Comparison of Pain Severity, Sleep Quality and Psychological Status in Patients with Migraine with and without Cutaneous Allodynia

Year 2020, Volume: 25 Issue: 2, 102 - 107, 13.06.2020

Oğuzhan Mete , Şeyda Toprak Çelenay , Özge Çoban , Nesrin Karahan

https://doi.org/10.21673/anadoluklin.644740

Abstract

Aim:
The aim of study was to compare pain severity, sleep quality and psychological
status in patients with migraine with and without cutaneous allodynia.

Materials and Methods: The study was planned as a case-controlled study.
Thirty-two (32) patients with migraine were included in the study. The patients
were divided into two groups as with (16) and without (16) cutaneous allodynia
according to the Allodynia Symptom Checklist. Pain intensity was assessed with
Visual Analog Scale (VAS). Sleep quality was assessed with Pittsburgh Sleep
Quality Index (PSQI). Psychological status was assessed with Hospital Anxiety
(HAD-A) and Depression (HAD-D) Scale.

Results: In the cutaneous allodynia group, 6(37.5%) patients had severe,
5(31.2%) patients had moderate, 5(31.2%) patients had mild cutaneous allodynia.
In the control group, 1(6.2%) patient had mild, 10(62.5%) patients had moderate
and 5(31.2%) patients had severe pain. In the cutaneous allodynia group, 8(50%)
patients had moderate and 8(50%) patients had severe pain. It was observed that
the VAS score (p:0.005), HAD-A score (p:0.034) and PSQI score (p:0.028) were
higher in individuals with cutaneous allodynia. HAD-D score (p:0.089) was found
to be similar in individuals with and without cutaneous allodynia.

Conclusion: It was observed that migraine patients with cutaneous
allodynia had higher pain severity and anxiety and impaired sleep quality
compared to those without cutaneous allodynia. In migraine patients with
cutaneous allodynia, it is important to evaluate the severity of pain as well
as sleep quality and psychological status and should be considered in terms of
treatment planning.

Keywords

anxiety, depression, headache, migraine, sleep disorders

Kutaneal Allodinisi Olan ve Olmayan Migren Hastalarında Ağrı Şiddeti, Uyku Kalitesi ve Psikolojik Durumun Karşılaştırılması

Abstract

Amaç:
Çalışmanın amacı, kutaneal allodinisi olan ve olmayan migren hastalarında ağrı
şiddeti, uyku kalitesi ve psikolojik durumun karşılaştırılmasıydı.

Gereç ve Yöntemler: Çalışma olgu kontrol çalışma tipinde planlandı.
Çalışmaya otuz iki (32) migren hastası dahil edildi. Hastalar Allodini Semptom
Kontrol Listesine göre kutaneal allodinisi olan (16) ve olmayan (16) olmak
üzere iki gruba ayrıldı. Ağrı şiddeti Görsel Analog Skalası (GAS) ile, uyku
kalitesi Pittsburgh Uyku Kalitesi İndeksi (PUKİ) ile, psikolojik durum Hastane
Anksiyete (HAD-A) ve Depresyon Ölçeği (HAD-D) ile değerlendirildi.

Bulgular: Kuteneal allodini grubunda 6(%37.5) hasta ciddi, 5(%31.2) hasta orta,
5(%31.2) hasta hafif derecede kuteneal allodiniye sahipti. Kontrol grubunda
1(%6.2) hasta hafif, 10(%62.5) hasta orta, 5(%31.2) hasta ise ciddi şiddette
ağrıya sahipti. Kutaneal allodini grubunda 8(%50) hasta orta ve 8(%50) hasta
ciddi şiddette ağrıya sahipti. Kutaneal allodinisi olan bireylerin olmayanlara
göre GAS skorunun (p:0.005), HAD-A skorunun (p:0.034) ve PUKİ skorunun
(p:0.028) daha yüksek olduğu görüldü. Kutaneal allodinisi olan ve olmayan
bireylerin HAD-D skorunun (p:0.089) benzer olduğu saptandı.

