The presence of allodynia in adult individuals with migraine may be associated with symptom severity, intensity and frequency of headache, depression and/or anxiety, and overuse of medications, according to a study published in Cephalalgia.
The phenomenon of cutaneous allodynia is commonly observed in people with migraine and is thought to be associated with greater chance for disease progression and lower efficacy of acute therapies. Investigators sought to identify and characterize potential predictors of allodynia in a large sample of adult patients with migraine.
A secondary analysis of data from the Migraine in America Symptoms and Treatment (MAST) study collected between October 2016 and January 2017 was conducted. A total of 15,133 individuals with migraine (73.0% women; mean age, 43.1 years; 81.0% white; mean monthly headache days [MHD], 5.56) identified using an online patient survey who had ≥1 headache day per month over a 3-month period were enrolled in this study. The Allodynia Symptom Checklist was used to collect data on the nature and prevalence of allodynia, and the Migraine Symptom Severity Scale, the Patient Health Questionnaire, and the Migraine Disability Assessment Scale were used to catalogue relevant clinical characteristics.
A total of 39.9% of patients were found to experience allodynia, with a greater percentage of women reporting having vs not having allodynia (80% vs 68.3%, respectively; P <.001). Individuals with vs without allodynia were also younger (41.4 vs 44.2 years, respectively; P <.001). Smokers were more prevalent in those with vs without allodynia (14.4% vs 9.4%, respectively; P <.001), and headache frequency was greater in individuals with vs without allodynia (mean MHD, 6.56 vs 4.90, respectively; P<.001). Oral prophylactic medications were taken more often by those with vs without allodynia (15.7% vs 8.7%, respectively; P <.001). Individuals with vs without allodynia had a higher rate of medication overuse (20.7% vs 11.9%, respectively), probable anxiety and/or depression (33.3% vs 17.1%), mean Migraine Symptom Severity Scale score (17.64 vs 15.93, respectively), and mean pain intensity (7.07 vs 6.41, respectively) (P <.001 for all).
After adjusting for headache features and sociodemographic variables, associations between allodynia and a higher Migraine Symptom Severity Scale score (odds ratio [OR], 1.17; 95% CI, 1.15-1.19), greater pain intensity (OR, 1.11; 95% CI, 1.08-1.14), acute medication overuse (OR, 1.23; 95% CI, 1.09-1.38), and likely anxiety and/or depression (OR, 1.83; 95% CI, 1.67-2.00) were established. Women (OR, 1.70; 95% CI, 1.56-1.86) and smokers (OR, 1.37; 95% CI, 1.22-1.55) were also found to be more likely to experience allodynia.
Study strengths include a large representative sample and validated screening tools and assessments. Study limitations include the use of a retrospective self-report, lack of corroborating data, and a cross-sectional design that precludes causal inferences.
“The results from the MAST Study further highlight the need to query [patients with] migraine about symptoms of allodynia,” noted the study authors.
Dodick DW, Reed ML, Fanning KM, et al. Predictors of allodynia in persons with migraine: results from the Migraine in America Symptoms and Treatment (MAST) study [published online February 7, 2019]. Cephalalgia. doi:10.1177/0333102418825346
This article originally appeared here.