Defeating migraine pain with triptans: A race against the development of cutaneous allodynia
Defeating migraine pain with triptans: A race against the development of cutaneous allodynia
复制标题
DOI：
10.1002/ana.10786
复制
发表时间：
2004-01-01
影响因子：
11.2
通讯作者：
Jakubowski, M
中科院分区：
文献类型：
--
作者：
Burstein, R;Collins, B;Jakubowski, M
对于许多偏头痛患者，曲坦类药物治疗在某些发作中提供完全的疼痛缓解，但在其他发作中不能。在这里，我们测试了曲坦类药物治疗的成功是否在皮肤异常性疼痛（对正常皮肤的无害刺激引起的疼痛）的存在下受到阻碍，我们先前描述的一种现象在70%以上的患者的偏头痛发作过程中逐渐发展。我们对偏头痛患者进行了三次重复研究：在没有偏头痛的情况下（基线），在一次发作的第一个小时内，或在另一次发作后4小时内。基于偏头痛和基线对眶周皮肤的机械和热刺激的疼痛阈值之间的差异来确定是否存在异常性疼痛。在31例患者中，我们研究了34例在曲坦治疗时与异常性疼痛相关的偏头痛发作和27例与异常性疼痛无关的发作。在曲坦治疗2小时内，34例异常性疼痛发作中有5例（15%）患者疼痛消失，而27例非异常性疼痛发作中有25例（93%）患者疼痛消失。在疼痛发作后1小时（早期）或4小时（晚期）治疗偏头痛发作，在异常性疼痛的情况下诱导无痛状态同样无效，在无异常性疼痛的情况下同样有效。对于在发作期间易发生异常性疼痛的患者，如果在皮肤异常性疼痛建立之前而不是之后给予曲坦治疗，则更有可能提供完全的疼痛缓解。从未发生过异常性疼痛的患者在疼痛发作后的任何时候都很可能通过曲坦治疗而消除疼痛。我们的结论是，一致的无痛结果的概率大幅增加，如果曲坦治疗是警惕定时之前的任何迹象皮肤异常性疼痛。
For many migraine patients, triptan therapy provides complete pain relief in some attacks but not in others. Here, we tested whether the success of triptan therapy is hindered in the presence of cutaneous allodynia (pain resulting from a nonnoxious stimulus to normal skin), a phenomenon we previously described develop gradually during the course of the migraine attack in more than 70% of patients. We studied migraine patients repeatedly on three visits to the dinic: in the absence of migraine (baseline), within the first hour of one attack, or at 4 hours from onset of another attack. Presence or absence of allodynia was determined based on differences between migraine and baseline pain thresholds to mechanical and thermal stimulation of periorbital skin. In 31 patients, we studied 34 migraine attacks that were associated with allodynia at the time of triptan treatment and 27 attacks that were not. Within 2 hours of triptan treatment, patients were rendered pain-free in 5 of 34 (15%) of allodynic attacks versus 25 of 27 (93%) of nonallodynic attacks. Treating migraine attacks I hour (early) or 4 hours (late) after the onset of pain was equally ineffective in inducing a pain-free state in the presence of allodynia, and equally effective in the absence of allodynia. For patients susceptible to allodynia during the attack, triptan therapy was by far more likely to provide complete pain relief if administered before rather than after the establishment of cutaneous allodynia. Patients who never developed allodynia were highly likely to be rendered pain-free by triptan therapy anytime after the onset of pain. We conclude that the probability of consistent pain-free outcome increases drastically if triptan therapy is vigilantly timed to precede any signs of cutaneous allodynia.