Massaging over the greater occipital nerve reduces the intensity of migraine attacks: evidence for inhibitory trigemino-cervical convergence mechanisms.
Activation of the trigemino-cervical system constitutes one of the first steps in the genesis of migraine. The objective of this study was to confirm the presence of trigemino-cervical convergence mechanisms and to establish whether such mechanisms may also be of inhibitory origin. We describe a case of a 39-years-old woman suffering from episodic migraine who showed a significant improvement in her frontal headache during migraine attacks if the greater occipital nerve territory was massaged after the appearance of static mechanical allodynia (cortical sensitization). We review trigemino-cervical convergence and diffuse nociceptive inhibitory control (DNIC) mechanisms and suggest that the convergence mechanisms are not only excitatory but also inhibitory.
Piovesan
Elcio Juliato
EJ
Neurology Division, Internal Medicine Department, Hospital de Clínicas, Federal University of Paraná, Rua General Carneiro 181, 80060-900 Curitiba, PR, Brazil. piovesan@avalon.sul.com.br
Di Stani
Fabrizio
F
Kowacs
Pedro André
PA
Mulinari
Rogério Andrade
RA
Radunz
Victor Hugo
VH
Utiumi
Marco
M
Muranka
Eder B
EB
Giublin
Mario Luiz
ML
Werneck
Lineu César
LC
D000328:Adult; D002574:Cervical Vertebrae / Q000503:physiopathology; D004599:Electric Stimulation Therapy; D005260:Female; D006801:Humans; D008405:Massage; D020326:Migraine without Aura / Q000503:physiopathology / Q000628:therapy*; D009407:Nerve Block / Q000379:methods; D009619:Nociceptors / Q000502:physiology*; D009778:Occipital Lobe / Q000502:physiology*; D010147:Pain Measurement; D012720:Severity of Illness Index; D013997:Time Factors; D014279:Trigeminal Nucleus, Spinal / Q000503:physiopathology*