Central sensitization theory of migraine: Clinical implications

David William Dodick, Stephen Silberstein

Research output: Contribution to journalArticle

154 Citations (Scopus)

Abstract

The clinical science of migraine headache continues to evolve. Theories of the pathophysiology of migraine have progressed from the early vascular basis of migraine to more complex current theories that emphasize the centrality of neuronal dysfunction. The most recently articulated theory of migraine is the central sensitization hypothesis, which proposes that altered processing of sensory input in the brainstem, principally the trigeminal nucleus caudalis, could account for many of the temporal and symptomatic features of migraine, as well as its poor response to triptan therapy when such treatment is initiated hours after the onset of pain. Both preclinical and clinical data support the central sensitization theory. A critical clinical implication of this theory is that drugs that are capable of either aborting or arresting the process of central sensitization, most prominently dihydroergotamine, may have a unique role in the treatment of migraine. An additional, and highly practical, implication is based upon the finding that cutaneous allodynia - pain arising from innocuous stimulation of the skin, as in hair brushing or the application of cosmetics - is an easily identifiable marker of central sensitization. Thus, the presence or absence of cutaneous allodynia can be integrated into the routine clinical assessment of migraine and utilized as a determinant of treatment. Future basic and clinical research on central sensitization is likely to be of ongoing importance to the field.

Original languageEnglish (US)
JournalHeadache
Volume46
Issue numberSUPPL. 4
DOIs
StatePublished - Nov 2006

Fingerprint

Central Nervous System Sensitization
Migraine Disorders
Hyperalgesia
Skin
Dihydroergotamine
Tryptamines
Trigeminal Nuclei
Pain
Therapeutics
Cosmetics
Hair
Brain Stem
Blood Vessels
Research

Keywords

  • Central sensitization
  • Cutaneous allodynia
  • Dihydroergotamine
  • Migraine headache
  • Pathophysiology of migraine
  • Peripheral sensitization

ASJC Scopus subject areas

  • Clinical Neurology
  • Neuroscience(all)

Cite this

Central sensitization theory of migraine : Clinical implications. / Dodick, David William; Silberstein, Stephen.

In: Headache, Vol. 46, No. SUPPL. 4, 11.2006.

Research output: Contribution to journalArticle

Dodick, David William ; Silberstein, Stephen. / Central sensitization theory of migraine : Clinical implications. In: Headache. 2006 ; Vol. 46, No. SUPPL. 4.
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