Allodynia

no-touchy

So you hair hurts. A breeze gently caresses you and you scream. Your clothing seems to rip the flesh from your body when you move. Yeah, it is Allodynia: A painful response to a generally non-painful stimulus. Today I suffer from it on my scalp, forehead and legs. So no touchy. It is actually extremely painful in my legs. Feels like my clothing is scraping across exposed nerves and every time I sit, well, it is very unpleasant. As is walking.  I am of course wearing non-confining clothing. For migrainuers it is most often seen in the scalp, face and neck. But I have FM as well and can and do get it anywhere. Once it starts it tends to spread, but on the scalp it is pretty continuous. This is a pain that can be mild to severe. From a sunburn to a torturous nerve pain. It can be bouts or continuous.

So what is going on with this skin pain and migraines? It is related to central sensitization in the brain. This is the central nervous system becoming sensitized to persistent stimulation. It is actually, according to my neurologist, the cause of my chronic migraines. It is basically the brain having a idea of pain and making that pain travel faster and easier in the brain. Pain memory if you will. Pain begets pain. And when this occurs for a bit allodynia can be the result. The pain signals are just traveling on a super slick speedway designed by that pain memory.

And “Cutaneous allodynia is a risk factor for migraine chronification and may warrant preventive treatment strategies.”Brain

Here is a study on depression and allodynia: The study concludes that “allodynia, in addition to high migraine attack frequency, as a new migraine-specific factor associated with depression.” Also “Pathophysiologically, the triad migraine, depression and allodynia may suggest a self-reinforcing dysfunction of central nervous system (CNS) structures involved in the modulation of neuronal excitability and pain.”

Article I wrote on Fibromyalgia related allodynia: Allodynia and Fibromyalgia

When a migraine makes your hair hurt

migraine hurts so much my hair hurts.

 

Allodynia  refers to central pain sensitization following painful, often repetitive, stimulation. It can lead to the triggering of a pain response from stimuli which do not normally provoke pain. Making the skin burn to the touch, making clothing hurt against your skin and a slight breeze scrape in pain over the highly tender flesh. It can feel sunburned to very painful. With migraines it is common in the scalp… and it feels like our hair hurts and it hurts to wash it. But in fact, it can occur anywhere.

It is a migraine symptom. That occurs with central sensitization. That is the brain becoming more sensitized to stimulation. Pain begets pain.

In some people once allodynia has set in studies have found treatment of the migraine can be more difficult. For example triptans less effective. This is the case for me, but I asked on a forum and it wasn’t so for everyone.

My scalp allodynia can be frequent but my more severe bouts are when it hits the length of my back, thighs and patches of my arms. Triptans either fail or barely bring down the pain and it just comes back… less than an effective tool.

Here is the research for that tidbit ” In 31 patients, we studied 34 migraine attacks that were associated with allodynia at the time of triptan treatment and 27 attacks that were not. Within 2 hours of triptan treatment, patients were rendered pain-free in 5 of 34 (15%) of allodynic attacks versus 25 of 27 (93%) of nonallodynic attacks. Treating migraine attacks 1 hour (early) or 4 hours (late) after the onset of pain was equally ineffective in inducing a pain-free state in the presence of allodynia, and equally effective in the absence of allodynia. For patients susceptible to allodynia during the attack, triptan therapy was by far more likely to provide complete pain relief if administered before rather than after the establishment of cutaneous allodynia. Patients who never developed allodynia were highly likely to be rendered pain-free by triptan therapy anytime after the onset of pain. We conclude that the probability of consistent pain-free outcome increases drastically if triptan therapy is vigilantly timed to precede any signs of cutaneous allodynia.” Study

According to some research in 2008 cutaneous allodynia is more common in woman, those with more frequent attacks, those with higher BMIs and are disabled or depressed.+

It should be noted cutaneous allodynia is not just seen in migraines. It is seen in other conditions like fibromyalgia. I actually assumed the reason I get it so severely bodily wise instead of just the scalp was due to my FM. But I know others with migraines who do get it in other pleases severely. So it happens.

Nevertheless it is very unpleasant. I cannot treat with NSAIDs but they do offer that treatment. I treat with tramadol, and it brings it down to less agonizing.