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Increased pain sensitivity but normal pain modulation in adolescents with migraine

Nahman-Averbuch, Hadasa,b,*; Leon, Erica; Hunter, Benjamin M.a; Ding, Lilic; Hershey, Andrew D.b,d,e; Powers, Scott W.a,b,e; King, Christopher D.a,b; Coghill, Robert C.a,b,f

doi: 10.1097/j.pain.0000000000001477
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Inhibitory pain modulation has been reported to be deficient in adults across different types of chronic pain, including migraine. To determine whether a similar phenomenon occurs in youth, we performed a quantitative sensory testing investigation in adolescents with migraine (N = 19). These patients were compared to healthy adolescents with (Fam-His; N = 20) or without (Healthy; N = 29) a family history of migraine (eg, first-degree relative with migraine). Subjects were first familiarized with the stimuli and visual analogue rating scales using graded noxious stimuli (0°C, 43-49°C range). These data were used to explore potential pain sensitivity differences between the groups. Pain inhibition was assessed by conditioned pain modulation (CPM), which used both suprathreshold heat pain (heat CPM) and pressure pain thresholds (pressure CPM) as the test stimuli before and during cold-water immersion (8°C). In response to the graded heat stimuli, Fam-His participants reported higher pain intensity ratings compared with patients with migraine, who in turn reported higher pain intensity ratings than the healthy controls (F = 3.6, [df = 2, 459], P = 0.027). For heat and pressure CPM, there was no significant group difference in the magnitude of CPM responses. Thus, adolescents with migraine and healthy adolescents have similar inhibitory pain modulation capability, despite having marked differences in pain sensitivity. Although Fam-His participants are asymptomatic, they demonstrate alterations in pain processing, which may serve as markers for prediction of migraine development.

Patients with migraine and healthy adolescents with familial migraine history show increased pain sensitivity to noxious heat stimuli relative to healthy adolescents without familial migraine history.

aDepartment of Pediatrics, Division of Behavioral Medicine and Clinical Psychology, Cincinnati, OH, United States

bConsortium for Understanding Pediatric Pain, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States

cDivision of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States

dDepartment of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States

eUniversity of Cincinnati College of Medicine, Cincinnati, OH, United States

fPediatric Neuroimaging Research Consortium, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States

Corresponding author. Address: Department of Pediatrics, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital 3333 Burnet Ave, Cincinnati, OH 45229-3026, United States. Tel.: +1 513 636 4416. E-mail address: Hadas.NahmanAverbuch@cchmc.org (H. Nahman-Averbuch).

Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (www.painjournalonline.com).

Received July 14, 2018

Received in revised form December 12, 2018

Accepted December 19, 2018

© 2019 International Association for the Study of Pain
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