Abstract
Medication overuse could interfere with the activity of critical brain regions involved in the supraspinal control of pain signals at the trigeminal and spinal level, leading to a sensitisation phenomenon responsible for chronic pain. We hypothesised that medication-overuse headache (MOH) patients might display abnormal processing of pain stimuli at the spinal level and defective functioning of the diffuse noxious inhibitory controls. We tested 31 MOH patients before (bWT) and after (aWT) standard inpatient withdrawal treatment, 28 episodic migraine (EM) patients and 23 healthy control subjects. We measured the threshold, the area and the temporal summation threshold (TST) of the nociceptive withdrawal reflex before, during and after activation of the diffuse noxious inhibitory controls by means of the cold pressor test. A significantly lower TSTwas found in both the MOH (bWT and aWT) and the EM patients compared with the controls, and in the MOH patients bWT compared with both the MOH patients aWT and the EM patients. In the MOH bWT patients the cold pressor test induced a TST increase significantly lower than that found in the MOH aWT, EM and control groups. Abnormal spinal cord pain processing and a decrease of the antinociceptive activity of the supraspinal structures in MOH patients can be hypothesised. These abnormalities could, in part, be related to the medication overuse, given that the withdrawal treatment was related to an improvement in the neurophysiological findings.
| Original language | English |
|---|---|
| Pages (from-to) | 272-284 |
| Number of pages | 13 |
| Journal | Cephalalgia |
| Volume | 30 |
| Issue number | 3 |
| DOIs | |
| Publication status | Published - Mar 2010 |
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Keywords
- Descending control of pain
- Medication-overuse headache
- Nociceptive withdrawal reflex
- Spinal sensitisation
- Temporal summation
ASJC Scopus subject areas
- Clinical Neurology
Cite this
Sensitisation of spinal cord pain processing in medication overuse headache involves supraspinal pain control. / Perrotta, A.; Serrao, M.; Sandrini, G.; Burstein, R.; Sances, G.; Rossi, P.; Bartolo, M.; Pierelli, F.; Nappi, G.
In: Cephalalgia, Vol. 30, No. 3, 03.2010, p. 272-284.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Sensitisation of spinal cord pain processing in medication overuse headache involves supraspinal pain control
AU - Perrotta, A.
AU - Serrao, M.
AU - Sandrini, G.
AU - Burstein, R.
AU - Sances, G.
AU - Rossi, P.
AU - Bartolo, M.
AU - Pierelli, F.
AU - Nappi, G.
PY - 2010/3
Y1 - 2010/3
N2 - Medication overuse could interfere with the activity of critical brain regions involved in the supraspinal control of pain signals at the trigeminal and spinal level, leading to a sensitisation phenomenon responsible for chronic pain. We hypothesised that medication-overuse headache (MOH) patients might display abnormal processing of pain stimuli at the spinal level and defective functioning of the diffuse noxious inhibitory controls. We tested 31 MOH patients before (bWT) and after (aWT) standard inpatient withdrawal treatment, 28 episodic migraine (EM) patients and 23 healthy control subjects. We measured the threshold, the area and the temporal summation threshold (TST) of the nociceptive withdrawal reflex before, during and after activation of the diffuse noxious inhibitory controls by means of the cold pressor test. A significantly lower TSTwas found in both the MOH (bWT and aWT) and the EM patients compared with the controls, and in the MOH patients bWT compared with both the MOH patients aWT and the EM patients. In the MOH bWT patients the cold pressor test induced a TST increase significantly lower than that found in the MOH aWT, EM and control groups. Abnormal spinal cord pain processing and a decrease of the antinociceptive activity of the supraspinal structures in MOH patients can be hypothesised. These abnormalities could, in part, be related to the medication overuse, given that the withdrawal treatment was related to an improvement in the neurophysiological findings.
AB - Medication overuse could interfere with the activity of critical brain regions involved in the supraspinal control of pain signals at the trigeminal and spinal level, leading to a sensitisation phenomenon responsible for chronic pain. We hypothesised that medication-overuse headache (MOH) patients might display abnormal processing of pain stimuli at the spinal level and defective functioning of the diffuse noxious inhibitory controls. We tested 31 MOH patients before (bWT) and after (aWT) standard inpatient withdrawal treatment, 28 episodic migraine (EM) patients and 23 healthy control subjects. We measured the threshold, the area and the temporal summation threshold (TST) of the nociceptive withdrawal reflex before, during and after activation of the diffuse noxious inhibitory controls by means of the cold pressor test. A significantly lower TSTwas found in both the MOH (bWT and aWT) and the EM patients compared with the controls, and in the MOH patients bWT compared with both the MOH patients aWT and the EM patients. In the MOH bWT patients the cold pressor test induced a TST increase significantly lower than that found in the MOH aWT, EM and control groups. Abnormal spinal cord pain processing and a decrease of the antinociceptive activity of the supraspinal structures in MOH patients can be hypothesised. These abnormalities could, in part, be related to the medication overuse, given that the withdrawal treatment was related to an improvement in the neurophysiological findings.
KW - Descending control of pain
KW - Medication-overuse headache
KW - Nociceptive withdrawal reflex
KW - Spinal sensitisation
KW - Temporal summation
UR - http://www.scopus.com/inward/record.url?scp=77956252325&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=77956252325&partnerID=8YFLogxK
U2 - 10.1111/j.1468-2982.2009.01914.x
DO - 10.1111/j.1468-2982.2009.01914.x
M3 - Article
C2 - 19614707
AN - SCOPUS:77956252325
VL - 30
SP - 272
EP - 284
JO - Cephalalgia
JF - Cephalalgia
SN - 0333-1024
IS - 3
ER -