M. Valeriani); IRCCS San Raffaele Pisana, Tosinvest Sanità, Rome, Italy (L. De Armas and D. Le Pera); Centre for Sensory-Motor Interaction, Aalborg University, Aalborg, Denmark (M. Valeriani); Department of Neurosciences, University of Modena and Reggio Emilia, Modena, Italy (D. Ferraro).
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  • Liala De Armas MD,

    1. From the Department of Neurosciences, Catholic University, Rome, Italy (D. Ferraro, D. Virdis, C. Pazzaglia, and G. Di Trapani); Headache Centre, Neurology Division, Pediatric Hospital “Bambino Gesù” IRCCS, Rome, Italy (C. Vollono, R. Miliucci, S. Tarantino, M. Balestri, and M. Valeriani); IRCCS San Raffaele Pisana, Tosinvest Sanità, Rome, Italy (L. De Armas and D. Le Pera); Centre for Sensory-Motor Interaction, Aalborg University, Aalborg, Denmark (M. Valeriani); Department of Neurosciences, University of Modena and Reggio Emilia, Modena, Italy (D. Ferraro).
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  • Costanza Pazzaglia MD, PhD,

    1. From the Department of Neurosciences, Catholic University, Rome, Italy (D. Ferraro, D. Virdis, C. Pazzaglia, and G. Di Trapani); Headache Centre, Neurology Division, Pediatric Hospital “Bambino Gesù” IRCCS, Rome, Italy (C. Vollono, R. Miliucci, S. Tarantino, M. Balestri, and M. Valeriani); IRCCS San Raffaele Pisana, Tosinvest Sanità, Rome, Italy (L. De Armas and D. Le Pera); Centre for Sensory-Motor Interaction, Aalborg University, Aalborg, Denmark (M. Valeriani); Department of Neurosciences, University of Modena and Reggio Emilia, Modena, Italy (D. Ferraro).
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  • Domenica Le Pera MD, PhD,

    1. From the Department of Neurosciences, Catholic University, Rome, Italy (D. Ferraro, D. Virdis, C. Pazzaglia, and G. Di Trapani); Headache Centre, Neurology Division, Pediatric Hospital “Bambino Gesù” IRCCS, Rome, Italy (C. Vollono, R. Miliucci, S. Tarantino, M. Balestri, and M. Valeriani); IRCCS San Raffaele Pisana, Tosinvest Sanità, Rome, Italy (L. De Armas and D. Le Pera); Centre for Sensory-Motor Interaction, Aalborg University, Aalborg, Denmark (M. Valeriani); Department of Neurosciences, University of Modena and Reggio Emilia, Modena, Italy (D. Ferraro).
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  • Samuela Tarantino Psy,

    1. From the Department of Neurosciences, Catholic University, Rome, Italy (D. Ferraro, D. Virdis, C. Pazzaglia, and G. Di Trapani); Headache Centre, Neurology Division, Pediatric Hospital “Bambino Gesù” IRCCS, Rome, Italy (C. Vollono, R. Miliucci, S. Tarantino, M. Balestri, and M. Valeriani); IRCCS San Raffaele Pisana, Tosinvest Sanità, Rome, Italy (L. De Armas and D. Le Pera); Centre for Sensory-Motor Interaction, Aalborg University, Aalborg, Denmark (M. Valeriani); Department of Neurosciences, University of Modena and Reggio Emilia, Modena, Italy (D. Ferraro).
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  • Martina Balestri MD,

    1. From the Department of Neurosciences, Catholic University, Rome, Italy (D. Ferraro, D. Virdis, C. Pazzaglia, and G. Di Trapani); Headache Centre, Neurology Division, Pediatric Hospital “Bambino Gesù” IRCCS, Rome, Italy (C. Vollono, R. Miliucci, S. Tarantino, M. Balestri, and M. Valeriani); IRCCS San Raffaele Pisana, Tosinvest Sanità, Rome, Italy (L. De Armas and D. Le Pera); Centre for Sensory-Motor Interaction, Aalborg University, Aalborg, Denmark (M. Valeriani); Department of Neurosciences, University of Modena and Reggio Emilia, Modena, Italy (D. Ferraro).
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  • Girolamo Di Trapani MD,

    1. From the Department of Neurosciences, Catholic University, Rome, Italy (D. Ferraro, D. Virdis, C. Pazzaglia, and G. Di Trapani); Headache Centre, Neurology Division, Pediatric Hospital “Bambino Gesù” IRCCS, Rome, Italy (C. Vollono, R. Miliucci, S. Tarantino, M. Balestri, and M. Valeriani); IRCCS San Raffaele Pisana, Tosinvest Sanità, Rome, Italy (L. De Armas and D. Le Pera); Centre for Sensory-Motor Interaction, Aalborg University, Aalborg, Denmark (M. Valeriani); Department of Neurosciences, University of Modena and Reggio Emilia, Modena, Italy (D. Ferraro).
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  • Massimiliano Valeriani MD, PhD

    Corresponding author
    1. From the Department of Neurosciences, Catholic University, Rome, Italy (D. Ferraro, D. Virdis, C. Pazzaglia, and G. Di Trapani); Headache Centre, Neurology Division, Pediatric Hospital “Bambino Gesù” IRCCS, Rome, Italy (C. Vollono, R. Miliucci, S. Tarantino, M. Balestri, and M. Valeriani); IRCCS San Raffaele Pisana, Tosinvest Sanità, Rome, Italy (L. De Armas and D. Le Pera); Centre for Sensory-Motor Interaction, Aalborg University, Aalborg, Denmark (M. Valeriani); Department of Neurosciences, University of Modena and Reggio Emilia, Modena, Italy (D. Ferraro).
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  • Conflict of Interest: The authors report no conflict of interest.

  • Financial support: None.

M. Valeriani, Neurology Division, Pediatric Hospital “Bambino Gesù” IRCCS, Piazza Sant'Onofrio 4, 00165 Rome, Italy, email: m.valeriani@tiscali.it

Abstract

(Headache 2012;52:792-807)

Objective.— Our aim was to investigate CO2 laser-evoked potential (LEP) habituation to experimental pain in a group of patients affected by medication-overuse headache, with a history of episodic migraine becoming chronic, before and after treatment, consisting in acute medication withdrawal and a preventive treatment cycle.

Background.— One of the main features of LEPs in migraineurs is a lower habituation to repetitive noxious stimuli during the interictal phase.

Methods.— LEPs were recorded to stimulation of both the right hand and the right perioral region in 14 patients and in 14 healthy subjects. The habituation of both the N1 and the vertex N2/P2 components was assessed by measuring the LEP amplitude changes across 3 consecutive repetitions of 30 trials each.

Results.— In the 8 patients who had clinically improved after treatment, the N2/P2 amplitude habituation was significantly higher after treatment than before treatment following both hand (F = 43.2, P < .0001) and face stimulation (F = 6.9, P = .01). In these patients, the N2/P2 amplitude habituation after treatment was not different from that obtained in healthy controls (P = .18 and P = .73 for hand and face stimulation, respectively). On the contrary, in the patients who did not improve, the N2/P2 amplitude still showed reduced habituation after both hand (F = 3.1, P = .08) and face (F = 0.7, P = .4) stimulation.

Conclusion.— The deficient habituation of the vertex N2/P2 complex was partly restored after successful treatment of medication-overuse headache, reflecting a modification in pain-processing pathways.

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