Acute migraine headache: possible sensitization of neurons in the spinal trigeminal nucleus?
OBJECTIVE
To investigate trigeminal sensory processing in patients with migraine using a novel "nociception-specific" blink reflex.


METHODS
Seventeen patients with unilateral migraine headache were studied within 6 hours of onset. Blink reflexes were elicited with a standard stimulating electrode (standard blink reflex) and concentric stimulating electrode (nociception-specific blink reflex) during the acute migraine attack, after treatment with IV lysine acetylsalicylate (1,000 mg) or oral zolmitriptan (5 mg) and interictally.


RESULTS
After standard stimulation, no differences were detected for the R1 and R2 onset latencies and areas under the curve (AUC) between the different time points and the headache and nonheadache side. Nociception-specific stimulation revealed a shortening of R2 onset latencies (44.3 +/- 5.4 ms for headache side vs 48.9 +/- 5.8 ms for nonheadache side) during the acute migraine attack compared with the headache-free interval (49.8 +/- 5.3 vs 49.8 +/- 4.5 ms). The AUC of the R2 increased on the headache side by 680% and on the nonheadache side by 230% compared with the headache-free interval. Drug treatment parallel to pain relief increased the onset latencies (zolmitriptan: 48.0 +/- 8.2 ms for headache side vs 52.3 +/- 7.6 ms for nonheadache side; lysine acetylsalicylate: 48.0 +/- 5.0 ms for headache side vs 51.2 +/- 5.6 ms for nonheadache side) and reduced the AUC of R2 (zolmitriptan by 45% and lysine acetylsalicylate by 48%).


CONCLUSIONS
The data suggest temporary sensitization of central trigeminal neurons during acute migraine attacks.
Kaube
H
H
Institute of Neurology, National Hospital for Neurology and Neurosurgery, London, UK. holgerk@ion.ucl.ac.uk
Katsarava
Z
Z
Przywara
S
S
Drepper
J
J
Ellrich
J
J
Diener
H-C
HC
D000208:Acute Disease; D000328:Adult; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000494:pharmacology / Q000627:therapeutic use; D019540:Area Under Curve; D001241:Aspirin / Q000494:pharmacology / Q000627:therapeutic use; D001767:Blinking / Q000502:physiology; D004569:Electroencephalography; D004594:Electrophysiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008881:Migraine Disorders / Q000188:drug therapy / Q000503:physiopathology*; D009412:Nerve Fibers / Q000502:physiology; D009474:Neurons / Q000187:drug effects / Q000502:physiology*; D009619:Nociceptors / Q000502:physiology; D023303:Oxazolidinones / Q000494:pharmacology / Q000627:therapeutic use; D014279:Trigeminal Nucleus, Spinal / Q000187:drug effects / Q000503:physiopathology*; D014363:Tryptamines
D000894:Anti-Inflammatory Agents, Non-Steroidal; D023303:Oxazolidinones; D014363:Tryptamines; C089750:zolmitriptan; D001241:Aspirin