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BACKGROUND: There is growing evidence that central sensitization plays a role in migraine pathogenesis, and that cutaneous allodynia is its clinical correlate. In headache research, allodynia has largely been studied in episodic migraine. The purpose of this investigation was to determine whether cutaneous allodynia occurs in transformed migraine, using individuals without headaches as controls. METHODS: Fifteen patients with a diagnosis of transformed migraine and 15 control subjects with no history of headaches were included. All subjects were females between 18 and 50. Similar to the methods of Burstein et al, Von Frey hairs (VFH) were sequentially applied to territories supplied by divisions of the trigeminal nerve, cervical paraspinal muscles, trapezius muscles, ventral forearm, and lower leg to determine a pain threshold. As a milder stimulus, a cotton swab was stroked in the same locations. Each trial was repeated 3 times on 2 occasions. Group comparisons were made using the Student's t-test. RESULTS: Mean pain thresholds were lower among migraine patients than control subjects across all test areas. The thresholds were statistically significantly lower in migraine patients than in control subjects for the 1st division of the trigeminal nerve (34.0 g versus 115.8 g, P= .035) and for the 2nd division (23.5 g versus 97.6 g, P= .039). Six patients found a cotton swab-stroke painful, compared to zero control subjects. Using a quantitative definition of allodynia, 75% of patients had allodynia to mechanical stimuli. CONCLUSIONS: This study is the first to demonstrate allodynia in transformed migraine patients using a headache-free control population and supports the hypothesis that central sensitization plays a role in the evolution of transformed migraine. [ABSTRACT FROM AUTHOR]

Objective.-To evaluate the effect of topiramate migraine prophylaxis on subject responsiveness to triptans used for acute symptomatic migraine treatment. Background.-Clinical experience suggests that prophylactic migraine treatment may enhance the efficacy of symptomatic medications used to treat acute migraine attacks. Methods.-This open-label, single-arm multicenter study consisted of a 6-week baseline period followed by a 16-week topiramate treatment period. Subjects meeting International Headache Society (IHS) criteria for migraine with and without aura signed consent and entered the baseline period. Those with 3 to 12 migraine periods per month during baseline received topiramate prophylactic treatment. Only patients who completed at least 12 weeks of topiramate treatment were included in the data analysis. Results.-Of 55 patients screened, 40 subjects entered the topiramate treatment period and 21 subjects received at least 12 weeks of treatment. Mean final dose of topiramate was 124 mg per day (range 50 to 200 mg per day). During the baseline period, the mean percentage of attacks rendered pain-free at 2 hours for the 21 subjects was 46.9% (SD = 31.9), while during the topiramate treatment period it was 44.6% (SD = 32.2) (P= .8). On topiramate, after the first 8 weeks of dosage titration, patients experienced a mean of 3.68 migraine attacks/month, compared to 4.31 during the baseline period (P < .03). Thirteen subjects discontinued because of adverse events. The most commonly reported adverse events were paresthesia, fatigue, anxiety, and dizziness. Conclusion.-Although topiramate prophylaxis did reduce migraine attack frequency, in this pilot study topiramate prophylactic migraine treatment did not increase the proportion of patients pain-free 2 hours after symptomatic triptan therapy. [ABSTRACT FROM AUTHOR]