Sonuç: Kuteneal allodinisi olan migren hastalarının kuteneal allodinisi
olmayan migren hastalarına göre ağrı şiddetinin ve anksiyete düzeyinin daha
yüksek olduğu ve uyku kalitesinin bozulduğu görüldü. Kuteneal allodinisi olan
migren hastalarında ağrı şiddetinin yanında uyku kalitesi ve psikolojik durumun
da değerlendirilmesi önemlidir ve tedavi planlanması açısından göz önünde
bulundurulmalıdır.

Keywords

anksiyete, baş ağrısı, depresyon, migren, uyku bozuklukları

References

• 1. Arnold M. Headache Classification Committee of the International Headache Society (IHS) The International Classification of Headache Disorders, 3rd edition. Cephalalgia. 2018;38(1):1-211.
• 2. Steiner TJ, Stovner LJ, Vos T. GBD 2015: Migraine is the third cause of disability in under 50s. J Headache Pain. 2016;17(1):104.
• 3. Lipton RB, Bigal ME, Ashina S, Burstein R, Silberstein S, Reed ML, et al. Cutaneous allodynia in the migraine population. Ann. Neurol. 2008;63(2):148-58.
• 4. Woolf CJ, Wall PD. Relative effectiveness of C primary afferent fibers of different origins in evoking a prolonged facilitation of the flexor reflex in the rat. J. Neurosci. 1986;6(5):1433-42.
• 5. Burstein R, Cutrer MF, Yarnitsky D. The development of cutaneous allodynia during a migraine attack clinical evidence for the sequential recruitment of spinal and supraspinal nociceptive neurons in migraine. Brain. 2000;123 ( Pt 8):1703-9.
• 6. Sessle BJ, Hu JW, Amano N, Zhong G. Convergence of cutaneous, tooth pulp, visceral, neck and muscle afferents onto nociceptive and non-nociceptive neurones in trigeminal subnucleus caudalis (medullary dorsal horn) and its implications for referred pain. Pain. 1986;27(2):219-35.
• 7. Bigal ME, Lipton RB. Modifiable risk factors for migraine progression. Headache. 2006;46(9):1334-43.
• 8. Hamel E. Serotonin and migraine: biology and clinical implications. Cephalalgia: an international journal of headache. 2007;27(11):1293-300.
• 9. DaSilva AF, Nascimento TD, Jassar H, Heffernan J, Toback RL, Lucas S, et al. Dopamine D2/D3 imbalance during migraine attack and allodynia in vivo. Neurology. 2017;88(17):1634-41.
• 10. El Mansari M, Guiard BP, Chernoloz O, Ghanbari R, Katz N, Blier P. Relevance of norepinephrine-dopamine interactions in the treatment of major depressive disorder. CNS Neurosci. Ther. 2010;16(3):e1-e17.
• 11. Koyama Y. Regulation of sleep and wakefulness through the monoaminergic and cholinergic systems. Brain nerve. 2012;64(6):601-10.
• 12. Yalin OÖ, Uludüz D, Sungur MA, Sart H, Özge A. Identification of Allodynic Migraine Patients with the Turkish Version of the Allodynia Symptom Checklist: Reliability and Consistency Study. Noro. Psikiyatr. Ars. 2017;54(3):260.
• 13. Jakubowski M, Silberstein S, Ashkenazi A, Burstein R. Can allodynic migraine patients be identified interictally using a questionnaire? Neurology. 2005;65(9):1419-22.
• 14. Carlsson AM. Assessment of chronic pain. I. Aspects of the reliability and validity of the visual analogue scale. Pain. 1983;16(1):87-101.
• 15. Karcioglu O, Topacoglu H, Dikme O, Dikme O. A systematic review of the pain scales in adults: Which to use? Am. J. Emerg. Med. 2018;36(4):707-14.
