The development of cutaneous allodynia during a migraine attack Clinical evidence for the sequential recruitment of spinal and supraspinal nociceptive neurons in migraine

Most migraine patients experience cutaneous allodynia during their attacks. This study analyzed how cutaneous allodynia develops in a 42-year-old male. Before the headache, he had various aura symptoms. During the headache, he suffered from photophobia, phonophobia, nausea, and vomiting. He also experienced cutaneous pain while grooming. Pain thresholds were measured at different times during his migraine. After 1 hour, mechanical and cold allodynia started on the affected side. After 2 hours, this allodynia increased and spread to the opposite side and forearm. By 4 hours, heat allodynia was also detected. The findings suggest a sequence of events along the trigeminovascular pain pathway. Early activation of peripheral nociceptors leads to sensitization and cutaneous allodynia. This research highlights the need for early treatment targeting peripheral nociceptors to prevent central sensitization in migraine patients. Developing effective drugs for this purpose is essential. Clinical relevance: This study highlights the importance of early treatment targeting peripheral nociceptors in migraine patients.