allodynia

23 June 2012

Pain During Migraine: Not Just in Your Head

James Discoveries & Stats, Website news 2

Our latest poll asked this question: Other than your head, where else do you sometimes/always experience pain during a migraine attack? (choose as many as apply)

The results were not surprising, but they do reinforce what a complex disease migraine really is. Here are the stats, with some comments.

During I migraine attack, I also have pain here:

Neck (83%): The question with all of these is – does the pain come from the migraine attack, or is there a related cause. Or, for example, does the cause of neck pain also trigger the migraine attack? There’s no doubt that neck pain (and neck stiffness) come along with migraine. For more on neck pain, read Methods that are Really Fighting Neck Pain and Get rid of neck pain!
Face (60%): Facial pain is very common in migraineurs. In fact, in rare cases facial pain is the main pain in a migraine attack. Sometimes, migraine is mistaken for sinusitis because of the pain in the sinus area. See Migraine: Does your face hurt?
Stomach (37%): Another very common issue in migraine, and again, stomach pain (abdominal pain) may be the main symptom in your attack. This is especially common in children. Read about abdominal migraine here.
Back (32%): Back pain is another prime suspect when it comes to migraine triggers. Could pain and tense muscles trigger (not cause) an attack? Also, could your body’s reaction to migraine pain cause back pain? I think the answer to both could be yes. Read Dissolving tension.
Arms (22%): This was an interesting response that I hadn’t given much thought to. But I do know that migraine can cause pain from head to toe – been there, done that. But why is arms so high on the list? What are your experiences with this?
Skin (19%): Sensitive and painful skin is very common in migraine. The technical term is cutaneous allodynia, and it commonly strikes on the scalp and arms. Combing your hair or wearing a shirt can be very painful. Read My Hair Hurts! Migraine and Allodynia
Other (16%): As I said, head to toe. And I could say inside to outside.

These were the most common answers. However, visitors also included hands (14%), legs (12%), chest (12%), fingers/toes (12%), feet (8%), and finally pelvis (6%).

I’ve taken to saying that migraine attacks can cause pain all over the body – and they really can. It’s time to bust the myth that migraine is a bad headache. Oh yes, migraine often brings on bad headaches – really bad – but that’s not all.

Be sure to take our new poll on migraine triggers!

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.

25 May 2009

Allodynia: A feature of Cluster as well as Migraine?

James Discoveries & Stats 0

A symptom known as allodynia may be an important feature of cluster headaches, research from the Jefferson Headache Center in Philadelphia, USA is telling us.

Over the last few years, allodynia has actually been a hot topic in migraine circles. How prevalent is it, and can it be used to show how successful a treatment will be?

No joke – with allodynia, even brushing your hair can be a very painful task!

Like about 2/3 of migraineurs, I suffer from this extreme sensitivity and pain when the skin is touch during certain phases of attacks. It probably comes from the hypersensitivity in the brain during a typical attack.

Researchers wanted to get an initial idea how many cluster headache sufferers deal with allodynia. They measured 41 patients for dynamic mechanical allodynia (also called brush allodynia – pain or sensitivity when the skin is "brushed"), and discovered that about 49% of the patients had the symptom.

There was no great difference between age, gender, or even chronic or episodic cluster headache, or how long patients had had cluster.

This may be a real indication that allodynia is a major feature of cluster, and like migraine it may give us clues about what is happening during a cluster attack, and how it can be better treated. It also helps us understand what cluster patients deal with beyond the incredible pain.

(A similar study with similar results was done with migraineurs in 2007 – see Identifying Cutaneous Allodynia in Chronic Migraine Using a Practical Clinical Method).

More on the May 2009 study at Dynamic mechanical (brush) allodynia in cluster headache: a prevalence study in a tertiary headache clinic.

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.