cutaneous allodynia

10 November 2016

When Taking a Shower Hurts: Migraine and Depression

Taking a shower can be pretty painful for some people during a migraine attack. And I’m not necessarily referring to migraine pain. I’m talking about allodynia.

When taking a shower HURTS! Allodynia – in this case, cutaneous allodynia, is a strange discomfort and/or pain on the skin, for no normal reason. The slightest touch can cause this pain – wearing jewellery, even standing outside on a windy day – or taking a shower.

It’s a fairly common symptom of migraine, affecting about 2/3 of us, and more common in women (although I have had the dubious pleasure myself).

Sometimes, allodynia is a warning sign, coming before the headache phase of the migraine attack. Repeated episodes of allodynia may also signal a future worsening of migraine, from episodic to chronic.

Researchers in Korea studied 332 patients to find out what other issues may be comorbid with allodynia – what did patients with allodynia have in common?

They found that fewer Korean patients seemed to suffer from allodynia than expected, but there was still a large enough group to draw some tentative conclusions.

As with previous studies, they confirmed that the symptom was most common in women. But they also found that allodynia frequently went along with major depressive disorder. Chronic migraine was also present in many patients, as well as sensitivity to light.

Depression continues to be a tricky thing to understand when it comes to migraine. Although certainly migraine symptoms may make you depressed, there seems to be something else going on that makes the depression worse than expected in some people. The commonality of allodynia and depression may give us further clues into the connection.

As we continue to study, be sure to mention as many symptoms as you can to your doctor. Depression, allodynia, and other symptoms and conditions may help her treat you better. Although some medications may better help patients with allodynia, it’s important to treat migraine – and depression – as a whole, in order to get rid of this possibly disabling symptom.

For more on cutaneous allodynia, check out My Hair Hurts! Migraine and Allodynia.

Also see the study abstract here: Cutaneous Allodynia and Its Risk Factors in Korean Patients with Migraine: A Survey of Two Tertiary Care Hospitals. Another in-depth article on allodynia: Cutaneous Allodynia in the Migraine Population

5 March 2015

Migraine Scalp Tenderness – Should I be worried?

James Information, Tips 0

You’ve suffered from other migraine symptoms – maybe headache, or visual aura, nausea – but what about migraine scalp tenderness? Is it a sign of something more serious?

When your migraine symptoms change, or become much worse, you should see a doctor as soon as possible. In the case of migraine scalp tenderness, it’s not likely to be something serious, but it could indicate a change – and you may need to change to a treatment which will be more helpful.

The most common reason for a tender scalp for a migraine patient will be cutaneous allodynia. Even brushing your hair may be painful. Although most common on the scalp, allodynia may also affect your arms, or other parts of your body.
Migraine Scalp Tenderness?
For a migraine patient, the symptoms are temporary (they generally come and go with migraine attacks). They often come early in the migraine attack, before the headache strikes (if it does).

Some doctors may recommend a change in treatment if you have allodynia. It’s a controversial topic, but it may be worth investigating with your doctor.

However, scalp tenderness can be a sign of other conditions, such as giant cell arteritis (GCA). GCA will likely cause headache as well. If your headache just isn’t going away, see your doctor right away. GCA can lead to permanent tissue damage and even blindness.

Various skin disorders can also lead to tenderness or pain which comes and goes. Chemicals that are bothering your skin, shingles, and infections. It could also be a sign that the medications you’re taking are causing problems.

Although migraine scalp tenderness may not be a serious change in your symptoms, it could still indicate a change in treatment. But if your symptoms change, or the tenderness and/or headache isn’t going away, it’s another sign that you need to talk to a doctor or specialist.

9 January 2012

New Clues about Medication Overuse Headache and Opioids

James Medications 7

In the video below, researcher Dr. Julie Wieseler discusses new research into the opioid medications.

Opioids include medications such as codeine and meperidine (Demerol). They’re common when it comes to migraine treatment, but they’re also highly suspect when it comes to Medication Overuse Headache (MOH). Meaning – taking them for migraine symptoms can temporarily help, but make symptoms worse later on. (Actually, most medications can do this – but opioids seem to be among the more likely)

Researchers have noticed that taking opioid medications can make symptoms of cutaneous allodynia worse – but why?