• 16. Agargun M. Pittsburgh uyku kalitesi indeksinin gecerligi ve guvenirligi. Turk Psikiyatri Derg. 1996;7:107-15.
• 17. Buysse DJ, Reynolds III CF, Monk TH, Berman SR, Kupfer DJ. The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Res. 1989;28(2):193-213.
• 18. Aydemir O. Hastane anksiyete ve depresyon olcegi Turkce formunun gecerlilik ve guvenilirligi. Turk Psikiyatri Derg. 1997;8:187-280.
• 19. Snaith RP. The hospital anxiety and depression scale. Health Qual. Life Outcomes. 2003;1(1):29.
• 20. Staud R, Smitherman ML. Peripheral and central sensitization in fibromyalgia: pathogenetic role. Curr. Pain Headache R. 2002;6(4):259-66.
• 21. Landy S, Rice K, Lobo B. Central sensitisation and cutaneous allodynia in migraine: implications for treatment. CNS Drugs. 2004;18(6):337-42.
• 22. Meeus M, Nijs J. Central sensitization: a biopsychosocial explanation for chronic widespread pain in patients with fibromyalgia and chronic fatigue syndrome. Clin. Rheumatol. 2007;26(4):465-73.
• 23. Nijs J, Malfliet A, Ickmans K, Baert I, Meeus M. Treatment of central sensitization in patients with ‘unexplained’chronic pain: an update. Expert Opin. Pharmacother. 2014;15(12):1671-83.
• 24. Curatolo M, Petersen-Felix S, Arendt-Nielsen L, Giani C, Zbinden AM, Radanov BP. Central hypersensitivity in chronic pain after whiplash injury. Clin. J. Pain. 2001;17(4):306-15.
• 25. Mathew NT, Kailasam J, Seifert T. Clinical recognition of allodynia in migraine. Neurology. 2004;63(5):848-52.
• 26. Lovati C, D'Amico D, Bertora P, Raimondi E, Rosa S, Zardoni M, et al. Correlation between presence of allodynia and sleep quality in migraineurs. Neurol. Sci. 2010;31 Suppl 1:S155-8.
• 27. De Tommaso M, Delussi M, Vecchio E, Sciruicchio V, Invitto S, Livrea P. Sleep features and central sensitization symptoms in primary headache patients. J. Headache Pain. 2014;15:64.
• 28. Inamorato E, Minatti-Hannuch SN, Zukerman E. The role of sleep in migraine attacks. Arq. Neuropsiquiatr. 1993;51(4):429-32.
• 29. Ebrahim IO, Howard RS, Kopelman MD, Sharief MK, Williams AJ. The hypocretin/orexin system. J. Roy. Soc. Med. 2002;95(5):227-30.
• 30. Yamamoto T, Nozaki-Taguchi N, Chiba T. Analgesic effect of intrathecally administered orexin-A in the rat formalin test and in the rat hot plate test. Br. J. Pharmacol. 2002;137(2):170-6.
• 31. Odo M, Koh K, Takada T, Yamashita A, Narita M, Kuzumaki N, et al. Changes in circadian rhythm for mRNA expression of melatonin 1A and 1B receptors in the hypothalamus under a neuropathic pain-like state. Synapse. 2014;68(4):153-8.
• 32. Breslau N, Schultz LR, Stewart WF, Lipton RB, Lucia VC, Welch KM. Headache and major depression: is the association specific to migraine? Neurology. 2000;54(2):308-13.
• 33. Kao CH, Wang SJ, Tsai CF, Chen SP, Wang YF, Fuh JL. Psychiatric comorbidities in allodynic migraineurs. Cephalalgia. 2014;34(3):211-8.
• 34. Mendonca MD, Caetano A, Viana-Baptista M. Association of depressive symptoms with allodynia in patients with migraine: A cross-sectional study. Cephalalgia. 2016;36(11):1077-81.