Central sensitization theory of migraine: clinical implications.
ABSTRACT 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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ABSTRACT: JUSTIFICATIVA E OBJETIVOS: De acordo com a Classificação Internacional das Cefaleias, a cefaleia pós-traumática é caracterizada por dor de intensidade variável, máxima na área do trauma, que se inicia em até sete dias após a lesão. O objetivo deste estudo foi relatar o caso de cefaleia pós-traumática crônica, secundária à lesão por arma de fogo. A dor era desencadeada pela palpação de pontos de gatilho em cicatriz. RELATO DO CASO: Paciente do sexo masculino, 31 anos, sofreu lesão por arma de fogo na região cervical esquerda, desenvolvendo cefaleia refratária, com área máxima em região de cicatriz. Observou-se ponto de gatilho nessa região. Foi proposto tratamento com bloqueio periférico com excelente resposta. CONCLUSÃO: Sugere-se que a formação de neuromas em áreas de cicatriz possa estar envolvida com a fisiopatologia da cefaleia pós-traumática.Revista Dor. 06/2011; 12(2):191-193.
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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.Clinical Medicine and Diagnostics. 12/2012; 1(1).
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ABSTRACT: Cephalic allodynia (CA) can be observed in 50-70% of patients with chronic migraine (CM). The aim of this trial was to assess the efficacy of botulinum toxin type A (Botx-A) in the treatment of CA associated with CM. In this placebo-controlled trial, patients were randomized either into Botx-A or 0.9% saline injections and efficacy measures were assessed every 4 weeks for 3 months. Efficacy endpoints were number of migraine episodes associated with CA, changes from baseline in visual analogical scale scores for pain (VAS) and frequency of common analgesics use for migraine. A total of 38 subjects were randomized to saline (n=18) or Botx-A (n=20). There were no significant differences in baseline between active intervention or placebo groups regarding mean age, number of headache episodes [mean 12.1 (9.22) and 17.00 (9.69) respectively; P=0.12], pain severity as measured by the VAS or frequency of analgesic use for headache episodes. Efficacy analysis showed that Botx-A injections led to an important decrease from baseline in the mean migraine episodes associated with CA after 12 weeks (5.20 versus 11.17; P=0.01). Also, VAS scores and frequency of analgesics use for headache were significantly reduced in the Botx-A group. This study suggests that Botx-A injections are superior to saline in the treatment of CA associated with CM, with mild self limited side effects.Neurology International 10/2014; 6(4):5133.