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Super-Sensitive Nerves Play Key Role in Migraine Pain

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WebMD Health News

April 27, 2000 -- Attention migraine sufferers: those weird pains aren't all in your head. A new study shows that when people say headaches makes their hair hurt, it's true.

In fact, the painful sensitivity to even the slightest touch -- experienced by many or perhaps most migraine sufferers -- has led researchers to the discovery of how migraines happen. It also offers clues to how they might be stopped. That's according to a study in the journal Annals of Neurology.

"The most interesting part of the study was when I asked patients 'Does your hair hurt? Do you feel pain from your earrings or glasses or water in the shower; can you shave without pain?'" lead investigator Rami Burstein, PhD, tells WebMD. "In general, they didn't want to admit it because they thought it had nothing to do with their migraines. After testing in the clinic showed it to be real, I was able to say, 'This doesn't mean you are crazy -- just tell me what you are feeling.' Then they went on and on and on about these symptoms that they were reluctant to tell about."

Burstein and colleagues at Harvard University found that almost 80% of 42 migraine patients they studied experienced painful sensitivity to touch and/or temperature in specific areas of their skin. This and earlier evidence from laboratory animals led them to the conclusion that migraine pain results from a chain reaction along the pain pathways leading to a region of the spine at the base of the neck.

Chemicals released by pain receptors, the part of the nervous system that senses pain, turn on nerve cells in the spinal cord. When these nerve cells get stuck in the "on" position, they turn even the slightest sensation into excruciating pain. This is why people with migraines say their head throbs -- the nerves connecting to their head become so sensitive that even the pulse of blood in the brain is a source of pain.

This new understanding of how migraines happen explains why, for many people, migraine medicine doesn't work once the headache has become severe.

"Not all patients experience increases in skin sensitivity -- and for them existing pain medications are almost 100% effective at any point of the migraine," notes Burstein, vice chair of the anesthesia department at Beth Israel Deaconess Medical Center in Boston. "However, 79% of the patients in our study exhibited this skin sensitivity. These patients will benefit from currently available drugs only if they take them in the first hour after the onset of an attack. If they take them later it is much, much less effective because these drugs do not address the sensitization that develops in the spinal cord."

However, drugs that can prevent or reverse the chemical changes in the spinal cord would benefit these patients. "There are hundreds of ways to do that, and this is the kind of medicine that will eventually do the job," Burstein says. He and his Harvard University research team currently are looking for drugs that can do this without too many unwanted side effects.

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