Central Sensitization Theory of Migraine: Clinical Implications

Mayo Clinic, Scottsdale, AZ 85255, USA.
Headache The Journal of Head and Face Pain (Impact Factor: 2.71). 12/2006; 46 Suppl 4(s4):S182-91. DOI: 10.1111/j.1526-4610.2006.00602.x
Source: PubMed


The clinical science of migraine headache continues to evolve. Theories of the pathophysiology of migraine have progressed from the early vascular basis of migraine to more complex current theories that emphasize the centrality of neuronal dysfunction. The most recently articulated theory of migraine is the central sensitization hypothesis, which proposes that altered processing of sensory input in the brainstem, principally the trigeminal nucleus caudalis, could account for many of the temporal and symptomatic features of migraine, as well as its poor response to triptan therapy when such treatment is initiated hours after the onset of pain. Both preclinical and clinical data support the central sensitization theory. A critical clinical implication of this theory is that drugs that are capable of either aborting or arresting the process of central sensitization, most prominently dihydroergotamine, may have a unique role in the treatment of migraine. An additional, and highly practical, implication is based upon the finding that cutaneous allodynia-pain arising from innocuous stimulation of the skin, as in hair brushing or the application of cosmetics-is an easily identifiable marker of central sensitization. Thus, the presence or absence of cutaneous allodynia can be integrated into the routine clinical assessment of migraine and utilized as a determinant of treatment. Future basic and clinical research on central sensitization is likely to be of ongoing importance to the field.

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    • "Early appropriate conservative management [50] is also important given the emerging role for central sensitisation [51-57] and the autonomic nervous system (ANS) in COFP [58]. Reducing the peripheral afferent barrage at the earliest opportunity and down regulating any dysfunctional ANS as soon as possible through early diagnosis, reassurance, and management will also all hopefully reduce the chance of central neuroplastic changes, “central sensitisation” [51,59]. Reducing the potential for central sensitisation, or up regulation of the ANS, occurring may then help improve the success of (simpler) therapies, reduce treatment times, and improve prognosis by reducing the potential for the condition becoming chronic. "
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    ABSTRACT: Pain affecting the face or mouth and lasting longer than three months ("chronic orofacial pain", COFP) is relatively common in the UK. This study aims to describe and model current care pathways for COFP patients, identify areas where current pathways could be modified, and model whether these changes would improve outcomes for patients and use resources more efficiently.Methods/design: The study takes a prospective operations research approach. A cohort of primary and secondary care COFP patients (n = 240) will be recruited at differing stages of their care in order to follow and analyse their journey through care. The cohort will be followed for two years with data collected at baseline 6, 12, 18, and 24 months on: 1) experiences of the care pathway and its impacts; 2) quality of life; 3) pain; 4) use of health services and costs incurred; 5) illness perceptions. Qualitative in-depth interviews will be used to collect data on patient experiences from a purposive sub-sample of the total cohort (n = 30) at baseline, 12 and 24 months. Four separate appraisal groups (public, patient, clincian, service manager/commissioning) will then be given data from the pathway analysis and asked to determine their priority areas for change. The proposals from appraisal groups will inform an economic modelling exercise. Findings from the economic modelling will be presented as incremental costs, Quality Adjusted Life Years (QALYs), and the incremental cost per QALY gained. At the end of the modelling a series of recommendations for service change will be available for implementation or further trial if necessary. The recent white paper on health and the report from the NHS Forum identified chronic conditions as priority areas and whilst technology can improve outcomes, so can simple, appropriate and well-defined clinical care pathways. Understanding the opportunity cost related to care pathways benefits the wider NHS. This research develops a method to help design efficient systems built around one condition (COFP), but the principles should be applicable to a wide range of other chronic and long-term conditions.
    BMC Oral Health 01/2014; 14(1):6. DOI:10.1186/1472-6831-14-6 · 1.13 Impact Factor
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    • "Then, discontinue it gradually after 75% reduction in frequency and intensity of attacks [1] [2] [15]. This improvement is observed through a headache diary [16]. If there is recurrence, treatment will be extended for as long as necessary, considering the limitations of each medication [1]. "
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    ABSTRACT: To determine the minimum duration of migraine prophylaxis, after patients become pain-free. Migraine patients diagnosed according to criteria of International Classification of Headache Disorders-2 were treated prophylactically. After becoming pain-free, they were divided into two equal groups: in group 1, prophylaxis was maintained for another 12months and in group 2, for 24months. Each group was followed for more three years after prophylaxis period. Of the 50 patients, 39 (78%) were female and 11 (22%) were male. The age ranged from 18 to 50years. Before treatment, the attack frequency for groups 1 and 2 was, respectively, 16.3±12.8 and 16.4±11.8days per month (p=0.769). Patients in groups 1 and 2 have become pain-free, respectively, with 21.4±11.2 and 16.8±9.9months (p=0.161). During three years without treatment, groups 1 and 2 maintained an annual frequency of respectively 3.2 and 0.5 headache days. Of the patients in group 2, 76.0% (19/25) remained pain-free during follow-up, versus 44.0% (11/25) of group 1, with a significant difference (p=0.001). The best results were obtained when migraine prophylaxis was maintained for 24months after patients became pain-free.
    Journal of the neurological sciences 11/2013; 337(1-2). DOI:10.1016/j.jns.2013.11.013 · 2.47 Impact Factor
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    • "Reduction of stress levels can significantly improve the patient's pain threshold, their maladaptive behavioral responses and autonomic balance. [12] [14] [17] [35] [36] [66] [67] [68] Transcutaneous Electrical Nerve Stimulation TENS is commonly employed in chronic pain states. Its effectiveness is related to activation of polysegmental inhibitory feedback, and additional elements of CS. "
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    ABSTRACT: Chronic clinical pain associated with CS, is a potentially progressive, devastating, multimodal disease with a significant worldwide economic and social burden. Effective intervention is dependent upon recognizing the fundamental differences in acute and chronic pain, the effects on and by the neuromatrix upon the biopsychosocial health of the indi-vidual patient, and integrating that knowledge into a comprehensive multidisciplinary therapeutic plan.
    12/2012; 1(1). DOI:10.5923/j.cmd.20110101.01
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