Article

Central Sensitization Theory of Migraine: Clinical Implications

Thomas Jefferson University Hospitals, Filadelfia, Pennsylvania, United States
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

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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    • "Therefore, it can play the role of NSAIDs such as Naproxen and Ibuprofen without their adverse GI effects. 3. Neuroinflammation of the meningeal and dural trigeminal nociceptors leads to peripheral sensitization [37]. Chamomile is traditionally used for inflammation, pain, neuralgia, etc [44]. "
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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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    • "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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