İLAÇ AŞIRI KULLANIM BAŞAĞRISINDA BELİRLEYİCİ ÖZELLİKLER VE AĞRI DUYARLILIĞININ DEĞERLENDİRİLMESİ

Abstract

Hypersensitivity to non-noxious stimulus is reported in migraine patients during acute attacks. We aimed to assess the demographical, clinical and headache characteristics, the comorbidities,the pain sensitivity characteristics and chronicity-related factors in medication overuse headache patients with chronic migraine (MOH+CM) compared to the episodic migraineurs (EM) and healthy control (HC). Adult participants were prospectively enrolled in 3 groups. Demographical features, clinical, laboratory and neuroimaging findings, MIDAS, 12-item Allodynia Symptom Checklist-12 (ASC-12), Beck Depression and Anxiety Inventory scores were recorded. To quantify the type of pain sensitivity and spatial characteristics of central sensitization; pinprick hyperalgesia, brush allodynia, cold allodynia, and temporal summation tests were applied to cephalic (left forehead region) and extra-cephalic (left forearm anterior surface) regions. Comparisons among the groups were analyzed. A total of 90 participants (30 in each group) were enrolled to the study. Age and sex (female dominance) did not differ among the groups. The MOH+CM patients revealed higher BMI, fasting glucose, total cholesterol levels, and lower iron binding capacity compared to the HC. The migraine disease history, attack duration, frequency, severity, triptan usage, combination analgesic usage, the MIDAS, Beck Depression and Anxiety, ASC-12 scores were statistically significant and high in MOH+CM compared to the EM. All of the MOH+CM patients reported that they felt a compulsion to take their pain killers regularly for their attacks and the possibility of missing a dose made them anxious or disturbed. The 70% MOH+CM patients wished they could stop taking their painkillers and knew that painkillers could harm. On sensory examinations, MOH+CM and EM patients disclosed both cephalic and extra-cephalic cold allodynia (statistically significant high scores in MOH+CM compared to EM and HC).The pinprick hyperalgesia and temporal summation were detected at cephalic region in both group migraineurs and statistically significant high scores in the MOH+CM compared to EM and HC groups. Among the ASC-12 items, combing hair, wearing eyeglasses, wearing contact lenses, wearing a necklace, tight clothing, resting the face or head on a pillow, exposure to heat (e.g., cooking, washing your face with hot water) and exposure to cold (e.g., using an ice pack, washing your face with cold water) were correlated with pain sensitivity sensory examination modalities. Pain sensitivity examinations provide qualitative and quantitative findings for understanding the pathophysiology of headache. The MOH+CM patients revealed metabolic syndrome, depressive features, severe disability, and prominent cephalic and extra-cephalic pain hypersensitivity. The pain hypersensitivity is associated with chronicity and higher levels of disability. Pain modulation systems are prominently altered in MOH+CM compared to EM and HC. Identification of chronicity-related factors and quantification of central sensitization, may provide insight into pathogenesis and personalized treatment options in chronic headache patients.