Migraine, allodynia, and implications for treatment

Eur J Neurol. 2008 Dec;15(12):1279-85. doi: 10.1111/j.1468-1331.2008.02343.x.


Allodynia--perception of pain from non-noxious stimuli--is a common clinical feature in various pain syndromes. The significance for migraine has increasingly been recognized and the pathophysiology has been investigated in detail. Allodynia is a marker for sensitization of central trigeminal neurons. Intensity and persistence of allodynic symptoms are a function of duration of migraine attacks, frequency of attacks, and migraine history. It has been hypothesized that treatment success with triptans may be severely impaired in the presence of allodynia. However, randomized controlled trials did not confirm that. Treatment with cyclooxygenase inhibitors and dihydroergotamine does not seem to be limited by allodynia; these medications may be able to reverse allodynia. Data on the new class of calcitonin-gene related-peptide antagonists are not yet available. Additional and more refined randomized controlled trials, focusing on methodological issues pertaining to the determination of allodynia, are warranted to resolve the true relationship between allodynia and treatment response. Regardless--based on available randomized controlled trials--the recommendation prevails to initiate abortive treatment as soon as possible after attack onset when pain is still mild.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Analgesics / pharmacology*
  • Analgesics / therapeutic use
  • Brain / drug effects
  • Brain / physiopathology*
  • Clinical Trials as Topic / statistics & numerical data
  • Comorbidity
  • Cyclooxygenase Inhibitors / pharmacology
  • Cyclooxygenase Inhibitors / therapeutic use
  • Dihydroergotamine / pharmacology
  • Dihydroergotamine / therapeutic use
  • Humans
  • Hyperalgesia / drug therapy
  • Hyperalgesia / physiopathology*
  • Migraine Disorders / drug therapy
  • Migraine Disorders / physiopathology*
  • Trigeminal Nerve / drug effects
  • Trigeminal Nerve / physiopathology
  • Tryptamines / pharmacology
  • Tryptamines / therapeutic use


  • Analgesics
  • Cyclooxygenase Inhibitors
  • Tryptamines
  • Dihydroergotamine