Source: DGNews  |  Posted 8 years ago

By Larry Schuster

ROME, ITALY -- September 22, 2003 -- Allodynia, often ignored or misunderstood by physicians, may be present in more than 50% of migraine patients.

This finding, which may have serious management implications for physicians, was presented here September 15th at the 11th Congress of the International Headache Society.

"The average neurologist doesn't know about allodynia. People's complaints [about allodynia] are ignored," said Ninan T. Mathew, MD, DM, director, Houston Headache Clinic, Texas, United States. "I used to think [patients complaining of allodynia] were crazy."

In a study of 295 randomly selected migraine patients, however, Dr. Mathew found that 53% of patients had allodynia, which manifested itself in pain and discomfort associated with hair and putting on make-up.

Dr. Mathew said that one woman complained about her "heavy hair" due to the hypersensitivity. "She had to cut off her hair, because the weight of her hair was bothering her," he said.

In the study, 45% of participants had cephalic allodynia, 18% had both cephalic and extracephalic allodynia, and 8.5% had only extracephalic allodynia.

Scalp symptoms included sensitivity to touch in 61 cases; soreness or tenderness in 52 cases; tingling in 32 cases; difficulty brushing, combing or washing hair in 30 cases; difficulty resting the allodynic side of the head in 15 cases; feeling hot or burning in 9 cases; parasthesis involving face, cheeks, lips or neck in 16 cases, and itchy scalp in 2 cases.

Scalp allodynia persisted for hours or days in 29 patients. Upper-limb allodynia occurred in 72 cases, compared with 6 cases affecting toes. Bilateral headache was associated with unilateral limb allodynia in 18 of 42 cases, and unilateral headache was associated with ipsilateral limb allodynia in 21 out of 36 cases, and bilateral in the others.

Management implications of the presence of allodynia in migraine attacks have begun to emerge. Another paper presented at the IHC meeting by Rami Burstein, MD, Harvard Medical School and Beth Israel Deaconess Hospital, Boston, Massachusetts, United States, reported that allodynia in migraine patients greatly reduced the efficacy of triptan agents if the treatment was delayed beyond 1 hour of attack onset.

"Patients with allodynia, Dr. Mathew said, need to be counseled to start treatment at the first sign of migraine to maximize the treatment's benefits." While physicians may have been advising patients to treat early, new research provides additional support for early treatment by allodynic patients, and provides greater urgency for physicians to identify these patients.

Dr. Mathew said he now asks migraine patients such questions as whether their scalp or hair bother them.

[Study title: Allodynia in Migraine. Abstract P3H7]