Does Allodynia occur with Migraine?

Allodynia comes from the Ancient Greek άλλος állos "other" and οδύνη odúnē "pain."  Clinically it refers to pain produced by a non-painful stimulus, such as touch.  Normally it does not hurt to touch the head or the brow or the temple, but during a migraine with allodynia, a simple touch to the head or temple may be perceived as painful.

Allodynia is like a sunburn.  Normally if I touch my arm it does not hurt but after a sunburn at the beach, my arm is painful to touch.  This is what allodynia is like.

This is an article by Britt Talley Daniel MD, retired member of the American Academy of Neurology, the American Headache Society, migraine textbook author, podcaster, YouTube video producer, and blogger.

What usually caused allodynia in the Migraine world? Read all about it here.

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Allodynia with Migraine is pain caused from a non-painful source. Touching or stroking the skin of the scalp, during the late course of a single Migraine may hurt. This is called allodynia.

Allodynia during migraine is a neurological term used for pain a person experiences from non-painful events, like wearing glasses, brushing the hair, touching bed sheets with your head, or wearing a tight ponytail, all experiences which normally would  not cause pain. 

The pain occurs anywhere in the body where there are pain fibers, but especially in the scalp, head, and neck area. Allodynia is a neurological phenomenon that is confusing to Migraineurs as to what is causing it.  Allodynia is limiting and disabling.  Allodynia is a mix up between cranial sensory and pain fibers so that the pain fibers discharge following touch.

Treating with a triptan drug at onset of the Migraine prevents the release of the inflammatory neurochemicals and stops the headache at 2 hours in 80% of Migraine patients. Using a triptan at the beginning of a single Migraine will prevent further migraine development and the occurrence of Allodynia.

Causes of Allodynia during a migraine.

Touch or light pressure from a belt or bra strap

Mechanical allodynia from motion across the skin from light massage or touching fabric

Thermal allodynia from hot or cold stimuli

Combing, washing, or brushing the hair

Pulling your hair back, like in a ponytail

Shaving

Showering

Wearing contact lenses or glasses

Wearing necklaces, earrings, or tight clothes

Bathing or showering and water hits your face

Resting your head on a pillow

Resting your head on the right side, the same side as the pain of  your Migraine

Allodynia comes in stage four of a Migraine attack which is called Central Sensitization and occurs usually 3-4 hours after onset of a Migraine starts.

Central Sensitization is a neurological term indicating hyperexcitability of cerebral neurons due to exposure to the inflammatory neurochemicals Neurokinin A, Substance P, and Calcitonin Gene Related Protein (CGRP.)

Normal time course of a Migraine

A single Migraine attack.  The International Classification of Headache Disorders 3 (ICHD3) states that the duration of a Migraine is 4-72 hours.  Episodic Migraine is defined as less than 15 Migraine headaches per month. 

Chronic Migraine (CM), is defined as more than 15 headache days a month, 8 of which have Migraine features.

Eighty to Ninety percent of persons with CM have a headache syndrome from overtreating with analgesics, caffeine, triptans, opioids, or butalbital called Medication Overuse Headache.  Medication Overuse Headache was formerly called Rebound Headache.

An attack of Migraine has 4 stages: 1) trigeminal activation, 2) neurochemical release, 3) arterial vasodilatation, 4) central sensitization of the thalamus (the pain center) in the brain.  In general patients with an attack of migraine are at stage 3 in two hours and after 3-4 hours they are in stage 4, central sensitization.

Thus, patients with long duration (headaches lasting more than several hours) spend most of their time in stage 4 central sensitization until the Migraine stops.

Patients with medication overuse headache are continuously in stage 4 central sensitization which causes allodynia. These unfortunate individuals may have “sore, touch me not” heads for months at a time. Medication overuse headache is due to overtreating with acute Migraine type drugs like caffeine, ibuprofen, Tylenol, naproxen, opiate narcotics, butalbital, or triptans more than 10 days a month.

Clearing of Allodynia

With episodic migraine the allodynia clears when the headache ends, and the offending neurochemicals are metabolized and excreted.  For a single Migraine this is usually allodynia clearing on the fourth day after a Migraine attack. It is the sore head that migraineurs have late in the course of their headache that eventually goes away.

The same thing occurs during treatment of medication overuse headache when the patient is detoxed off of analgesics, caffeine, or triptans and the offending neurochemicals are no longer produced so that the headache and the allodynia clears.

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All the best.

Britt Talley Daniel MD