Modality and Location Specific Alterations in Pain Thresholds in Migraine Patients

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Modality and Location Specific Alterations in Pain Thresholds in Migraine Patients

Quantitative sensory testing is used to examine the function of both large and small nerve fibers and the sensory perception after application of different mechanical and thermal stimuli of controlled intensity. This method is widely in use to quantify somatosensory function. It further points out towards the impairments or interference in pain pathways of an individual in response to controlled stimuli across a variety of modalities encompassing pressure and thermal.

The present meta-analysis was conducted to evaluate 1) the differences in pain thresholds in migraine patients and healthy controls 2) effect of stimulus modality and stimulus location on pain thresholds.

A comprehensive search was performed using the keywords like 'a migraine' AND ('pain,' 'threshold,' 'pressure,' 'electrical,' 'warm,' 'heat,' 'cold,' 'mechanical,' 'quantitative sensory testing'). This meta-analysis included 14 studies to estimate the pressure pain thresholds. However, as such no particular differences were found between migraine patients and healthy controls (effect size 95% CI, -1.28 to 0.30, p=0.22). Subdivision based on stimulus region (head and neck area), migraine patients were found to have a lower pressure-pain threshold (PPT) than the control group (effect size 95% CI, -1.5 to -0.19, P=0.01). Assessment of PPT on the outside of the head and neck region (non-local) found no significant differences between the groups (effect size 95% CI,-2.04 to 2.74, p=0.77). To assess heat pain thresholds (HPT), 9 studies were included. Here no evidence was found supporting significant differences in HPT between migraine patients and controls (effect size 95% CI, -0.33 to 0.02, p=0.09). Similarly, no differences were noticeable on dividing data to local (effect size 95% CI,-0.36 to 0.19, p=0.14) or non-local areas (effect size 95% CI,-0.34 to 0.08, p=0.11).

This meta-analysis estimated that the changes in the nociceptive processing of migraine patients were modality and location specific. Symptoms associated with pressure sensations were usually reported during the migraine attack. This might explain the reasons for differences found for PPT but not HPT. As well sensory abnormalities found to be soma topically localized to the head and neck areas and do not seem to indicate a pattern of generalized sensitization. 


The Journal of Pain

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The original title of the article:

Meta-Analysis Confirms Modality and Location Specific Alterations in Pain Thresholds in Migraine Patients


H. Nahman-Averbuch, T. Shefi et al.

Exploratory, Migraine, Meta-analysis
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