Comparison of dynamic (brush) and static (pressure) mechanical allodynia in migraine
Comparison of dynamic (brush) and static (pressure) mechanical allodynia in migraine
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DOI：
10.1111/j.1468-2982.2006.01121.x
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发表时间：
2006-07-01
期刊：
影响因子：
4.9
通讯作者：
Ashkenazi, A.
中科院分区：
文献类型：
--
作者：
LoPinto, C.;Young, W. B.;Ashkenazi, A.
异位性疼痛已被描述为偏头痛，但尚未对不同的感觉模式进行充分的研究。本研究的目的是比较偏头痛患者中动态（刷）和静态（压）机械异位痛的患病率，并提出一种在临床环境中测试它们的实用方法。国际头痛学会定义的发作性偏头痛（EM）或西尔伯斯坦和利普顿定义的转化性偏头痛（TM）患者从杰斐逊头痛中心门诊前瞻性招募。对偏头痛的特征和异常性疼痛的症状进行问卷调查。用纱布垫皮肤刺激法检测毛刷异常性痛（BA），用von Frey毛发（VFH）检测压力异常性痛（PA）。计算所有患者和不同亚组中BA和PA的患病率，并将其与偏头痛特征相关联。我们招募了55名偏头痛患者。25例EM， 30例TM。BA 18例（32.7%），PA 18 ~ 24例（32.7 ~ 43.6%）。13-17例（23.6-30.9%）患者出现刷压异常痛。如果患者只有一种形态的异常性疼痛，则更有可能是PA而不是BA。BA和PA在TM患者中比EM患者更常见[BA 46.7% vs. 16.0%；PA（中厚VFHs差异显著）分别为50% vs. 20%和50% vs. 12%]。与无先兆偏头痛患者相比，有先兆偏头痛患者中这两种类型的异常性痛也更常见（BA 57.1% vs. 17.6%; PA 57.1-61.9% vs. 17.6-32.7%）。BA和PA的异常性疼痛评分（通过检查获得）与异常性疼痛指数（通过病史获得）呈正相关。BA和PA之间的不完全重叠虽然相当大，但表明对不同感觉模式的异常性疼痛与不同神经元群的敏化有关。由于PA比BA更常见，它可能是偏头痛异常性疼痛的一个更敏感的指标。PA可以在临床上以实用和系统的方式进行检测。
Allodynia has been described in migraine but has not been fully investigated for the different sensory modalities. The aim of this study was to compare the prevalence of dynamic (brush) and static (pressure) mechanical allodynia in migraine patients and to suggest a practical method of testing them in a clinical setting. Patients with International Headache Society-defined episodic migraine (EM) or with transformed migraine (TM) as defined by Silberstein and Lipton were prospectively recruited from the Jefferson Headache Center out-patient clinic. A questionnaire of migraine features and symptoms of allodynia was administered. Brush allodynia (BA) was tested by cutaneous stimulation with a gauze pad and pressure allodynia (PA) was tested using von Frey hairs (VFH). The prevalence of BA and PA in all patients and in the different subgroups was calculated and correlated with migraine features. We recruited 55 migraine patients. Twenty-five had EM and 30 had TM. BA was present in 18 (32.7%) patients and PA in 18-24 (32.7-43.6%). Allodynia to both brush and pressure was found in 13-17 (23.6-30.9%) patients. If a patient had allodynia to one modality only, it was more likely to be PA than BA. Both BA and PA were more common in patients with TM compared with those with EM [BA 46.7% vs. 16.0%; PA (differences significant for the medium and thick VFHs) 50% vs. 20% and 50% vs. 12%, respectively]. Both types of allodynia were also more common in patients with migraine with aura compared with those with migraine without aura (BA 57.1% vs. 17.6%; PA 57.1-61.9% vs. 17.6-32.7%). There was a positive correlation between allodynia score (as obtained by examination) and allodynia index (as obtained by history) for both BA and PA. The incomplete, although considerable, overlap between BA and PA suggests that allodynia to different sensory modalities is associated with sensitization of different neuronal populations. Because PA was more common than BA, it may be a more sensitive indicator of allodynia in migraine. PA can be tested clinically in a practical and systematic manner.