Abstract：
We aimed to assess the differences in quantitative sensory testing between chronic migraine and healthy controls and to explore the association between pain sensitivities and outcomes in chronic migraine following preventive treatment.
In this prospective open-label study, preventive-naïve chronic migraine and healthy controls were recruited, and cold, heat, mechanical punctate, and pressure pain thresholds over the dermatomes of first branch of trigeminal nerve and first thoracic nerve were measured by quantitative sensory testing at baseline. Chronic migraines were treated with flunarizine and treatment response was defined as ≥50% reduction in the number of monthly headache days over the 12-week treatment period.
Eighty-four chronic migraines and fifty age-and-sex-matched healthy controls were included in the analysis. The chronic migraine had higher cold pain thresholds over the dermatomes of the first branch of trigeminal nerve and the first thoracic nerve (p < 0.001 and < 0.001), lower pressure pain thresholds over the dermatomes of the first thoracic nerve (p = 0.003), heat pain thresholds over the dermatomes of the first branch of the trigeminal nerve and the first thoracic nerve (p < 0.001 and p = 0.015) than healthy controls. After treatment, 24/84 chronic migraine had treatment response. The responders with relatively normal pain sensitivity had higher heat pain thresholds over the dermatome of the first branch of the trigeminal nerve (p = 0.002), mechanical punctate pain thresholds over the dermatomes of the first branch of the trigeminal nerve (p = 0.023), and pressure pain thresholds over the dermatomes of the first branch of the trigeminal nerve (p = 0.026) than the hypersensitive non-responders. Decision tree analysis showed that patients with mechanical punctate pain threshold over the dermatomes of the first branch of the trigeminal nerve > 158 g (p = 0.020) or heat pain threshold over the dermatome of the first branch of the trigeminal nerve > 44.9°C (p = 0.002) were more likely to be responders.
Chronic migraine were generally more sensitive compared to healthy controls. Preventive treatment with flunarizine should be recommended particularly for chronic migraine who have relatively normal sensitivity to mechanical punctate or heat pain.Trial registration: This study was registered on ClinicalTrials.gov (Identifier: NCT02747940).
In this prospective open-label study, preventive-naïve chronic migraine and healthy controls were recruited, and cold, heat, mechanical punctate, and pressure pain thresholds over the dermatomes of first branch of trigeminal nerve and first thoracic nerve were measured by quantitative sensory testing at baseline. Chronic migraines were treated with flunarizine and treatment response was defined as ≥50% reduction in the number of monthly headache days over the 12-week treatment period.
Eighty-four chronic migraines and fifty age-and-sex-matched healthy controls were included in the analysis. The chronic migraine had higher cold pain thresholds over the dermatomes of the first branch of trigeminal nerve and the first thoracic nerve (p < 0.001 and < 0.001), lower pressure pain thresholds over the dermatomes of the first thoracic nerve (p = 0.003), heat pain thresholds over the dermatomes of the first branch of the trigeminal nerve and the first thoracic nerve (p < 0.001 and p = 0.015) than healthy controls. After treatment, 24/84 chronic migraine had treatment response. The responders with relatively normal pain sensitivity had higher heat pain thresholds over the dermatome of the first branch of the trigeminal nerve (p = 0.002), mechanical punctate pain thresholds over the dermatomes of the first branch of the trigeminal nerve (p = 0.023), and pressure pain thresholds over the dermatomes of the first branch of the trigeminal nerve (p = 0.026) than the hypersensitive non-responders. Decision tree analysis showed that patients with mechanical punctate pain threshold over the dermatomes of the first branch of the trigeminal nerve > 158 g (p = 0.020) or heat pain threshold over the dermatome of the first branch of the trigeminal nerve > 44.9°C (p = 0.002) were more likely to be responders.
Chronic migraine were generally more sensitive compared to healthy controls. Preventive treatment with flunarizine should be recommended particularly for chronic migraine who have relatively normal sensitivity to mechanical punctate or heat pain.Trial registration: This study was registered on ClinicalTrials.gov (Identifier: NCT02747940).
摘要：
我们旨在评估慢性偏头痛和健康对照组之间定量感觉测试的差异，并探讨疼痛敏感性与慢性偏头痛预防性治疗后结局之间的关系。
在这项前瞻性开放标签研究中，招募了预防性初治慢性偏头痛和健康对照，寒冷,热,机械点状,在基线时通过定量感觉测试测量三叉神经第一分支和第一胸神经皮区的压力疼痛阈值。使用氟桂利嗪治疗慢性偏头痛，治疗反应定义为在12周治疗期内每月头痛天数减少≥50％。
分析中包括84例慢性偏头痛和50例年龄和性别匹配的健康对照。慢性偏头痛的冷痛阈值高于三叉神经第一分支和第一胸神经的皮区（p<0.001和<0.001），较低的压力疼痛阈值超过第一胸神经的皮区（p=0.003），与健康对照组相比，三叉神经第一分支和第一胸神经的皮组的热痛阈值（p<0.001和p=0.015）。治疗后,24/84慢性偏头痛有治疗反应。疼痛敏感性相对正常的反应者在三叉神经第一分支的皮区有较高的热痛阈值（p=0.002），三叉神经第一分支皮区的机械性点状疼痛阈值（p=0.023），三叉神经第一分支皮区的压力疼痛阈值（p=0.026）高于超敏无应答者。决策树分析表明，三叉神经第一分支皮段机械性点状痛阈值>158g(p=0.020)或三叉神经第一分支皮段热痛阈值>44.9℃(p=0.002)的患者更有可能成为反应者。
与健康对照组相比，慢性偏头痛通常更敏感。应建议使用氟桂利嗪进行预防性治疗，特别是对于对机械性点状或热痛具有相对正常敏感性的慢性偏头痛。试验注册：本研究在ClinicalTrials.gov上注册（标识符：NCT02747940）。
在这项前瞻性开放标签研究中，招募了预防性初治慢性偏头痛和健康对照，寒冷,热,机械点状,在基线时通过定量感觉测试测量三叉神经第一分支和第一胸神经皮区的压力疼痛阈值。使用氟桂利嗪治疗慢性偏头痛，治疗反应定义为在12周治疗期内每月头痛天数减少≥50％。
分析中包括84例慢性偏头痛和50例年龄和性别匹配的健康对照。慢性偏头痛的冷痛阈值高于三叉神经第一分支和第一胸神经的皮区（p<0.001和<0.001），较低的压力疼痛阈值超过第一胸神经的皮区（p=0.003），与健康对照组相比，三叉神经第一分支和第一胸神经的皮组的热痛阈值（p<0.001和p=0.015）。治疗后,24/84慢性偏头痛有治疗反应。疼痛敏感性相对正常的反应者在三叉神经第一分支的皮区有较高的热痛阈值（p=0.002），三叉神经第一分支皮区的机械性点状疼痛阈值（p=0.023），三叉神经第一分支皮区的压力疼痛阈值（p=0.026）高于超敏无应答者。决策树分析表明，三叉神经第一分支皮段机械性点状痛阈值>158g(p=0.020)或三叉神经第一分支皮段热痛阈值>44.9℃(p=0.002)的患者更有可能成为反应者。
与健康对照组相比，慢性偏头痛通常更敏感。应建议使用氟桂利嗪进行预防性治疗，特别是对于对机械性点状或热痛具有相对正常敏感性的慢性偏头痛。试验注册：本研究在ClinicalTrials.gov上注册（标识符：NCT02747940）。
