Matteo Castaldo [IRCCS Fondazione Don Carlo Gnocchi, Milano, Italy]
Tiziana Atzori [Dept. of Biomedical and Clinical Sciences, University of Milan, Milan, Italy]
Daniele Lovattini [Dept. of Biomedical and Clinical Sciences, University of Milan, Milan, Italy]
Carlo Manzoni [Dept. of Biomedical and Clinical Sciences, University of Milan, Milan, Italy]
Chiara-Camilla Derchi [IRCCS Fondazione Don Carlo Gnocchi, Milano, Italy]
Giacomo Querzola [Ospedale Luigi Sacco, Milano, Italy]
Carlo Lovati [Ospedale Luigi Sacco, Milano, Italy]
Angela Comanducci [IRCCS Fondazione Don Carlo Gnocchi, Milano, Italy]
Simone Sarasso [Dept. of Biomedical and Clinical Sciences, University of Milan, Milan, Italy]
Alessandro Viganò [IRCCS Fondazione Don Carlo Gnocchi, Milano, Italy]
Pain neuroscience education (PNE) has been recently added as option for different chronic pain conditions. To date, however, no standard content or methods for PNE have been developed for chronic migraine (CM). This study aims at highlight mechanisms responsible for PNE effect in CM
We recruited consecutive CM patients aged 18-65. We excluded those with other headache diagnosis (except medication-overuse headache, MOH), migraine prophylaxis started in the last 3 months, concomitant neurological or psychiatric conditions, language barrier. Patients’ assessment included headache frequency and medication use, validated questionnaires (CSI, HADS, PCS, HIT-6, MIDAS), neurophysiological evaluations with nociceptive blink reflex (nBR), intensity dependence of auditory evoked potentials (IDAP), and clinical evaluation with pressure pain thresholds (PPTs) and wind-up ratio at baseline (T0), midway (T1) and at the end of the treatment (T2). PNE was administrated in ten lessons, once a week. Patients were treated in groups. Data from Responders (R) and Nonresponders (NR) were further analyzed.
We recruited 14 female patients (mean age 43.4±16.4 years; mean schooling years 15.5±3.8). Headache days reduced from 18.5±5.2 to 13.4±7.5 (p=0.002) and HIT-6 from 63.1±3.3 to 56.0±6.0, p=0.013). Other evaluations were not significant. Serotonergic tone tended to reduce from T0 to T1 (p=0.13), while WUR significantly decreased from 3.1±1.8 at T0 to 1.8±1.6 at T1 (p=0.002) and negatively correlated with HIT-6 value at T2 (rho=-0.5, p=0.02). IDAP at midway negatively correlated with headache days’ reduction at T2 (rho=-0.5, p=0.04). Values of PPT on tibialis anterior (but not on temporalis muscle or metacarpophalangeal tendon) recorded midway to treatment positively correlated with ipsi- (rho= 0.73, p=0.002) and contralateral (rho=0.6, p=0.007) nBR at the same time point but not in other time-points
PNE resulted to be effective in reducing migraine days and disability in a sample of CM patients as stand-alone preventive therapy. Early determination of the serotonergic tone could represent a predictive biomarker of response since, as in other studies, it correlated with later clinical benefit. PPT values on tibialis anterior could serve as a proxy of nNR, allowing for an intra-subject evaluation of central sensitization in CM also at clinical bed-side level.
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