Super-Sensitive Nerves Play Key Role in Migraine Pain
Stephen Silberstein, MD, director of the Jefferson Headache Center in
Philadelphia, calls the research a major advance in understanding migraines.
Silberstein, who was not involved in the study, tells WebMD that the findings
confirm something physicians long suspected.
"This is a very important paper because for a long time we have been
hypothesizing what happens in people during a migraine attack -- we've been
saying maybe it is sensitization, but nobody ever demonstrated it is true,"
he says. "It tells us why migraine sufferers suffer pain everywhere, why
their hair hurts. It may give us better approaches for treatment."
Burstein and his colleagues performed a battery of skin sensitivity tests on
patients referred to a pain center for migraines. They then asked the patients
to return to the center when they had a migraine so the tests could be
"The patients all got my pager number and they paged me whenever they
got migraines," Burstein remembers. "They would call at three, four,
five o'clock in the morning, on Sunday, around the clock. We met them in the
clinic four hours into the attack, in which they took no medication. Then all
we had to do was subtract the results of the pain testing in the presence of a
migraine from the results we got in the absence of the headache. It became
obvious that they had changes in their skin sensitivity."
This experience leads Burstein to recommend that people who get migraines
should tell their doctor about anything unusual that happens to them, no matter
how weird it seems. "Symptoms like the inability to form sentences, or a
spreading sensation of numbness in the fingers, or hallucinations of different
smells or tastes -- these are not part of what we studied, but ? they are
related to migraines and not any other type of headache," he says.
And Burstein offers another important piece of advice. "Don't be
stoic," he says. "If you are a patient who has skin sensitization, you
have only one hour after the first symptoms of migraine for current drugs to be
effective. Take the medication as soon as the pain starts."
Burstein and colleagues are now conducting studies to see whether the skin
sensitivity seen in nearly 80% of their pain-clinic patients also happens in
patients with less advanced migraine symptoms.
- Researchers report most migraine sufferers seem super-sensitive to even the
slightest touch. Skin contact against their own hair or eyeglasses can be very
- The sensitivity may be a result of nerves getting stuck in the "on"
position so that even gentle stimulation triggers extreme pain messages.
- Nearly all of the 42 study subjects reported skin sensitivity, and the
author notes today's drugs are most helpful if they are taken within the first
hour of an attack in these patients. Researchers also need to determine which
drugs can be used to reverse the changes in the spinal cord that cause patients
to feel this pain.