| Objectives:Migraine is a common chornic neurovascular disorder that affects 12% of the general population and is characterized by intense head pain that can be accompanied by nausea and sensitivity to light (photophobia) and sound (phonophobia). It affects around 18% of women and 7% of menfrom infancy throughout adulthood,and causes severe disability and work loss in a significant proportion of the population during the mostproductive time of the life.The rate of cutaneous allodynia in migraine was very high.A growing body of evidence suggests that migraine patients are mostly non-allodynic during the first years of their migraine experience, and are eventually destined to develop allodynia during their migraine attacks.cutaneous allodynia(CA) is likely to represent a clinical correlation to the central sensitization.It has been claimed that the presence of allodynia can be a predictor of chronification of migraine.CA has significant implications for understanding of the pathophysiology of migraine attacks, for the implementation of treatment, and for assessing prognosis.Migraine patients with cutaneous allodynia were more often females, had lower age at onset, longer disease duration, higher migraine attack frequency, used prophylactic agents more often, and had more lifetime depression.CA can be measured by Quantitative sensory testing (QST)or Allodynia Symptom Checklist(ASC).The course of QST is very complex,the testers must be trainede for the test. So it is difficult to be applied to outpatient clinic.The method of ASC is simple and practicable,but it can’t quantize the pain threshold.Prophylactic treatment of migraine should be mandatory for patients with frequent headaches. To prevent allodynia, thereby protecting migraine patients from chronification.But only about 3%-13% of migraineur currently received migraine-specific preventive care.Most of the prophylactic antimigraine drugs have been evaluated for their effect on the reduction of frequency and severity of headache. There is little report on the effect of prophylactic therapy on cutaneous allodynia that is central sensitization in patients with migraine.(1)The gender,age,frequency of headache,and duration of migraine,severity of headache between migraine with cautaeuous allodyia and without were compared,In order to conclude the clinical characteristics and the risk factors of CA in migraine.(2) The migraine patients were divided into treatment with Topiramate and Flunarizine groups, The effect of durgs were evaluated through the change of CPT between these groups, and the variation of CA was investigated in order to find the role of classic prophylactic therapy in migraine-related allodynia,which is central sensitization.Methods:1.Subjects:A total of 71 patients with migraine admitted to our headache clinic from June,2013 to June,2013 was recruited. All subjects were outpatients that were selected in Shandong provincial hospital.because of the damage of the experimental apparatus,we can’t determine the pain threshold of 16 patients,the other 55 patients were determined for the pain threshold.we record the data regarding the patients’ name,gender,age, age of onset of migraine, frequency, duration.The headache severity was measured by the Visual Analogue Scale (VAS):mild (0-3), moderate (4-6), or severe (7-10). The patients with cutaneous allodynia were determined with Allodynia Symptom Checklist (ASC) questionnaire, containing 12 questions.The total score was calculated, and patients were identifid as having no allodynia (scores of 0-2), mild (3-5), moderate (6-8), or severe (≥ 9) allodynia.The inclusion criteria were as follows:(1) patients were diagnosed as having migraine with or without aura, chronic migraine,according to the criteria of The International Classifiation of Headache Disorders (2nd edition) (ICHD-Ⅱ1.1, 1.2,1.5.1);(2) patients were aged between 12 and 65 years old; (3) males or females;(4) durg treatments of acute stage had less effect or no effect before;(5)no history of head injury,no positive symptoms according to the nervous system examination were observed. Brain CT or MRI image is normal;(6)All the patients signed informed consent.2.Methods:The patients were randomly allocated to two groups, one group with topiramate(25 to 200 mg daily),the other with flunarizine(5 to 10 mg daily). There was no statistical difference in the gender,age between two groups.The total treating course reached nine months,follow-up visits per three months.we recorded the therapeutic effects and side effects.Pressure allodynia were measuredwithFORCE ONETM DIX DIGITAL FORCE GAGE(WAGNER,USA), and pricking was measured with Electronic Von Frey Anesthesiometer(IITC INC./Life Science,USA) for measuring. They were applied on the bilateral four aeras with average growth rate of force (0.1kg/s),random order for interval of 3 s each aera.repeatd for three times,After stop pressure or prick, the patientswere asked when the touch became a painful or very uncomfortable sting.The average pain threshold of three times measurements was considerd for cautaneous pain threshold(CPT). CPT was measured per three months, The changes of pain threshold of before and after therapy were recorded and compared.Results:The median age of all subjects was 18 to 62y(37±13)years old, of which,76.1% were females,70.4% patients had allodynia, thermal allodynia was more common (61.2%) than dynamic mechanical (22.4%) or static mechanical (16.3%) allodynia.Female gender,the duration of illness, frequency of migraine attacks per month were significantly associated with allodynia.The rate of cautenous allodynia,the frequency of headache,the number of patients with allodynia declined significantly at 3(P<0.05) and 6 months (P<0.05)after the topiramate and flunarizinetreatment, the pain thresholds have been improved obviously,CA that is central sensitizationhad apparently improved, which manifested as a reduction in threshold. The effects of therapy had not significantly differencebetweentopiramate and flunarizine group(P<0.05). The composite side effects of topiramate and flunarizine were low and non very serious were found, there were also no statistical difference between these groups.Conclusions:1.Female gender,the duration of illness, frequency of migraine attacks per month were significantly associated with allodynia, allodynia was present especially in females who had frequent migraine attacks for long duration.Gender,duration of illness and number of migraine attacks per month were the best predictors of allodynia.2. Allodynia Symptom Checklist (ASC) questionnaire can be reliably be applied to measurement of allodynia.3. Oral drugs of topiramate and flunarizine in patients with migraine in a short treatment time can effectively improve the patients’ pain threshold,which can effectivelyrelieving allodynia,improve the central sensitization,they have definite therapeutic effects.No statistically significant differences between the two kinds of drugs.The side effects of topiramate and flunarizine were low and not very serious side effects were found,they can be used safely. |
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