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Appropriate treatment
strategies should be devised for combating allodynia as it was found to be
associated with poor outcomes for all medications. The best outcomes were
produced by triptans.
Migraine is a commonly occurring neurologic disorder, characterized by attacks of head pain and other symptoms like nausea, vomiting, photophobia, and phonophobia and in most patients (53-79%), cutaneous allodynia. Allodynia most often appear during the first few hours of an attack, but patients with a chronic migraine are sometimes allodynic between attacks. The objectives of the study were to use data of analysis of AMPP to 1) Evaluate rates and factors the2-hour pain freedom (2hPF), 24-hour pain response (24hPR), and 24-hour sustained pain response (24hSPR) with triptans vs other medication categories. 2) To understand the influence of allodynia on response to medication. 3) Assess the interaction between medication category and presence of allodynia in response to treatment. This study included a population sample of persons who had a migraine and is on the treatment of the single category of acute migraine medication. In the American Migraine Prevalence and Prevention (AMPP) it was found that Cutaneous allodynia was previously associated with inadequate 2hPF, 24hPR, and 24hSPR (sustained response at 24 hours among those with adequate 2hPF) among people with a migraine.
The AMPP Study received data from a representative US sample of persons with a
migraine by mailed questionnaire. The 2006 survey included 8233 people
suffering from migraine with age 18 or more who completed the Migraine
Treatment Optimization Questionnaire (mTOQ). The researchers used mTOQ to
assess the acute treatment outcomes including 2hPF, 24hPR, and 24hSPR. Eligible
individuals had only a single category of acute prescription migraine
treatments (n = 5236, 63.6%). One the basis of type of acute prescription
headache medication used the sample was stratified into 5 categories namely
triptans, non-steroidal anti-inflammatory drugs, barbiturate-combinations,
opioids, and opioid combinations and ergot alkaloids. Binary logistic
regression models were used seperately for each group
to evaluate:
(1)
triptans vs other medication types;
(2)
presence of allodynia vs no allodynia;
(3) the interaction of medication category with allodynia.
Sociodemographic variables like over-the-counter
and preventive medication, health insurance status use were termed as
covariates. 95% confidence intervals (CI) and Odds ratios (OR) were generated
for each acute treatment outcome.
The mean age among eligible participants, was 46 years, and 82.5% were women.
The findings revealed that the group using triptan showed better outcomes
compared to other medication groups for 2hPF (OR range: 2.00-2.63, all
significant except ergot alkaloids) and 24hPR (OR range: 2.10-6.22, all
significant). No significant medication effects were observed for the 24hSPR
outcome. The presence of allodynia was found to be associated with significantly
worse outcomes for both 2hPF (OR range: 1.42-1.55, all significant) and 24hPR
(OR range: 1.30-1.32, all significant, except for ergot alkaloids, P = .051).
Effects OF Allodynia were not significant for the 24hSPR. The medication and
allodynia interaction was also not significant (OR range for 2hPF: .68-2.02; OR
range for 2hPR: .35-1.34; OR range for 24hSPR: 1.21-2.72) in any of the models.
This reveals that allodynia is an important predictor of treatment response
regardless of the medication group prescribed.
From the study, we can conclude that the use of triptan medication was associated with significantly better 2hPF (except vs ergot alkaloids) and significantly better 24hPR outcomes compared with other acute medication categories. The presence of allodynia significantly increased the probability of an inadequate treatment response for both of these outcomes. Triptan use generated best outcomes. Because allodynia was associated with inadequate outcomes for all medication groups, we suggest that allodynia is an area of unmet treatment need.
Headache. 2017 Jun 11.
Allodynia Is Associated With Initial and Sustained Response to Acute Migraine Treatment: Results from the American Migraine Prevalence and Prevention Study
Richard B. Lipton et al.
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