|
|
| |
Central Sensitization and
Cutaneous Allodynia Implication on Migraine Treatment |
|
|
BY MAURY BREECHER
Contributing Writer |
SCOTTSDALE, ARIZ. (ECCC)—
Whether a patient shows signs of cutaneous allodynia—a painful
feeling on the skin or scalp during a migraine attack—is a
predictor of whether that patient can become migraine pain-free
with triptan treatment, said Dr. Rami Burstein on February 18
during a Headache Research Summit presented by the Diamond
Headache Clinic Research and Educational Foundation.
“The logical approach to triptan treatment of migraine pain is
to sort out the non-responders from the responders,” said Dr.
Burstein, an associate professor in the Harvard Medical School
Program of Neuroscience at Beth Israel Deaconess Medical Center.
He explained that migraine patients can be divided into three
categories: those who take triptans and become pain-free, those
who take triptans but don’t become pain-free, and a subgroup of
those who sometimes become pain-free and sometimes don’t.
“Today we know that patients who become pain-free are those
patients who don’t exhibit any signs of cutaneous allodynia,”
said Dr. Burstein. “Triptans do not provide pain relief for
patients exhibiting cutaneous allodynia between migraine
attacks.”
Non-allodynic patients can take triptans at any time during the
migraine and expect relief.
Dr. Burstein reported that he uses a questionnaire to identify
patients with cutaneous allodynia. Patients are diagnosed with
the condition if they respond “yes” to experiencing “pain or
unpleasant sensations on the skin” when they engage in
activities, such as combing hair, facial shaving, wearing
contact lenses, and wearing tight clothes.
Good news for these patients, however, is that COX1/COX2
inhibitors will work to stop migraine when triptans fail, Dr.
Burstein said.
Furthermore, delayed sumatriptan injection combined with a
ketorolac infusion can also end migraine pain in allodynic
patients. There is an exception to those positive findings,
however. Patients who had previously been given opioids for the
treatment of migraine did not respond, during later migraine
attacks, to ketorolac.
According to the 1998 Nationwide Hospital Ambulatory Medical
Care Survey of 811,401 migraine patients who visited the
emergency department for relief of migraine, 51% (411,350
patients) were treated with opioids, such as meperidine,
nalbuphine, butophanol, or morphine (Ann Emerg Med.
2002;39:215-222).
“Even more alarming is that 77% of the 411,350 who received
opioids did not receive any non-opioid abortive medication prior
to the opioid therapy,” said Dr. Burstein.
“We believe it is imperative that migraine patients arriving in
the emergency department for help, particularly those with no
prior exposure to opioids, be treated with parenteral COX1/COX2
inhibitors, not with opioids,” he concluded.
|
| Copyright 2008 Elsevier Custom Conference Coverage. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed. All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without the prior written permission of the copyright owner. No responsibility is assumed by the Publisher for any injury and/or damage to persons or property as a matter of products liability, through negligence or otherwise, or from any use or operation of any methods, products, instructions, or ideas contained in the material herein. Because of rapid advances in the medical sciences, the Publisher recommends that independent verification of diagnoses and drug dosages should be made. Opinions expressed in this publication are those of the original authors and do not necessarily reflect those of the Publisher, the sponsor, or the editors. Elsevier assumes no liability for any material published herein. |
|
