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Offset analgesia, a crucial endogenous pain inhibition mechanism, is substantially impaired in migraine patients, with the greatest abnormalities seen in chronic migraine and during certain episodic migraine phases.
A study led by Giuseppe Cosentino et al. revealed that the brain’s natural pain-inhibiting mechanism, known as offset analgesia, is considerably disrupted in migraine sufferers—varying notably depending on the migraine phase and type. This insight could help explain why migraines recur and why some patients experience more severe or chronic symptoms.
Researchers tested 68 individuals with episodic migraine at different stages of their migraine cycle (before, during, after attacks, or between attacks), 34 with chronic migraine (some with medication overuse headache, MOH), and 30 healthy controls. Using a controlled heat stimulus on the forehead, they measured pain perception changes through multiple trials.
Key findings
These findings suggest that migraine patients have disrupted top-down pain modulation—brain circuits responsible for controlling pain signals are malfunctioning. This dysfunction is most pronounced in chronic migraine patients without medication overuse, and the fluctuating pain modulation in episodic migraine patients might drive the cyclical nature of their attacks. While the study offers valuable new clues about migraine mechanisms, the authors note the need for larger, longitudinal studies to substantiate these results due to the limited sample size and cross-sectional design.
The Journal of Headache and Pain
Offset analgesia as a marker of dysfunctional pain modulation in episodic and chronic migraine
Giuseppe Cosentino et al.
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