Experimentally induced spinal nociceptive sensitization increases with migraine frequency: a single-blind controlled study. Issue 2 (February 2020)

• Record Type: Journal Article
• Authors: De Icco, Roberto; Perrotta, Armando; Grillo, Valentina; Cosentino, Giuseppe; Sances, Grazia; Sandrini, Giorgio; Tassorelli, Cristina
• Is Part Of: Pain. Volume 161:Issue 2(2020)
• Publication Date: 2020-02
• Subjects: Headache -- Migraine -- Migraine frequency -- Temporal summation threshold -- Nociceptive withdrawal reflex -- Central sensitization -- Nitroglycerin; Pain -- Periodicals; Douleur -- Périodiques; Anesthésie -- Périodiques; Pain; Electronic journals; Periodicals; Electronic journals; 616.0472
• DOI: 10.1097/j.pain.0000000000001726
• Languages: English
• ISSNs: 0304-3959

Abstract

Abstract : Abstract: The nitric-oxide donor nitroglycerin (NTG) administration induces a facilitation of nociceptive pathways in episodic migraine. This study aims to test the hypothesis that induced spinal sensitization could be more pronounced in patients affected by high-frequency migraine (HF-MIG) with respect to low-frequency migraine (LF-MIG). We enrolled 28 patients with LF-MIG (1-5 migraine days/month), 19 patients with HF-MIG (6-14 migraine days/month), and 21 healthy controls (HCs). Spinal sensitization was evaluated with the neurophysiological recording of the temporal summation threshold (TST) of the nociceptive withdrawal reflex at the lower limb. Temporal summation threshold was recorded at baseline and 30, 60, and 120 minutes after NTG administration (0.9 mg sublingual). Spinal sensitization was detected in LF-MIG at 60 ( P = 0.010) and 120 minutes ( P = 0.001) and in HF-MIG at 30 ( P = 0.008), 60 ( P = 0.001), and 120 minutes ( P = 0.001) after NTG administration. Temporal summation threshold did not change in HC ( P = 0.899). Moreover, TST reduction was more pronounced in HF-MIG with respect to LF-MIG ( P = 0.002). The percentage of patients who developed a migraine-like headache after NTG was comparable in the 2 migraine groups (LF-MIG: 53.6%, HF-MIG: 52.6%, P = 0.284), whereas no subjects in the HC group developed a delayed-specific headache. Notably, the latency of headache onset was significantly shorter in the HF-MIG group when compared with the LF-MIG group ( P = 0.015). Our data demonstrate a direct relationship between migraine frequency and both neurophysiological and clinical parameters, to suggest an increasing derangement of the nociceptive system control as the disease progresses, probably as a result of the interaction of genetic and environmental factors. Abstract : The comparison of low-frequency migraine with high-frequency migraine after nitroglycerin administration shows progression in the degree of derangement of spinal nociception processing.