Endogenous Analgesia in Patients with Chronic Migraine: A Study of Conditioned Pain Modulation

Hsiangkuo Yuan, MD, PhD

AHSAM 2020 - Oral session
Published on October 2, 2020 | NEW

2 minute listen

6 minute read

Key messages

  • Dysfunctional endogenous analgesia has been reported in various chronic pain conditions and is  of interest in migraine research.
  • Scientists have shown altered CPM in patients with migraine, but there is a lack of standardized CPM methodology.
  • A recommended protocol for testing CPM has recently become available.
  • Further research is required to determine if abnormalities in CPM are associated with migraine chronicity, if CPM changes with migraine therapeutics and if CPM predicts the therapeutic response to treatments.

Key messages

  • Dysfunctional endogenous analgesia has been reported in various chronic pain conditions and is  of interest in migraine research.
  • Scientists have shown altered CPM in patients with migraine, but there is a lack of standardized CPM methodology.
  • A recommended protocol for testing CPM has recently become available.
  • Further research is required to determine if abnormalities in CPM are associated with migraine chronicity, if CPM changes with migraine therapeutics and if CPM predicts the therapeutic response to treatments.

Background

What do we already know about this topic?

  • Endogenous analgesia (EA) is the complex system modulating pain perception with descending control from various parts of the brainstem, acting on the wide dynamic range of neurons in the trigeminal complex and dorsal horn of the spinal cord. 1,2
  • Dysfunctional EA is a risk factor for developing pain and Conditioned Pain Modulation (CPM) is the human experimental model used to measure EA.
  • Studies on migraine being associated with deficient pain modulation have been inconsistent due to a lack of standardized CPM methodology, and have mainly studied CPM in episodic migraine, not chronic migraine, where the role of CPM is largely unknown.

How was this study conducted?

  • Baseline CPM in patients meeting the International Classification of Headache Disorders, 3rd edition, (ICHD-3) criteria for chronic migraine (aged 18–65 years) will be compared to healthy age/sex-matched controls, using a recommended CPM testing method.3
  • Calcitonin gene-related peptide monoclonal antibody (CGRP mAb) and remote electrical neuromodulation (REN) wil be used to assess CPM in response to migraine therapeutics.
  • CPM response will be correlated with clinical response and assessed for predictive value.

Findings

  • Study to be performed.

Perspectives

How does this study impact clinical practice?

  • Understanding CPM in chronic migraine may allow for the development of personalized chronic migraine treatment.

Perspectives

How does this study impact clinical practice?

  • Understanding CPM in chronic migraine may allow for the development of personalized chronic migraine treatment.

This is a highlights summary of an oral session given at the AHSAM 2020 Virtual Annual Scientific Meeting and presented by:

Hsiangkuo Yuan, MD, PhD
Physician Resident
Thomas Jefferson University Hospital
Penllyn, Pennsylvania

The content is produced by Infomedica, the official reporting partner of ASHAM 2020 Virtual Annual Scientific Meeting. The summary text was drafted by Goldcrest Medical Writing, reviewed by Marco Vercellino, MD, an independent external expert, and approved by Jessica Ailani, MD, FAHS and Mark J. Burish, MD, PhD, the scientific editors of the program.

The presenting authors of the original session had no part in the creation of this conference highlights summary.

In addition, an expert commentary on the topic has been provided by:

Thomas N. Ward, MD
Geisel School of Medicine at Dartmouth

Thomas N. Ward, MD
Geisel School of Medicine at Dartmouth

Dr. Thomas N. Ward grew up in Portsmouth, NH where he attended the public school system. He graduated from Dartmouth College cum laude in 1975 and from Dartmouth Medical School with honors in 1980 and was elected a member of AOA.

He was an intern and resident in Internal Medicine at Albany Medical Center from 1980-1982 then a resident in Neurology from 1982-1985 at Dartmouth-Hitchcock Medical Center. Subsequently he practiced Neurology at Laconia Clinic in Laconia, NH until returning to Dartmouth-Hitchcock Medical Center in 1989 where he founded their headache clinic.

Dr. Ward is a Fellow of the American Headache Society and of the American Academy of Neurology as well as the American Neurological Association. He is President of the Headache Cooperative of New England and certified in the subspecialty of Headache Medicine by the United Council for Neurologic Subspecialties. He is an Active Emeritus Professor of Neurology at the Geisel School of Medicine at Dartmouth. He was the Editor in Chief of the journal Headache: the journal of head and face pain from 2013-2020. He currently sees patients at the White River Junction, VA Hospital

1. Kvasnak E, Rokyta R. Brain stimulation methods for pain treatment. General Physiology Biophysics 2018;37:477-494. 

2. Bannister K, Dickenson AH. The plasticity of descending controls in pain: translational probing. The Journal of Physiology 2017;595:4159-4166.

3. Yarnitsky D, Bouhassira D, Drewes AM, et al. Recommendations on practice of conditioned pain modulation (CPM) testing. European Journal of Pain 2015;19:805-806. 



Headache
Chronic Migraine


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