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Randomized Controlled Trial
. 2023 Aug 30;24(1):118.
doi: 10.1186/s10194-023-01651-9.

Cutaneous allodynia as predictor for treatment response in chronic migraine: a cohort study

Judith A Pijpers  1 , Dennis A Kies  1   2 , Erik W van Zwet  3 , Irene de Boer #  1 , Gisela M Terwindt #  4
Affiliations
Randomized Controlled Trial

Cutaneous allodynia as predictor for treatment response in chronic migraine: a cohort study

Judith A Pijpers et al. J Headache Pain. .

Abstract

Background: Central sensitisation is an important mechanism in migraine chronification. It is presumed to occur in second and third order neurons sequentially, resulting in an analogous spatial distribution of cutaneous allodynia with cephalic and extracephalic symptoms. We investigated whether allodynia, and its subtypes based on spatial distribution and type of stimulus, predict response to treatment in chronic migraine patients.

Methods: This study was conducted as part of the CHARM study (NTR3440), a randomized, double-blind, placebo-controlled trial in chronic migraine patients with medication overuse. We included 173 patients. The presence of cutaneous allodynia at baseline was established with the Allodynia Symptom Checklist. Primary endpoint was reversion from chronic to episodic migraine.

Results: Of all patients, 74.6% reported cutaneous allodynia. Absence of allodynia compared to presence of allodynia was predictive for reversion from chronic to episodic migraine, odds ratio (OR): 2.45 (95% CI: 1.03-5.84), p = 0.042. The predictive value was more pronounced when subdivided for spatial distribution, for participants without allodynia versus cephalic (OR: 4.16 (95% CI: 1.21-14.30), p = 0.024) and extracephalic (OR: 7.32 (95% CI: 1.98- 27.11), p = 0.003) allodynia. Mechanical, but not thermal, allodynia, was associated with outcome.

Conclusions: Cutaneous allodynia, an important marker for central sensitization, likely has predictive value for treatment response in chronic migraine.

Keywords: Allodynia; Biomarker; Central sensitization; Chronic migraine; Medication overuse.

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Conflict of interest statement

IdB reports independent support from the Dutch heart foundation. GMT reports consultancy support from Novartis, Allergan/Abbvie, Lilly, Teva, and Lundbeck and independent support from Dutch Organization for Scientific Research, the Dutch Heart & Brain Foundations, IRRF and Dioraphte. The other authors report no relevant conflicts of interest.

Figures

Fig. 1
Fig. 1
Flowchart study population. *All patients started withdrawal treatment from acute migraine mediation. Half of the patients were additionally treated with botulinum toxin A injections prior to start withdrawal in a randomized blinded fashion
Fig. 2
Fig. 2
Odds ratio for reversion from chronic to episodic migraine of no allodynia compared to different subtypes of allodynia. * p < 0.05; ** p < 0.01
See this image and copyright information in PMC

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