The investigation began to see why exactly this migraine treatment was causing more symptoms in the long run. Their results, discussed in the video below, may help researchers find better treatments, or use opioids more safely, or find ways to prioritize treatments that are less likely to cause MOH.

Find out more about this new research here: Why Opioids Enhance Migraine Pain: The Puzzle Points to Glia

19 September 2009

My Hair Hurts! Migraine and Allodynia

James Information, Medications 28

Like about 2/3 of migraineurs, allodynia is one of the wonderful symptoms that comes along with many of my migraine attacks. It’s always uncomfortable, and usually painful, and believe it or not most people have never heard of it.

Allodynia. Migraineurs often suffer from cutaneous allodynia – that is, sensitivity and/or pain when the skin is touched. Most common in women, it often comes during the headache stage of a migraine attack (if there is a headache at all), but for many people it comes before, and is a kind of "warning signal". The skin becomes so sensitive, that it may feel like your "hair hurts". Running a comb through your hair can be excruciating.

Though allodynia on the scalp is the most commonly known, some people (like me) get sensitivity on other parts of the skin – such as the arms. If you wear jewelry, it might become impossible during an attack. Just wearing a shirt can cause a great deal of pain – that’s right, just the brushing of a sleeve against your skin. Standing near a stove, even standing in the wind, can be a real problem.

Muscle tenderness could also be a related symptom, especially in the head and neck.

Studies are showing us how allodynia fits into a migraine attack. It’s believed that the hypersensitivity is a part of the migraine chain reaction, where neurons become sensitized. A vicious cycle of hypersensitivity and pain is a main feature of the migraine reaction in the brain.

Though for some the symptom is brief and not worth comparing to other symptoms (like headache or nausea), for others it can be very debilitating. It also may be that people with allodynia are at risk for worsening migraine – where you start having attacks more and more often. So what about treatment?

Treating Migraine with Allodynia

We’re still waiting for research on many of the new medications that are being used for migraine. It’s been suggested that one of the older (and now less frequently used) medications, may help with allodynia in some patients. That is dihydroergotamine (DHE).

Another class of drugs that might help is a cyclooxygenase inhibitor, a type of anti-inflammatory drug. There have been concerns about Cox2 inhibitors and their link to heart problems. However, if your symptoms are severe you may want to give one a try after talking to your doctor.

Some studies have suggested that triptan drugs (like Imitrex) don’t work well in the presence of allodynia. Today, this is being questioned.

Probably your best bet is to treat migraine as a whole, and if you’re taking abortive medication take it as soon as you feel the migraine attack starting. Generally speaking, if you find a treatment that fights your migraine attacks, you should also find your allodynia decreasing.

There is one thing that can make allodynia worse – and that is opioid drugs, such as codeine and meperidine (Demerol). In most cases these are better avoided in migraine treatment, but allodynia may give you another reason to look for other options.

Allodynia and Migraine – Summary

Pain on your skin, especially the scalp and arms, is very common in migraine. It’s not your imagination! It’s actually an important feature of migraine that is teaching us more about what happens in the brain during an attack.

As you treat your migraine disease, pay attention to increasing or decreasing allodynia, and discuss it with your doctor. You may be able to find better treatment options, using allodynia as another clue.

26 April 2008

Migraine and Sensitive Skin

James Discoveries & Stats 0

It’s not really news that a lot of migraineurs suffer from "sensitive skin" – otherwise known as cutaneous allodynia. I deal with allodynia myself.

The news is just how widespread the problem is. A massive study of 16,573 people showed us some interesting facts about cutaneous allodynia (CA). In short, 2/3 of people with migraine may deal with the problem. Actually, even over a third of those with chronic daily headache and tension type headache have had CA. But it was much much more common in those with migraine.

Those with frequent attacks of migraine were more likely to have sensitive skin, and women were also more often sufferers.

Allodynia most often occurs on the scalp or arms of the migraineur. Putting on jewelry, brushing your hair, or even standing near a hot stove can be a painful experience. Even feeling the sleeves of your shirt brush on your arms can be painful. This effect may have something to do with the hypersensitivity in the brain of someone having a migraine attack.

Usually this symptom starts after the headache portion of the migraine is well underway (if there is a headache). Many doctors recommend that taking an abortive (such as a triptan) before this stage is very important – otherwise the treatment will be less successful.

You can read more about allodynia here, and an overview of the study Prevalence and characteristics of allodynia in headache sufferers.